Sexual Wellness

Erectile Dysfunction: Symptoms, Causes, and Treatments

Fact Checked

One of the most common causes of ED comes down to the partial obstruction and narrowing of blood vessels caused by dyslipidemia (i.e., high fats in the blood, high cholesterol), smoking, diabetes, and coronary artery disease.

Last Updated: 04/22/2022

Written by

Warren Dutton

Medically Reviewed by

Dr. Paul Thompson

Erectile Dysfunction (ED) is a common condition that affects millions of men worldwide. The symptoms of ED can range from mild to severe, and often go unnoticed until a man becomes frustrated or depressed. 

In this article, we’ll take a look at the causes, symptoms, and treatments for ED, so you know what you need to know when it comes to diagnosing and treating this condition.

Who most commonly gets ED?

Symptoms of ED are most common in older people. The prevalence of ED in men is thought to be at least ⅓ of all men according to a 2018 study in the Journal of Sexual Medicine, and even above 50% according to other studies. However, while erection function declines as we age, this does not mean getting old will end your sex life. Family physicians treating ED is a common problem for all ages. 

However, there are more causes than age. Type 2 diabetes, weight gain, cigarette consumption, prostate cancer, heart disease, certain prescription medications, high blood pressure, and other issues can all increase the risk of erectile failure.

What causes ED?

Most men periodically fail to obtain or maintain an erection at some point in their lives, but in many cases, the problem is temporary due to performance anxiety, stress, exhaustion, too much alcohol, or some other temporary issue and is nothing to worry about.

However, if it occurs more frequently, it might be due to physical or mental issues that should be addressed.

Here are some common causes of erectile dysfunction:

Chronic Diseases

ED has the most significant relationship with chronic diseases, especially diabetes. Men who have diabetes may also have a high incidence of other erectile disorders as well. Nevertheless, a diet containing glucose may help reduce the risk.

 A disease that can affect blood flow could cause ED. These include coronary diseases and atherosclerosis (hardening arteries). Other medical conditions in your health history can include:

  • High blood sugar

  • Heart disease

  • Cardiovascular disease

  • Prostate surgery

  • Vascular disease

  • Bladder cancer

  • Multiple sclerosis

  • Prostate cancer

If you feel a medical condition may be the cause of your lack of erectile function, you will want to meet with your doctor to run blood tests and other tests to see if you have a medical condition in your medical history that is hindering your sexual function.

Lifestyle

Lifestyle decisions are also risk factors in the prevalence of not just ED, but a host of other types of sexual dysfunction. Alcohol abuse and the use of illegal drugs are common causes of loss of penile blood flow and vascular damage in the spleen. 

If you have excess weight you may need to lose weight to improve sexual function. Studies suggest that men exercising more often reduces their chances of having ED.

Psychological

Mental health is also a common cause of erectile dysfunction. The cause can simply be within your own mind. Researchers believe stress and depression could be short-circuiting the development of an erection. This can cause more problems in patients who are having physical edema if the symptoms are physical. 

In addition, there are other psychological factors on sexual performance such as having an abusive sexual partner, worries about a satisfactory sexual performance, or even past trauma. Sometimes psychological factors can also lead to premature ejaculation as well or even both problems in the same short period of time.

Prescription medications

ED is an underlying condition in people using oral medications that are used for high blood pressure as well as many other issues. Some medications can constrict blood vessels which lower erectile function.

Tell your physician when erectile symptoms occur. There are even some over-the-counter drugs that can alter normal erectile function. Don't stop taking drugs without speaking to a doctor first.

Symptoms of erectile dysfunction

ED symptoms include:

  • Being able to obtain an erection occasionally but not every time you want to have sexual intercourse despite the level of sexual arousal.

  • Getting an erection but not being able to keep the erection firm long enough for sex

  • Not being able to obtain an erection at any moment

ED is frequently an indication of another health condition or cause and not an illness in itself.

Diagnosing ED: Physical Examination

If an ED diagnosis is required by your doctor, your symptoms should be discussed. The doctor will perform a thorough physical exam that can identify symptoms of sexual dysfunction such as low blood pressure and problems that can reduce blood flow in the erection chambers. 

The doctors will look for other genital problems that can also affect the erection and likely take a look at your medical history as well as sexual history.

How's your sex life?

When making a diagnosis, information regarding your personal and sexual past may be important in addition to the physical exam. Your doctor may ask you questions like:

  • When did you first detect ED symptoms or a reduction in sexual performance?

  • What are the most serious symptoms you're experiencing?

  • How frequently do you experience erections?

  • How firm are your erections if you have them?

  • Do you experience erections in the morning or at night?

  • What methods do you employ during sexual intercourse?

  • Do you realize that your capacity to obtain an erection varies throughout sex?

  • Is there conflict in your current relationship?

  • How has your present relationship been influenced by ED?

  • Do you struggle with sexual desire or arousal?

It is critical to respond to these questions openly and honestly so that your doctor can appropriately diagnose your illness and offer effective erectile dysfunction treatments.

Prescription drugs and medication histories

Drugs, medications, and alcohol can affect erectile function. You should be asked about all prescription drugs you are currently taking and any over-the-counter products you are using. You should also be asked about your use of alcohol, cigarettes, and illicit drugs.

Mental health history

Some mental health issues have been related to ED. As a result, your doctor may ask you questions to rule out depression, anxiety, or other psychological issues.

You may also be questioned whether you have recently faced a lot of stress or if any major changes have occurred in your life.

If your doctor believes you have a psychological problem, your doctor may recommend you to a mental health expert.

Diagnostic testing

Other tests may be required to rule out underlying concerns or to better examine your situation. Among these are the following:

Blood test

A basic blood test involves obtaining a sample of your blood to screen for health concerns such as heart disease, renal illness, low testosterone, diabetes, low blood sugar, and others.

Urine test

A urine test can detect diabetes and other health issues that may be affecting your ED symptoms.

Ultrasound

An ultrasound is performed by placing a device over the blood arteries that feed blood to the penis. This test can establish if you have an issue with something that restricts blood flow. 

You may also be given an injection into your penis to induce an erection. This enables the ultrasound technologist to examine how the blood flow and pressure in your penis function.

Nocturnal erection test

In this test, you wear a plastic, ring-like device around your penis at night to see if you develop erections. This might indicate to your doctor whether you are physically capable of having an erection. 

A nocturnal erection test is often carried out at home or at a sleep lab. This exam may occasionally include the use of an electronic monitoring device to record how many erections you have, how firm they are, and how long they persist.

Injection test

An injection test will be performed in which a healthcare practitioner will use penile injections to inject medication into your penis in order to produce an erection. The medications are also sometimes injected into the urethra. This allows your doctor to monitor how full your penis becomes and how long your erection lasts.

Bulbocavernosus reflex

This test evaluates your penile nerve feeling. Your doctor squeezes the head of your penis to see if your pelvic floor muscles immediately contract. If it doesn't, a nerve issue might be to blame.

Penile biothesiometry

A technique that employs an electromagnetic vibration to assess sensitivity and nerve function in the penis. You may have nerve damage if you have diminished sensitivity to vibrations.

Dynamic infusion cavernosometry

Dynamic infusion cavernosometry is a test for males who have a venous leak. Fluid is injected into the penis and measured in order for doctors to determine the degree of the leak.

Cavernosography

Cavernosography is utilized in conjunction with dynamic infusion cavernosometry. It consists of injecting a dye into the penis and then X-raying it. This allows the physicians to see the venous leak.

Erectile dysfunction therapy options

You can treat ED with several methods, including lifestyle changes, medication, testosterone therapy, and surgical treatment options. 

If lifestyle changes such as having you exercise regularly, changing your diet, or dietary supplements are unsuccessful in treating ED, your doctor may try drug therapy and prescribe medications such as sildenafil citrate, tadalafil, and vardenafilor your partner may be prescribed the drug by a specialist. 

If ED is severe, your doctor may recommend surgical treatment.

Surgery

ED is often due to blocked vascular veins which lead into the penis. Surgical intervention can increase blood flow. It's most effective for men under 30 years of age. Doctors do not typically prescribe it to older men who suffer from extensive narrowed arteries.

Vacuum Devices (Pumps)

Vacuum equipment such as a penis pump for treating ED are non-invasive substitutes for medical treatments and for medication. 

The penis must be placed inside a cylinder, the pump pulling out the air into the chamber. This creates partial pressure on the penis causing blood to enter the blood vessel that causes an erection. 

Your erection is then maintained by elastic bands around the base during sex.

Injections

Injections can be difficult, but they may help in treating ED. Injecting medication directly into a penis can make the erectile function stronger. 

Injection drugs widen your blood vessels and fill your penis with blood. 

A second option available in treating ED is a medicated pellet that's inserted into an open penis hole. The pellets may initiate erectile contraction in less than 10 minutes.

Implants

Penile implants to treat ED are a treatment that helps with re-establishing sexual relations without medication or repeated doctor visits. Penile implants are made by putting two tubes inside the penis to fill a reservoir of compressed liquid. A surgical penile implant can use flexible splints and can also adjust its position; the penile implant can also be an effective long-term medical remedy for treating ED.

PRP (PRP) injection

According to the J Sex Med, men who have ED are given PRP treatment in the form of a "Priapus injection" or "P shot" to enhance their erections. PRP may be one of the most natural therapies accessible for guys suffering from ED since it uses your own platelets.

Revascularization

Penile revascularization surgery is comparable to cardiac bypass surgery, however, it is performed on the penis. It is intended for healthy males under the age of 50 who have no signs of a venous leak upon testing. 

The most prevalent reasons for erectile dysfunction that can be addressed with penile revascularization are perineal trauma or bike riding.

Shockwave therapy

During the therapy, a tiny wand-like device emits focused sound waves to stimulate penile tissue and increase blood flow, which can help hasten recovery. Low-intensity shock waves have also been proven to stimulate the growth of new blood vessels and enhance blood flow in the penis, both of which are required for erections.

Questions and Answers on Erectile Dysfunction

How is male sexual dysfunction prevented?

The single best thing you can do to prevent all sorts of sexual dysfunctions is to take care of your overall health. You can prevent erectile dysfunction (ED) and other sexual disorders by quitting smoking, following a good eating plan, maintaining a healthy weight, and being physically active.

What role does Peyronie's disease have in ED?

Peyronie's disease causes scarring and curvature of the penis, which can restrict blood flow.

Peyronie's disease can induce ED, but it requires a more intensive treatment plan that involves pharmacological medicines and surgical treatments.

What role do digestive and kidney diseases have in causing ED?

Erectile dysfunction (ED) is a prevalent problem among men with chronic kidney disease (CKD). Its frequency among these individuals is believed to be over 80% according to a prominent 2014 study.

Can high blood pressure cause ED?

High blood pressure causes artery walls to stiffen and thin, decreasing blood flow to the penis. Erectile dysfunction is a symptom of damaged blood vessels and possibly cardiovascular disease.

What alternative treatments are available for treating ED?

There are several alternative medical treatments for treating ED such as exercising pelvic floor muscles (Kegels), dietary supplements, and an inflatable penile prosthesis.

Takeaway point

Erectile dysfunction is a common sexual problem that can lead to emotional disorders. Therapy for erectile dysfunction is now more effective than ever thanks to medical and surgical developments. Also, the prevalence of psychological factors and the ability to combine mental and physical issues make therapy easier.

Speak with your doctor about the best treatment options for erectile dysfunction.