Also known as erectile dysfunction, or impotence, erectile disorder (ED) is the inability to get or maintain an erection that is firm enough for sexual intercourse or other satisfying sexual activity. While it is normal to occasionally lose an erection, men with ED have a chronic problem. ED affects at least 12 million American men and becomes more common with age. Generally, ED is only a matter of concern if the problem causes stress or loss of self-confidence, affects a relationship or is found to be a sign of an underlying health condition that requires immediate treatment.
The symptoms of ED may include inability to get an erection during sexual activity, getting an erection but not being able to sustain it long enough to finish a sexual act, or inability to get an erection that is as rigid as previously experienced. ED is diagnosed when one or more of these symptoms persist for at least six months. A five-part questionnaire, known as the International Index of Erectile Function, rates symptoms and helps determine the severity of dysfunction. Symptoms can be situational, which means they occur only in specific situations or with specific partners. Symptoms can also be generalized, meaning they occur all the time, regardless of the situation or partner involved. Low self-esteem, lack of confidence, and fear of sexual relations often accompany ED.
ED can have a physical, neurological, or psychological cause. The many physical conditions that are associated with ED include obesity, type-2 diabetes, metabolic syndrome, high blood pressure, high blood fats, coronary artery disease, premature ejaculation and a deficiency of the hormone testosterone. Medical treatments such as surgery, radiation and hormones commonly used for prostate cancer and medications, such as some antidepressants, can also cause or worsen ED, as can the use of tobacco, alcohol, and illegal drugs. Neurological conditions that can cause ED include Parkinson's disease and stroke. The psychological causes of ED generally occur in men under the age of 40 and include performance anxiety, relationship problems, religious taboos, prior sexual abuse and mood disorders such as depression, PTSD, and generalized anxiety.
Treatment often begins with lifestyle changes, such as quitting smoking (because tobacco causes narrowing of blood vessels) or taking steps to reduce cardiovascular disease risks, such as weight loss, exercise and control of blood sugar and blood pressure, which can also improve the symptoms of ED. Medications such as Cialis and Viagra, which prevent an enzyme in the penis from causing erection loss, are sometimes prescribed. When medication is unsuccessful, external vacuum pumps that increase blood flow to the penis or self-injected penile medication that induces an erection may be recommended, although these are not popular options due to the advanced planning and lack of spontaneity involved. In cases where these treatments are ineffective or not tolerated, penile implants, or internal penile pumps, that pump fluid into the penis, may be an option. When the cause of ED is psychological, however, treatment often begins with psychotherapy to get to the root of any stress, anxiety, or depression that is interfering in sexual relations.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
Rew KT and Heidelbaugh JJ. Erectile Dysfunction. Family Physician. 2016;94(1):820-827.
National Institutes of Health. Urologic Diseases. Erectile dysfunction. November 2015.
Mayo Clinic. Erectile Dysfunction.June 23, 2017.
Last reviewed 03/06/2018