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 about 30 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.
Erectile dysfunction is diagnosed when one or more of the following symptoms persist for six months or more, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
- Inability to get an erection during sexual activity
- Inability to maintain an erection long enough to finish a sexual act
- Inability to get an erection that is as rigid as previously experienced
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 the experience of erectile dysfunction.
Yes, Contrary to popular opinion, erectile disorder is not just an older man’s problem—in fact, a growing number of men under 40 are reporting ED experiences. How common is erectile disfunction in young men? A 2013 study found that 1 in 4 male participants was under 40; these younger men were also more likely to smoke and use illicit drugs than the older participants.
Diabetes can increase the likelihood of developing ED but doesn’t make it a foregone conclusion, and there are steps that men with diabetes can take to prevent or treat ED. The two main reasons why men with diabetes tend to develop erectile disorder include nerve damage (neuropathy) and cardiovascular complications (atherosclerosis, or arterial clogging that can obstruct blood flow to the penis, thus preventing erections). Certain factors can increase the risk of men with diabetes having ED, like the duration of diabetes, obesity and other health complications, smoking, and the use of specific blood pressure medications.
Men who are undergoing treatment for prostate cancer may be at higher risk of developing ED. The prostate gland is located close to the bundles of nerves that facilitate erections. These nerves are often cut during surgery or damaged by radiation, resulting in erectile problems for many male patients. However, medications like Viagra may help restore a man’s ability to get and maintain an erection. With a supportive partner, men can still enjoy orgasms and sexual satisfaction after prostate cancer treatment, even if their sexual encounters need to adapt.
Erectile disorder tends to be a chronic condition that takes time and energy to manage. Unsurprisingly, erectile dysfunction often appears in cases of low sexual desire and can be both a symptom as well as a key risk factor. It’s not uncommon for men with erectile disorder to also lose interest in sex, which can cause problems in committed, long-term relationships.
Erectile dysfunction can have a physical, neurological, or psychological cause. Physical conditions 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, 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 strokes. 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.
Certain mental health conditions, particularly depression and anxiety, can dampen a man’s sexual enthusiasm. If a man finds himself unable to perform sexually once, it’s not uncommon for him to struggle with negative self-talk and building anxiety that becomes a self-fulfilling prophecy for future sexual encounters. Identifying the source of the anxiety is critical when a man’s impotence is psychological so that it can be addressed and overcome. Men with an erectile disorder may find it helpful, either by themselves or with the help of a trained therapist, to identify any harmful beliefs and reframe their mindsets.
Pornography only negatively affects someone’s sex life when it causes them to develop unrealistic expectations (such as how quickly a partner should get aroused, how long sex should last, what a partner should look or sound like during sex, etc.). Using porn in and of itself doesn’t lead to erectile problems—and avoiding porn altogether doesn’t solve them. Erectile disorder is generally a lot more nuanced and grounded in individual fears and complex relationship dynamics. In fact, the major factors that are more likely to contribute to erectile disorder include anxiety about getting and maintaining an erection and worries about pleasing one’s partner.
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.
Erectile disorder is not the end of the world. After a few disappointing encounters, it might be tempting to simply avoid sex altogether, but partners can work together to improve the intimate side of their relationship. For example, they can try sensate focus exercises, which can help them get out of their head enough to enjoy the pleasure of physical sensations without having any weighty expectations. Stop-start exercises can give men with erectile disorders a greater sense of control over their erections, reducing their stress and fear of a sexual experience. Putting the emphasis back on having fun can help relieve some of the pressure to perform that men with erectile disorders may feel, resulting in better outcomes for them and their partners.
Low-intensity shockwave therapy (LIST) is one of the first new treatments for erectile dysfunction since Viagra was approved by the FDA in 1998. It works by nudging the body to produce new blood vessels, which may prove especially helpful to men whose erectile disorder is related to poor blood flow to the penis. LIST is relatively painless and non-invasive, and no major side effects have been noted so far. Men who participated in scientific studies observed improvements in their symptoms within one to three months. But the treatment is still experimental, and more research is needed.