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Erectile Dysfunction: Symptoms, Diagnosis and Causes

12 min read
Erectile Dysfunction: Symptoms, Diagnosis and Causes

Problems related to getting and maintaining erections are incredibly common in men, especially if they're older than 40 - though that's not to say younger men can't be affected too. Erectile dysfunction in particular affects around 30 million men in the USA alone, making it one of the most common kinds of male sexual dysfunction. 

Having issues with erections every now and then is not necessarily out of the ordinary. However, while these problems are generally nothing to stress over, erectile dysfunction that occurs often is not normal, and as such should be seen and treated by a doctor. Many men don't seek treatment as they believe there are either no cures, or that erectile dysfunction is inevitable due to aging, but neither of these are the case!

TL;DR Summary:

  • Erectile dysfunction (ED) is a common condition that affects men and refers to the inability to get or maintain an erection.
  • It can be caused by physical factors like cardiovascular disease, high blood pressure, obesity, and hormonal imbalances, as well as psychological factors.
  • Early symptoms include difficulty getting or maintaining erections, reduced penis sensitivity, and lowered sex drive.
  • Treatment options include lifestyle changes, oral medications, injectable medications, intraurethral suppositories, vacuum devices, testosterone replacement therapy, surgery, and counseling/sex therapy.
  • Preventive measures involve maintaining a healthy lifestyle and avoiding harmful substances.
  • Consult a doctor for a proper diagnosis and to discuss treatment options.


    If you're one of the millions of men who struggle with erectile dysfunction, or even if you're simply interested in learning more about the topic, this article is for you. Here, we'll give you an introduction to erectile dysfunction, going over how and why it happens, as well as taking a look at the main symptoms, causes, and treatments, in order to increase your understanding of an issue that affects men all around the world.

      What is erectile dysfunction?

      Erectile dysfunction (also known as ED) is a sexual condition referring to the inability to get or maintain an erection, to the extent where it gets in the way of your ability to achieve satisfactory sexual performance.

      ED is a type of sexual dysfunction that can show up in numerous ways. If you can't get an erection at any time, or, if you can get an erection sometimes but not every time you want to have sex, or not maintain an erection long enough for sex to be fulfilling, then you can be described as having erectile dysfunction.

      How erectile dysfunction happens

      Erections happen when blood flow to the penis is increased, due to chemicals released by your nerves when you're sexually aroused. The spongy muscle tissue of the penis' two erection chambers - the corpus cavernosum - relaxes when you get an erection, trapping blood inside, making the penis firm. Problems at any stage of the process of getting an erection can result in erectile dysfunction, such as nerve damage stopping the chemicals from being released, or blood flow being reduced for whatever reason.

      Symptoms of erectile dysfunction

      While the obvious symptom of erectile dysfunction is being unable to get an erection, usually men don't get to this stage overnight. The sexual dysfunction known as ED tends to be progressive, happening gradually and causing more issues as time goes on. Due to its progressive nature, there are various symptoms that can be spotted earlier.

      How to spot erectile dysfunction early on

      Here are some symptoms which can be caught early, helping men get round to treating erectile dysfunction quicker.

      Struggling to get an erection

      As we said earlier, men generally don't suddenly find it impossible to get an erection. Most often, getting to this point takes some time, and starts with it taking slightly longer than usual - resulting in increased amounts of stimulation being required. Struggling to get to the point of having an erection is a dead giveaway of ED.

      Difficulty maintaining erections

      Some men can manage to get an erection without too much trouble, but struggle to maintain it, even during sexual activity. Many men find this to be particularly embarrassing, despite it being no fault of their own - or their partner's for that matter. Having issues keeping an erection going is an early warning that in time you may experience further ED.

      Many men find this to be particularly embarrassing, despite it being no fault of their own 

      Reduced penis sensitivity

      Reduced sensitivity of the penis is a slightly more obscure effect of erectile dysfunction. In a previous point, we mentioned that you might find yourself needing more stimulation to get an erection. It's often caused by medical issues, an imbalance of hormones, or problems with the nerves and receptors of the penis - this is particularly common in older men. To add to this, if your erections aren't quite firm or rigid enough, you may also feel a lack of sensation. Any change or loss of feeling in your penis should be checked out by a doctor or other healthcare professional.

      It's often caused by medical issues, an imbalance of hormones, or problems with the nerves and receptors of the penis - this is particularly common in older men

      Lowered sex drive

      A frequent result of the issue, lots of men who experience erectile dysfunction feel less of a desire for sex. ED often causes men to feel embarrassed, ashamed, or not good enough. This can turn into feelings of anxiety and depression, both of which can lower your sex drive. Furthermore, biological issues, such as reduced testosterone (caused by a hormone imbalance) can also contribute to trouble with erections, and reduced sexual desire. If you usually have a high sex drive, noticing a lack of desire is a good sign something might be off.

      ED often causes men to feel embarrassed, ashamed, or not good enough. This can turn into feelings of anxiety and depression, both of which can lower your sex drive.

      It's important to visit your doctor if you're experiencing any symptoms of erectile dysfunction. Generally, you'll receive a physical examination to determine the diagnosis. This examination includes your penis and testicles, and sometimes a rectal examination to check your prostate. These tests are extremely useful, and they're also not painful, meaning there's no need to worry about the visit.

      What are the main causes of erectile dysfunction?

      It's a common misconception that erectile dysfunction is primarily a psychological issue. While this is true in some cases, ED often stems from physical issues, which can be further exacerbated by emotional and psychological factors. Here is a look at some of the physical and psychological factors that can be the cause of erectile dysfunction.

      Physical causes of ED

      • Cardiovascular disease (AKA heart disease)
      • Hypertension (AKA high blood pressure)
      • High cholesterol
      • Clogged blood vessels
      • Obesity
      • Diabetes
      • Multiple sclerosis
      • Parkinson's disease
      • Digestive and kidney diseases
      • Metabolic syndrome (which results in high blood pressure, high cholesterol, high insulin levels and increased body fat around the waist)
      • Peyronie's disease (which causes scar tissue to develop inside the penis)
      • Certain prescription drugs and medications
      • Radiation therapy and surgical treatment for some cancers
      • Injuries or trauma to the pelvic area or spinal cord
      • Low testosterone, or other hormone imbalances
      • Sleep disorders
      • Excessive consumption of alcohol
      • Tobacco use
      • Drug use

      Psychological causes of ED

      • Mental health issues such as anxiety and depression
      • Stress of all kinds, whether it stems from work, home, social issues, etc.
      • Relationship problems and conflicts
      • Worrying about sexual performance

      Best treatments for erectile dysfunction

      Usually, erectile dysfunction can be effectively treated. Lifestyle alterations are often the first port of call when treating erectile dysfunction, and include eating healthy, regular exercise, not smoking, and reducing intake of alcohol and drugs. More direct treatments for erectile dysfunction can be given, but these depend on how exactly it is being caused.

      Usually, erectile dysfunction can be effectively treated

      If caused by narrowing of blood vessels in the penis, high blood pressure, or high cholesterol, medicine can be prescribed to lower blood pressure, or statins to reduce cholesterol. Hormonal causes can be treated with hormone replacement therapy. If side effects of prescription drugs are the cause, doctors may offer alternatives to the ones being taken.

      Below, we've put together a list of some specific treatments for erectile dysfunction. We've also included pros and cons of each, to help you think about what might be best for you if you're struggling with ED.

      Oral medications

      PDE type-5 inhibitors are oral drugs that are used to increase blood flow to the penis. You've probably heard of some of these before, such as sildenafil citrate - more commonly known as Viagra. Other PDE5 inhibitors include Cialis (tadalafil), Levitra (vardenafil HCl), and Stendra (avanafil). These drugs tend to be effective at treating ED, but can come with various side effects. Additionally, they don't cause erections on their own - some sexual stimulation is still necessary.

      Pros and cons of using oral medications for ED

      Pros Cons
      Effective Can cause side effects such as headaches, blocked nose, aches, indigestion, and facial flushing
      Well tolerated  Might not be safe if you have heart disease, low blood pressure, or are taking nitrates
      Easy to take

      Injectable medications

      You may be offered the drug Alprostadil if oral medication proves to be unsuccessful. Alprostadil comes in two forms, one of which can be injected into the penis with a fine needle. While it is substantially more invasive than oral medications, injected Alprostadil does have a high success rate in treating ED, and can have fewer side effects. Your doctor should demonstrate how to safely inject yourself with the drug.

      Pros and cons of using injectable medications for ED

      Pros Cons
      Very effective Can cause side effects such as soreness at the site of injection, and prolonged erections (these can be reversed with an antidote from a doctor, and require urgent emergency room care if they last more than two to four hours as this can cause permanent damage)
      Reliable erections lasting up to 30 minutes  More invasive than oral medications
      Can be injected by yourself

        Intraurethral suppositories

        The other way Alprostadil is used to treat ED is as a suppository which is inserted into your urethra - where urine exits your penis. Though it doesn't require giving yourself an injection - meaning it may be preferable for anyone with an aversion to needles - this form of Alprostadil is not as effective as the form which is injected.

        Pros and cons of using intraurethral suppositories for ED

        Pros Cons
        Does work for some men  Not as effective as the injected version
        Doesn't require an injection Can cause side effects such as burning sensation in the penis, and, like the injected version, prolonged erections which can require emergency medical care

        Vacuum devices

        A vacuum device - or penis pump - may also be offered as a treatment for erectile dysfunction. These devices are hollow cylinders that, at the push of a button, can create a vacuum as the air is sucked out. This vacuum draws blood into the penis, resulting in an erection, which can be maintained with the help of an elastic tension ring that is placed around the base of the penis. Vacuum devices have been used for decades to treat ED.

        Pros and cons of using vacuum devices (penis pumps) for ED

        Pros Cons
        Effective  Can cause bruising in the penis
        Less invasive than some treatments  Some men find it uncomfortable to use
        Erections can be maintained for around 30 minutes
        Fairly simple to use

        Learn more about penis pumps and how they can help with Erectile Dysfunction

        Testosterone replacement therapy

        If your erectile dysfunction is being caused even partially by low testosterone levels, you may be prescribed testosterone replacement therapy. This treatment by itself, or in combination with other treatments such as oral medication, can help men regain their ability to get and maintain erections.

        Hormone therapy is usually done with creams, gels, patches, or injections. While it can be helpful for men who have low testosterone levels, it won't help men with levels that are normal. To add to this, there are numerous risk factors associated with the treatment.

        Pros and cons of using testosterone replacement therapy for ED

        Pros Cons
        Can help restore sex drive, which can help with ED  Not helpful for men with normal testosterone levels
        Can help protect against other ED risk factors (can reduce belly fat, and lower risk of diabetes)  ED is only rarely caused by low testosterone
          Can be expensive
         Can cause side effects such as acne, enlarged prostate, enlarged breasts, lower fertility, increased red blood cells, increased symptoms of sleep apnea, and the body retaining too much fluid
         Long term effectiveness and safety are not yet known


          Surgery may be offered to men who haven't had success with other treatments such as medication. Surgery can sometimes be done to repair damaged arteries to improve blood flow, but the usual surgical treatment for erectile dysfunction is the insertion of a penile implant.

          Penile implants come in a couple of varieties. One of these a semi-rigid, malleable implant which can be bent to alter the position of the penis - these are the simpler kind. The other kind is an inflatable implant, which is inflated using a pump, making for a natural looking and feeling erection.

          As the insertion of a penile implant requires surgery, there are certain risks. However, they have a very high rate of success and satisfaction, partially due to how they allow for more spontaneity than some other solutions.

          Pros and cons of using surgery for ED

          Pros Cons
          High rate of success and satisfaction Certain medical issues need to be treated before surgery, such as systemic, skin, or urinary tract infections
          Allow for more spontaneous sexual intercourse Surgery takes a while to recover from, with most men able to have sex after 8 weeks
          Results in natural looking and feeling erections Complications such as post-operation infections or mechanical failures can necessitate implants being removed or replaced - non-surgical treatment options might not work after this

          Counseling and sex therapy

          While not often the sole cause of erectile dysfunction, emotional and psychological factors such as anxiety, depression, stress, or relationship issues can definitely contribute to the problem. If these issues are affecting your ability to get or maintain an erection, doctors may recommend that you and/or your partner visit a counselor or psychologist for therapy, to help you work through complicated thoughts and feelings.

          When it is clear that erectile dysfunction is being caused by emotional or psychological issues, therapy will often be recommended before other treatments, particularly the more invasive kinds.

          Pros and cons of using counseling and sex therapy for ED

          Pros Cons
          Doesn't come with the side effects of medication  ED is rarely caused by emotional or psychological factors alone
          Non-invasive Cost can add up
          Can help fix issues contributing to ED even if they aren't the only cause  Doesn't have as fast results as some medical treatments
          ED itself can cause mental health and relationship issues - therapy can help stop the negative feedback loop

            Discover Everything You Need to Know About Erectile Dysfunction (ED)

            Erectile dysfunction FAQs

            Erectile dysfunction is a condition with many myths and beliefs surrounding it, which can often muddy the waters when people are trying to find out the real facts. In this section, we've collated a few of the most frequently asked questions about ED, in order to bring some clarity.

            Does cycling cause erectile dysfunction?

            Cycling, while a fantastic exercise that lots of men enjoy, may actually lead to erectile dysfunction under certain circumstances. When you're on a bicycle, the seat is constantly applying pressure to the area between your penis and your anus - your perineum. This area contains the nerves and arteries which are important in making sure your penis receives the right feelings, and the right amount of blood.

            As we mentioned earlier, nerves and blood flow are extremely important when it comes to erections! As such, this pressure from the bike seat is what can cause penile issues, and eventually erectile dysfunction.

            The good news is, cycling is not thought to be a serious risk in terms of fertility and ED, simply causing temporary issues in some men. If you're concerned though, there are a few things you can do to stop worrying about cycling-induced ED. These include:

            • Changing your bike seat to one that is wider and has more padding for support
            • Lowering your handlebars so you lean forwards slightly, taking pressure off your perineum
            • Make your cycling sessions less intense, and ensure you take regular breaks from the seat
            • If your exercise is mainly cycling, introduce some other forms of exercise such as running or swimming
            • Wear padded cycling shorts for more protection
            • Try a recumbent bike - these let you cycle while sat in a reclined position, which puts less pressure on your perineum

            Can everyone use ED medication?

            Erectile dysfunction medications should only ever be used if you have a real medical need for them - if you've seen a doctor and had them prescribed, for example. There are various risks to taking ED medication if you don't need them, including:

            • Having a negative reaction or bad drug interaction - ED meds may not work, or may even be dangerous if you're also taking nitrates for other medical issues, or recreational drugs like cocaine
            • Becoming psychologically dependent on medication - men who use ED medication recreationally start losing confidence in their ability to get erections when not using them, or start to have unrealistic expectations of their performance when not using medication
            • Getting scammed and receiving unsafe or counterfeit medication - at best these may not work, and at worst they may cause serious health problems

            Can ED be completely prevented or avoided?

            Making healthy lifestyle choices and changes is the best way to prevent and avoid erectile dysfunction. Eating a healthy diet and maintaining a healthy weight for your body type both help control your blood pressure, and prevent diabetes, which in turn prevents ED. Regular exercise helps increase blood flow all around the body, including to your penis.

            Putting harmful substances in your body can also hamper proper erectile function. Avoid drinking too much alcohol, and if you smoke, you should definitely seek help in quitting. Illegal drugs should also be avoided. Not only can these be damaging, but some can reduce bodily sensations, and stop you from getting sexually aroused. They don't stop at reducing physical sensations either - some illegal drugs can mask emotional and psychological factors that can contribute to ED as well. If you have issues with substance abuse, your healthcare provider should be able to help you out.

            Maintaining a healthy lifestyle is a great way to prevent ED, but we're all human and slip-ups can happen to the best of us. If you have concerns related to erectile dysfunction and your lifestyle, it's always best to visit a doctor or other healthcare professional.

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