Erectile Dysfunction

Erectile dysfunction (ED), also called impotence, is the inability to get and keep an erection firm enough for sex. It is a common type of male sexual dysfunction. ED becomes more common as men get older, but it is not a natural part of aging.

Having erection trouble from time to time is not necessarily a cause for concern. If ED is an ongoing issue, however, it can cause stress, affect self-confidence, and contribute to relationship problems. Problems getting or keeping an erection also can be a sign of an underlying health condition that needs treatment and is a risk factor for heart disease.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean that blood vessels are clogged or nerves are damaged.

There are several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.

ED may be caused by a combination of physical and psychological issues. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson's disease
• Multiple sclerosis
• Peyronie's disease — development of scar tissue inside the penis
• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of substance abuse
• Sleep disorders
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

The brain plays a key role in sexual arousal and the physical events that cause an erection. A number of things can interfere with sexual feelings and cause or worsen ED. These include:

• Depression, anxiety or other mental health conditions
• Stress
• Relationship problems due to stress, poor communication or other concerns
• Various risk factors can contribute to ED, including:
• Medical conditions, particularly diabetes or heart conditions
• Tobacco use, which restricts blood flow to veins and arteries, can cause chronic health conditions that lead to erectile dysfunction
• Being overweight or obese
• Certain medical treatments, such as prostate surgery or radiation treatment for cancer
• Injuries, particularly if they damage the nerves or arteries that control erections
• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
• Psychological conditions, such as stress, anxiety or depression
• Drug and alcohol use, especially if you're a long-term drug user or heavy drinker
• Prolonged bicycling, which can compress nerves and affect blood flow to the penis, may lead to temporary or permanent erectile dysfunction

Talk with your doctor if erection problems are ongoing, since ED can be an early sign of heart disease or diabetes. A medication review and check-up often identify a treatable cause.