Erectile dysfunction (ED), sometimes called impotence, happens when you have trouble getting and keeping an erection.

In some people, ED symptoms come and go quickly without treatment. But experiencing ED over and over might signal an underlying medical, psychological, or lifestyle cause that needs some extra treatment.

ED can be frustrating and disrupt your life. But it’s usually easy to treat with a combination of medication and lifestyle changes. Read on to learn how to recognize and treat the causes and symptoms of ED. 

Erectile dysfunction symptoms

ED can have symptoms that affect you both physically and psychologically.

Recognizing the different symptoms can help you identify any underlying issues and seek the right treatment.

Physical symptoms of ED 

• Having trouble getting an erection that’s hard enough to have sex, even if you’ve been able to get erections before or are enjoying the same kinds of stimulation that normally help you get hard 
• Having trouble keeping an erection while you’re having sex or getting close to having an orgasm
• Feeling less sexual desire or less interest in sexual activities than you normally do
• Ejaculating too early (premature ejaculation) or taking too long to ejaculate, which can lead you to have ED from the anxiety or discomfort of not ejaculating when you want to

Psychological symptoms of ED

• Feeling anxiety about being able to get hard or stay hard long enough to have sex, or feeling afraid that you won’t be able to perform the way you want to during sex
• Experiencing low self-esteem because you don’t feel that you’re confident in your sexual abilities or that you can’t please your sexual partners
• Feeling sad, depressed, or isolated because of your loss of confidence in your ability to get an erection, especially if it affects your sexual relationships or parts of your identity tied to sexual performance
• Difficulties in your relationships due to changes in sexual activities or issues with communication or intimacy in your sexual or social relationships 

Causes of erectile dysfunction

Erectile dysfunction (ED) can also have causes linked to both physical or psychological issues.

In some cases, an underlying disease or condition can be treated to help resolve your ED symptoms. In other cases, psychological causes of ED like anxiety and depression can be addressed to help reduce your ED symptoms. 

Physical Causes of ED

• Heart disease or vascular conditions, such as atherosclerosis, can impede blood flow to your penis and make it harder for you to get an erection 
• Diabetes can cause damage to the blood vessels and nerves in your penis, reducing sensation in your penis and restricting blood flow
• Imbalances in hormones like testosterone that can affect the hormone systems involved in getting sexually aroused – or conditions that affect hormone-producing organs like your thyroid
• Brain or neurological conditions that affect communications between the brain and nerves involved in sexual arousal, such as Parkinson’s disease or multiple sclerosis (MS)

Psychological Causes of ED

• Stress from different areas of your life, such as work, financial problems, or relationships – especially with sexual partners or with a spouse
• Anxiety about your sexual performance or about other areas of your life
• Clinical depression can result in impotence and difficulties with sexual intimacy
• Relationship problems that can result in sexual dysfunction or a loss of intimacy with your sexual partners

Lifestyle causes of ED

• Not getting enough activity or exercise, resulting in issues with your blood flow and hormones that can contribute to ED symptoms
• Eating an unhealthy diet consisting mostly of processed foods and sugars, which can cause cardiovascular issues that affect your sexual performance

Who's at risk for erectile dysfunction?

Age is the highest risk factor for ED. After you turn 40 years old, your risk of ED starts to rise gradually and peaks between 60 and 69 years old. Interestingly, your risk of ED gets lower as you cross into your 70s and beyond. 

But getting older doesn’t always mean that you’ll have ED — and you can still have ED even if you’re in your 20s or 30s. 

Many other risk factors for ED can account for ED symptoms at any age, including:

• Untreated heart disease or other cardiovascular conditions that affect your blood flow, such as high blood pressure or high cholesterol
• Complications from diabetes mellitus that can affect nerve function and circulation
• Drinking too much alcohol, which can affect your blood flow and response to sexual stimulation
• Smoking tobacco products or other products that contain nicotine
• Taking certain medications like antidepressants or antihistamines that might have side effects that result in ED symptoms
• Being overweight or obese, which can affect your blood flow and hormones involved in sexual arousal or cause you to not have enough strength or energy to have sex
• Chronic sleep disorders like sleep apnea that can reduce your energy levels and cause other medical or mental health conditions 
• Short-term or chronic stress that can increase your cortisol levels and affect your ability to get sexually aroused

You might also experience new ED symptoms if you’ve gotten surgery for prostate cancer. Surgical procedures done around your pelvic area can affect the nerves, blood vessels, and muscles that are involved in getting an erection.

Erectile dysfunction diagnosis

Think you might have ED? Speak with a doctor to find out how you can diagnose and treat ED.

Medical history for ED

When you visit a doctor to get diagnosed with ED, they’ll likely ask you some questions about your medical history. These questions can help your medical provider understand the underlying cause of ED and give you the right treatment for your symptoms:

• How often do you have ED symptoms?
• Have you been diagnosed with any other medical conditions?
• Have you been diagnosed with mental health conditions?
• Do you take any medications or use recreational substances?
• How often do you exercise?
• What does your diet consist of?
• Do you have any issues with your personal or romantic relationships?
• Are you feeling anxious or stressed?

You may feel a little awkward visiting a doctor in person to talk about something as personal as your sex life.

Try using a telehealth service for ED treatment like Motivated to talk to a licensed medical provider online to save yourself the trip to a doctor’s office.

If a doctor believes that your ED symptoms might be caused by anxiety or stress, they’ll likely refer you to a mental health professional to address any mental health causes of ED symptoms. 

Physical examination for ED

During a physical examination, a doctor or urologist will examine your penis, scrotum, and overall physical health. 

Some areas that a doctor might focus on include looking at your genitals for any signs of injuries or infections and taking your blood pressure and heart rate to look for signs of high blood pressure.

Lab tests for ED

Some of the most common lab tests for ED include blood tests that can show changes in your levels of important substances in your blood like cholesterol, testosterone or thyroid hormone. Changes in these levels may lead to ED symptoms. 

A doctor may also recommend a urine test that can help discover other underlying causes of ED, such as diabetes.

Erectile dysfunction treatment 

You can usually treat ED successfully with a combination of medication, lifestyle changes, and managing health problems like heart disease or diabetes, if needed.

Medications for erectile dysfunction (ED)

A doctor will likely prescribe you a phosphodiesterase type 5 (PDE5) inhibitor to treat issues with blood flow that result in ED symptoms:

• Viagra®: The original brand-name PDE5 inhibitor that’s been shown to be effective at treating ED since it was approved by the Food and Drug Administration (FDA) in 1998
• The generic version of Viagra, Sildenafil, first introduced in 2017, that’s just as effective as Viagra but available for a much lower cost
• Cialis®: Another effective brand-name PDE5 inhibitor approved by the FDA in 2003 that can be taken daily and lasts for up to 36 hours
• The generic version of Cialis, Tadalafil, first approved by the FDA in 2018 that’s also much more affordable than brand-name Cialis

Other prescription PDE5 inhibitors include Levitra® (vardenafil) and Stendra® (avanafil). 

Non-medical treatment for erectile dysfunction  

Some non-medical ED treatments that can also be effective when used along with a PDE5 inhibitor include:

• Make lifestyle changes like weight loss and more regular exercise
• Stop smoking tobacco or nicotine products
• Improve your diet by removing processed foods or drinking less alcohol
• Manage underlying conditions like heart disease or diabetes that contribute to your symptoms
• Get therapy or counseling to help you address anxiety, stress, or depression that might be affecting your sex life

A doctor may also recommend testosterone therapy to treat low testosterone levels that can be a risk factor for ED symptoms. 

In some cases, a doctor may suggest using medical devices that can help with physical or anatomical issues that result in ED symptoms. 

Vacuum erection devices, penile implants, and penis rings can both help you get and keep erections during sex if you’re not getting the results you want from medications or lifestyle changes.