DefinitionErectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex. Although erectile dysfunction is more common in older men, this common problem can occur at any age. Having trouble maintaining an erection from time to time isn't necessarily a cause for concern. But if the problem is ongoing, it can cause stress and relationship problems and affect self-esteem.
Formerly called impotence, erectile dysfunction was once a taboo subject. It was considered a psychological issue or a natural consequence of growing older. These attitudes have changed in recent years. It's now known that erectile dysfunction is more often caused by physical problems than by psychological ones, and that many men have normal erections into their 80s.
Although it can be embarrassing to talk with your doctor about sexual issues, seeking help for erectile dysfunction can be worth the effort. Erectile dysfunction treatments ranging from medications to surgery can help restore sexual function for most men. Sometimes erectile dysfunction is caused by an underlying condition such as heart disease. So it's important to take erectile trouble seriously because it can be a sign of a more serious health problem.
SymptomsErectile dysfunction is the inability to maintain an erection sufficient for sexual intercourse at least 25 percent of the time.
An occasional inability to maintain an erection happens to most men and is normal. But ongoing erection problems are a sign of erectile dysfunction and should be evaluated. In some cases, erectile dysfunction is the first sign of another underlying health condition that needs treatment.
CausesMale sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. If something affects any of these systems — or the delicate balance among them — erectile dysfunction can result.
At one time, doctors thought erectile dysfunction was primarily caused by psychological issues. But this isn't true. While thoughts and emotions always play a role in getting an erection, erectile dysfunction is usually caused by something physical, such as a chronic health problem or the side effects of a medication. Sometimes a combination of things causes erectile dysfunction.
- Heart disease
- Clogged blood vessels (atherosclerosis)
- High blood pressure
- Metabolic syndrome
- Certain prescription medications
- Tobacco use
- Alcoholism and other forms of drug abuse
- Treatments for prostate cancer
- Parkinson's disease
- Multiple sclerosis
- Hormonal disorders such as low testosterone (hypogonadism)
- Peyronie's disease
- Surgeries or injuries that affect the pelvic area or spinal cord
The brain plays a key role in triggering the series of physical events that cause an erection, beginning with feelings of sexual excitement. A number of things can interfere with sexual feelings and lead to — or worsen — erectile dysfunction. These can include:
- Poor communication or conflict with your partner
- Getting older. As many as 80 percent of men 75 and older have erectile dysfunction. Many men begin to notice changes in sexual function as they get older. Erections may take longer to develop, may not be as rigid or may take more direct touch to the penis to occur. But erectile dysfunction isn't an inevitable consequence of normal aging. Erectile dysfunction often occurs in older men mainly because they're more likely to have underlying health conditions or take medications that interfere with erectile function.
- Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone (male hypogonadism).
- Taking certain medications. A wide range of drugs — including antidepressants,
antihistamines and medications to treat high blood pressure, pain and prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.
- Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.
- Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive.
- Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.
- Smoking. Smoking can cause erectile dysfunction because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop erectile dysfunction.
- Obesity. Men who are obese are much more likely to have erectile dysfunction than are men at a normal weight.
- Metabolic syndrome. This syndrome is characterized by belly fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.
- Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.