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by Carmack A

Erectile Dysfunction

(ED; Impotence; Male Erectile Disorder)


Erectile dysfunction (ED) is trouble getting or keeping an erection of the penis. The penis is not firm enough to have sex.


An erection happens when blood fills the penis. Some blood vessels open wide to let blood flow into the penis. Other blood vessels shrink to keep the blood from leaving the penis. The change in the blood vessels is controlled by nerves.
ED may be caused by:
  • Blood vessel injury or disease. These can change blood flow.
  • Harm to nerves that control blood vessels or feeling in the penis.
  • Stress that change how the nerves work—This is more likely in men with sudden ED.
  • Hormone problems such as low testosterone or thyroid disease.
  • Certain medicines such as those that treat high blood pressure, mental health problems, or heart rhythm problems.
  • Structural problems caused by Peyronie disease, hypospadias, or penile fracture.

Risk Factors

ED is more common in men aged 40 years and older. The risk goes higher with age.
The chances of ED are higher in men who:


The main symptom of ED is not being able to get or keep an erection long enough to have sex.


The doctor will ask about your symptoms and health past. A physical exam will be done. This will include a genital and rectal exam.
The doctor will ask about the quality of erections. This may include questions about the time of day, how rigid the erection is, and how long it lasts. The doctor may also ask about your mental state, desire, arousal, ejaculation, and orgasms. The answers can help point to the source of the problem.
A nocturnal penile tumescence test will check for erections while you sleep. If you have normal erections during sleep the cause may be psychological. If you have problems with an erection, even while you sleep, the cause may be physical.
Other tests to find a cause may include:
  • Blood tests—to check for health problems such as diabetes or high cholesterol, or look at testosterone levels
  • Doppler ultrasound—to check blood flow in the penis


ED care may involve one or more of these:

Lifestyle Habits

Many lifestyle habits can be changed. These can help blood flow, or how nerves and blood vessels work. General steps are:
  • Lose excess weight—This can also help balance hormones.
  • Quit smoking—Your doctor will help you find the best method.
  • Get regular exercise.
  • Limit alcohol to 2 drinks or less a day.
  • Do not use illegal drugs.
  • Find ways to relax and lower stress.


ED can be treated with medcine to:
  • Relax muscles and improve blood flow to the penis—Do not take some of these medicines if you take nitrates
  • Boost testosterone levels—These supplements are only helpful if you have low testosterone
ED medicine can be taken by mouth or as a shot, or be placed on the skin or into the tip of the penis.
Talk to your doctor before taking any over the counter medicine for ED. Some of them may be unsafe.

Vacuum Devices

A vacuum device pulls blood into the penis. A band is placed around the penis to keep the erection.


Surgery can be used to fix blood vessels or other structural problems.

Penile Implants

Implants may be placed in the penis. The implants can be inflated to make an erection when needed.
Penile Implant
penile implant smaller
Copyright © Nucleus Medical Media, Inc.

Sex Therapy

Sex therapy may help ED caused by:
This can be done alone or with a partner.


To help lower your chances of ED:


Family Doctor—American Academy of Family Physicians
Urology Care Foundation


Health Canada
Sex & U—The Society of Obstetricians and Gynaecologists of Canada


Erectile dysfunction. EBSCO DynaMed website. Available at: Updated February 29, 2016. Accessed July 17, 2019.
Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: Accessed July 17, 2019.
Erectile dysfunction. Urology Care Foundation website. Available at: Accessed July 17, 2019.
Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153-165.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 06/2019
  • Update Date: 10/02/2019
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