Erectile dysfunction

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 18, 2016
StartDiseasesErectile dysfunction

Erectile dysfunction, commonly referred to as ED, is a man's inability to achieve or maintain an erection for successful sexual intercourse. Impotence, as it is also called, can be related to psychological, medical or behavioral issues.


Definition & Facts

Erectile dysfunction is a man's inability to successfully attain and maintain and erection suitable for sexual intercourse. There are a multitude of causes for ED. These can include illnesses, exhaustion, psychological hindrances, medications, overconsumption of alcohol and insufficient blood flow to the penis.

Most men experience problems with getting an erection from time to time. This can be quite normal and should not necessarily cause alarm. However, when erectile dysfunction is an ongoing problem, it can become quite stressful. Self-confidence can be affected and relationship problems may result.

Symptoms & Complaints

The primary symptoms of erectile dysfunction include problems achieving an erection, difficulty in keeping an erection, diminished sexual desire. Most men experiencing erectile dysfunction are hesitant to seek medical assistance for their problem. Many experience the symptoms of impotence for a long period of time or on multiple occasions before speaking to their healthcare provider about the problem.

The condition can affect self-esteem and add psychological stress to the weight of the ED problem. Many men who suffer from impotence also have problems with ejaculation, whether that is premature ejaculation or delayed ejaculation. They may also have health conditions like diabetes, heart disease or other diseases which are linked to erectile dysfunction.


Gaining an erection seems like a simple physical response to sexual stimulation. But it is actually a complex process with many areas of the body supporting it. Hormones, emotions, nerves, muscles, blood vessels and the brain are all involved in an erection.

When any of the contributing areas of the body or mind are unhealthy, impotence may result. Stress and psychological problems can cause or make impotence worse, just as physical illnesses can. When illness is the reason for ED, psychological issues can erupt. These may worsen the impotence problem, whether through anxiety or a loss of self-confidence in sexual performance.

Some physical reasons for impotence include:

Psychological causes of ED may include:

  • Depression
  • Anxiety
  • Stress
  • Other mental health conditions
  • Relationship conflict

There are numerous risk factors for erectile dysfunction. Most men expect that at some point in their aging, erections may take longer to achieve and may not be as strong as they once were. It may also require more physical stimulation to gain an erection.

Diagnosis & Tests

A physical examination by a primary care physician or other healthcare provider, along with medical history and answers to some questions will allow a doctor to diagnose erectile dysfunction. From there, treatment can be provided. Men with chronic health problems or possible underlying health conditions may require additional tests or consultation. If additional tests are ordered to determine whether an underlying condition is at fault for the ED, those tests may include:

Another common test is the overnight erection test, which measures the number and strength of erections achieved during sleep. This helps to determine whether ED has psychological or physical causes. A psychological test may help the doctor determine whether depression or other psychological problems are causing impotence.

Treatment & Therapy

There are a wide variety of treatments available for erectile dysfunction. Once the cause of ED has been determined, treatment can be recommended by the doctor. Partners are often involved in treatment decision-making, according to patient preference. Medications are often successful for men with erectile dysfunction. Common medications for impotence include:

Some of these medications use nitric oxide, a chemical also produced naturally in the body. This chemical relaxes penile muscles to increase blood flow, allowing for a more easily obtained erection when sexual stimulation occurs. Nitric oxide is not an aphrodisiac and does not cause an erection without sexual desire and associated stimulation. Over-the-counter medications use herbal remedies which offer varied levels of success for treatment of ED.

If medications are not suited for an individual's erectile dysfunction, a penis pump may be used. This is a vacuum device which is placed over the penis to draw blood into the organ. When the penis has an erection, a tension ring is placed at the base of the penis to keep blood from flowing out of the organ, thus maintaining the erection until the ring is released. Penile implants and blood vessel surgery are two other treatment options, both offering a good chance of remedy.

Prevention & Prophylaxis

Prevention of erectile dysfunction is best approached through healthy living and management of any health conditions. Measures of prevention may include:

  • Manage diabetes, heart disease or other illnesses
  • Regularly visit the doctor for checkups and screenings
  • Do not smoke or quit smoking
  • Avoid alcohol and illicit drugs
  • Keep stress low
  • Exercise regularly
  • Seek help for mental disorders and other psychological issues