What is erectile dysfunction?

Erectile Dysfunction

Erection problems: Overview

An erection problem means that you routinely can't get or keep an erection that allows satisfactory sex. You may not be able to have an erection at any time. Or you may not be able to have one that is firm enough or lasts long enough to complete intercourse. The problem is also called erectile dysfunction (ED).

It's not the same as having trouble getting an erection now and then. That's common.

Erection problems can be caused by problems with the blood vessels, nerves, or hormones. They can be caused by diabetes, heart disease, and injuries. Nerve problems also can cause them.

Medicines, alcohol, and tobacco also can cause problems. So can depression, stress, grief, and relationship problems.

Erection problems (erectile dysfunction)

An erection problem means that you can't get or keep an erection that is firm enough for you to have sex. Erection problems are also called erectile dysfunction or impotence.

Erection problems can happen at any age but are more common if you have other health problems, like diabetes. Having an occasional episode is considered normal and usually isn't a serious problem.

What happens when you have erection problems?

It's common to have erection problems at times. When you have them often, "performance anxiety" can make the problem worse. If you can't keep an erection that's firm enough for intercourse, or if you have an orgasm right after entering your partner, you may feel frustrated. Many causes of erection problems can be treated.

What are the symptoms of erection problems?

The only symptom of an erection problem is being unable to get and keep an erection that is firm enough or lasts long enough to have sex. But even with an erection problem, you may still have sexual desire and be able to have an orgasm and to ejaculate.

How are erection problems treated?

Treatment for an erection problem depends on the cause of the problem. The cause may be mental or physical. Or it might be a mix of both.

Treatment can include having you:

  • Avoid tobacco and drugs and limit alcohol.
  • Talk about the issue with your partner, do sensual exercises, and get counseling.
  • Ask your doctor about changing any medicines that may be causing the problem. In some cases, you may be able to use a different medicine.
  • Take testosterone or another treatment to fix a hormone problem, such as low testosterone, if tests show that you have one.
  • Take pills that help you get an erection. These pills are called PDE-5 inhibitors. They include sildenafil (such as Viagra), tadalafil (such as Cialis), and vardenafil (such as Levitra). Check with your doctor to see if it's safe for you to take one of these medicines with your other medicines. These pills can be dangerous if you take nitroglycerin or other medicines that contain nitrates (for heart disease).
  • Use medicines that are injected or inserted into the penis.
  • Use vacuum devices. These devices have a tube that you place around the penis. You pump the device to create a vacuum that leads to an erection.
  • Have surgery to place an implant in the penis.

It's important to involve your partner in your decision, no matter which treatment you choose.

Transurethral Therapy for Erection Problems

Picture of how to apply transurethral therapy for erection problems

An applicator is used to insert a small pellet of medicine inside the opening at the end of the penis. The pellet dissolves, and the medicine causes an erection. The erection can last for at least 30 minutes.

Preventing erection problems

You may be able to avoid erection problems related to anxiety and stress by taking a more relaxed approach to sex. Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner talk about sex, it will help reduce your stress and anxiety. And you may become more relaxed.

Erections may gradually become more difficult to get and keep as you get older. But foreplay—erotic stimulation before intercourse—and the right environment can help increase your ability to have an erection, regardless of your age.

Here are some other things you can do that may reduce your risk for erection problems.

  • Quit smoking.
  • Avoid using illegal drugs.
  • Limit alcohol.

    Even small amounts of alcohol can cause erection problems.

  • Manage high blood pressure and high cholesterol.

    This can help lower your risk of hardening of the arteries (atherosclerosis).

  • Keep your blood sugar in your target range if you have diabetes.
  • Exercise regularly.
  • Lose weight, especially if you are obese.
  • Lower stress in your life.

How are erection problems diagnosed?

To diagnose an erection problem, your doctor may:

  • Review your risk factors. This includes things like any medicines you take and how much you drink.
  • Ask questions about your sexual function, including how often you have erection problems.
  • Do a complete physical exam of the belly, penis, prostate, rectum, and testicles.
  • Do lab tests for testosterone and other hormones and for blood sugar.

Your doctor may start treatment with pills. But you may get more tests if pills don't work or your doctor thinks that testing is needed.

Tests can help your doctor find out whether physical factors are causing your erection problem. These may include lab tests for:

  • Testosterone. A low level may reduce sexual desire.
  • Thyroid hormone.
  • Blood sugar. A high level may indicate diabetes. This can cause erection problems.

If your doctor thinks you have a mental health issue, a mental health evaluation may be recommended.

What are the risks of medicines for erection problems if you have heart or blood pressure problems?

You may use medicine to treat erection problems. But this can be dangerous.

Talk with your doctor about whether medicines for erection problems are safe for you if you:

  • Have heart disease.
  • Have heart failure or low blood pressure.
  • Are taking medicine for high blood pressure.

PDE-5 inhibitors

PDE-5 inhibitors should never be used if you may need to take a nitrate-containing medicine, such as nitroglycerin. Taking nitroglycerin and a PDE-5 inhibitor within 24 hours (or 72 hours for long-acting tadalafil) of each other may greatly lower your blood pressure. This could lead to a heart attack, stroke, or death.

These medicines include sildenafil (such as Viagra), tadalafil (such as Cialis), and vardenafil (such as Levitra).

Taking PDE-5 inhibitors can also cause low blood pressure if:

  • You use a combination of drugs for high blood pressure.
  • You take alpha blockers. These drugs are used to lower blood pressure and to treat an enlarged prostate.

For these reasons, you also shouldn't take PDE-5 inhibitors with these medicines without talking to your doctor. The combination could cause a dangerous drop in blood pressure.

Tests for heart disease

If you take a PDE-5 inhibitor and are going to have a test for heart disease, make sure that your doctor knows that you take it.

  • You should not take sildenafil (such as Viagra), vardenafil (such as Levitra), or tadalafil (such as Cialis) for 24 hours before the test.
  • Do not take long-acting tadalafil (such as Cialis) for at least 72 hours before the test.

Then if you have a problem during the test, it will be safe to use nitrate-containing medicines such as nitroglycerin.

How can you care for yourself when you have erection problems?

Sometimes you can treat occasional erection problems at home. Look at relationships and events that may be causing sexual problems. Talk with your partner outside of the bedroom about your sex life. Sensual exercises may help. Not smoking and drinking less alcohol may also help. Seek professional help if you keep having problems.

What are erection problems?

You have erection problems if you can't get or keep an erection that is firm enough for you to have sex. Erection problems are also called erectile dysfunction or impotence.

It's common to have erection problems every now and then. This is normal. These problems can occur at any age. But they are more common as you get older, when you are more likely to have other health problems. Treatment can help if you are older or younger.

What causes erection problems?

Erection problems may be caused by physical problems related to the blood vessels, nerves, and hormones. Or they may be caused by mental health issues.

Normally, an erection occurs when your imagination or senses (vision, hearing, touch, smell, taste) are stimulated. You then get aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis.

Causes of erection problems may include:

  • Problems with the blood vessels. These problems may prevent blood from filling the penis or from staying there long enough to keep an erection.
  • Problems with the nerves. These may prevent arousal signals from traveling from the brain and spinal cord to the penis.
  • Other health problems, such as low testosterone levels, diabetes, or high blood pressure.
  • Side effects of certain medicines.
  • Drinking too much alcohol or smoking.
  • Surgery, such as for prostate cancer.
  • Mental health issues, such as depression, anxiety, stress, or grief.

How to use sensual exercises to help with erection problems

Sensual exercises may help with erection problems (erectile dysfunction). Doing these with your partner may help you relax and focus more on the pleasurable touching of lovemaking than on the erection itself. Focusing too much on having an erection may make it difficult to have one.

Sensual exercises may be most helpful if done in a soothing, relaxing, and playful atmosphere. Put on some pleasant music, turn off the phone, and concentrate on your partner. Try these steps over the course of several days or more. Move to the next step only when both partners are ready.

  1. Start by caressing your partner without touching any part of the genitals.
    Remove your clothes.
    Have your partner lie face down.
    Beginning at the neck, slowly caress and/or kiss your partner from head to toe.
    Then, have your partner turn over.
    Repeat the caressing and kissing.

    Avoid touching the nipples or any part of the genitals. Concentrate on how good touching your partner feels.

    Then, trade places. Lie on your stomach while your partner caresses you.

    Do not have intercourse the first day. Enjoy holding each other, relaxing, and laughing.

  2. Include genital touching.

    Again, do not have intercourse. If sexual tension from any erection that occurs is too much to stand, masturbate to relieve the tension.

  3. Continue genital touching and have intercourse.

    Do not force lovemaking too soon. Rather, fully enjoy the genital pleasure leading up to it.

Erection problems: When to call

Call your doctor now or seek immediate medical care if:

  • You took a medicine for erection problems and you have an erection that lasts longer than 3 hours.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

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The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.