Erectile Dysfunction (Impotence): Symptoms, Causes, Diagnosis, and Treatment

Erectile dysfunction, commonly known as impotence, is difficulty to achieve and maintain an erection firm enough for sexual intercourse.

An erection issue that occurs occasionally isn’t necessarily a cause for concern. However, it becomes an issue if erectile dysfunction is ongoing, such that it affects your self-confidence and causes problems in your relationship. Erectile dysfunction may be a sign of an underlying health condition that requires medical evaluation and treatment.

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Consult your doctor if you’re concerned about erectile dysfunction. Sometimes, treating a causal condition may help reverse erectile dysfunction. Medications may be needed in other cases.

Symptoms of Erectile dysfunction

Erectile dysfunction symptoms might include:

  • Difficulty getting an erection
  • Trouble maintaining an erection
  • Low sexual drive or libido

Causes of Erectile dysfunction

Male sexual arousal involves the brain, nerves, hormones, emotions, muscles and blood vessels. This is very complex because erectile dysfunction can result from a problem with any of these. Stress and mental health concerns can cause or worsen erectile dysfunction.

In some cases, erectile dysfunction may be caused by a combination of physical and psychological matters. A minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The subsequent anxiety can lead to or aggravate erectile dysfunction.

Physical causes of erectile dysfunction

Erectile dysfunction may be caused by something physical issues such as:

  • High blood pressure (hypertension)
  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • Diabetes
  • High cholesterol
  • Obesity
  • Metabolic syndrome
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Sleep disorders

Psychological causes of erectile dysfunction

Starting from feelings of sexual arousal, the brain plays a key role in generating the series of physical events that cause an erection. A number of things can hinder sexual feelings and cause or worsen erectile dysfunction. These include:

  • Stress
  • Depression, anxiety or other mental health conditions
  • Relationship problems due to stress, poor communication or other concerns

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Risk factors

Erections might take longer to develop and might not be as firm as you advance in age. In some cases, you might need more direct touch to your penis to get and sustain an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions for diabetes, heart conditions, antidepressants, high blood pressure, or prostate disorders
  • Being overweight
  • Tobacco use,which restricts blood flow to veins and arteries, leading to chronic health conditions that lead to erectile dysfunction
  • Certain medical treatments,such as prostate surgery or radiation treatment for cancer
  • Injuries,particularly if they damage the nerves or arteries that control erections
  • Psychological conditions,such as stress, anxiety or depression
  • Drug and alcohol use,especially if you’re a long-term drug user or heavy drinker

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Complications resulting from erectile dysfunction can include:

  • Stress and anxiety
  • Inability to impregnate your partner
  • Poor sex life
  • Embarrassment or low self-esteem
  • Relationship problems


Some tips to preventing erectile dysfunction includes:

  • Consult your doctor for regular checkups and medical screening tests.
  • Engage in regular exercise
  • Manage diabetes, heart disease or other chronic health conditions.
  • Manage stress, anxiety, depression and other mental problems
  • Quit smoking, limit or avoid alcohol, and don’t use illegal drugs.


Your doctor may carry out a physical exam and ask questions concerning your medical history. Further test may be required if you have chronic health conditions or your doctor suspects that an underlying.

Tests for underlying conditions might include:

  • Physical exam.This is carefully examining your penis and testicles and checking your nerves for sensation.
  • Blood tests.Blood test sample might be sent to a lab to check for signs of diabetes, heart disease, low testosterone levels and other health conditions.
  • Urine tests (urinalysis).These test examines your urine for signs of diabetes and other underlying health conditions.
  • This test is usually performed by a specialist in an office. It involves using a transducer held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.

  • Psychological exam.Your doctor might ask questions to screen for possible psychological causes of impotence.


You may have different treatment options depending on the cause and severity of your condition. Your doctor can explain the risks and benefits of each treatment and will consider your likings. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

  • Tadalafil (Adcirca, Cialis)
  • Avanafil (Stendra)
  • Sildenafil (Viagra)
  • Vardenafil (Levitra, Staxyn)

These four medications helps to improve the effects of nitric oxide (natural chemical your body produces that relaxes muscles in the penis). This increases blood flow and help you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally.

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Other medications for erectile dysfunction include:

  • Alprostadil self-injection.This involves using a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. Examples include papaverine, alprostadil and phentolamine.

Side effects can include prolonged erection (priapism) and mild bleeding from the injection site.

  • Alprostadil urethral suppository. This involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You can then use a special applicator to insert the suppository into your penile urethra.

The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

  • Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps.A penis pump is a hollow tube with a hand-powered or battery-powered pump that is placed over your penis to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. The vacuum device would then be removed.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Possible side effect include bruising of the penis and restriction of the ejaculation by the band. Your penis might feel cold to the touch.

  • Penile implants.This surgery method involves placing devices into both sides of the penis. These implants consist of either inflatable or malleable rods which allows you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.


Disclaimer: The content provided on is purely informative and educational in nature and should not be interpreted as medical advice. Please use the content only in consultation with an appropriate certified medical doctor or healthcare professional.



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