What Is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to obtain and maintain an erection that is firm enough for a man to have intercourse, or the inability to keep an erection long enough to ejaculate inside the vagina. It is a newer and better name for what was previously called impotence.

It can happen in one of two ways:

  • A man may be unable to get an erection at all.
  • A man may lose his erection during intercourse, before he ejaculates.

A man is considered to have erectile dysfunction if he is unable to get or maintain an erection in at least 50 percent of his attempts at intercourse.

Erectile dysfunction is a problem for both the man and his partner. In most cases, it is a temporary condition that will disappear with little or no treatment. In others, it can be an ongoing difficulty that requires treatment.

In most men, erectile dysfunction does not affect their sex drive. ED also does not affect a man’s ability to have an orgasm once he achieves an erection.


Facts about erectile dysfunction

  • Erectile dysfunction (ED) affects more than a third of adult men of all ages.
  • ED affects more than half of adult men over age 50.
  • In the United States, up to 20 million men are affected by erectile dysfunction.
  • ED can be successfully treated in the vast majority of men. A variety of treatment options are available.
  • Cutting down on smoking, alcohol consumption, and drug abuse should be among the first lines of treatment, as they can affect potency. Erectile problems also can be a side effect of medication.

Is It All In The Mind?

Until recently, psychological factors were believed responsible for the majority of cases of erectile dysfunction. Impotent men often were given dismissive and unhelpful advice such as “don’t worry” or “just relax and it will take care of itself.”

Today, with vast improvements in diagnostic methods and more sophistication in the approach to the problem, the conclusion is that physical factors are the main cause in the majority of cases. But because the brain does play an important role in sexual activity, there is a definite mind-body connection as well.

How Common Is Erectile Dysfunction?

Erectile dysfunction happens much more often than most people think – it affects more than half of adult men over age 50, and more than a third of all adult men. Regardless of the cause, erectile dysfunction can decrease a man’s self esteem and harm his relationship with his partner.

Erectile dysfunction is common

Almost all men experience occasional erectile problems. About one in ten adult men experience erectile dysfunction. In the United States, up to 20 million men are affected by erectile dysfunction. Definite numbers are not known, however, because many men do not seek medical assistance for the problem.

Erectile dysfunction can happen at any age

The chance of erectile dysfunction does increase with age. But erectile dysfunction can affect men at any age and at any time in their lives.

Is Erectile Dysfunction Treatable?

Yes. Erectile dysfunction can be successfully treated in the vast majority of individuals. In fact, there have never been more treatment options. Most men regain their ability to have intercourse using one or more of the options available.

Medical treatments combined with counseling, to educate and reassure you and your partner about the condition, often are most effective.


How Does Erection Normally Happen?

An erection is a complex event that requires the interaction of the brain, nerves, hormones, and blood vessels. This process is separate from ejaculation and orgasm, both of which can occur without an erect penis.

The shaft of the normal penis consists of two erectile bodies, each called the corpus cavernosum,, which begin at the pelvic bone and extend to just below the head of the penis. They are spongy tissue made up of smooth muscle and blood vessels. The male hormone testosterone, which is secreted by the testicles, controls the function of the penis and a man’s sex drive.

The brain starts the changes that will produce an erection.

  • As a result of psychological or physical stimulation, the brain sends messages through the nervous system to the penis.
  • These messages relax the smooth muscles in the blood vessel walls of the corpus cavernosum, causing them to open wider.
  • When this happens, more blood flows through the vessels, filling the corpus cavernosum.
  • At the same time, the veins that carry blood away from the penis shut down, causing an increase in blood pressure in the penis.
  • The blood that is trapped within the corpus cavernosum causes the penis to become hard and erect.

What Makes Erection Fail?

Anything that interferes with this chain of events – either by reducing the blood flow to the penis or increasing the blood flow out of it – can cause erectile dysfunction. Fear, anxiety, anger, or any other strong emotion can interrupt the signal from the brain. An illness or physical condition can also impair erections if it interferes with this chain of events.

The Normal Changes As A Man Ages

Although sexual activity normally continues throughout a man’s lifetime, his reactions take longer as he ages. He may need more stimulation to get an erection. He may take longer to climax, and he may need to wait longer before he can get another erection.

Nice To Know:

  • A man in his 20s usually needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but can regain his erection in minutes.
  • A man in his 40s may need more direct stimulation and fantasy. His climax may be slower, and he often can regain his erection in an hour.
  • A man in his 60s needs even more direct stimulation and fantasy. He may take longer to get an erection, but he can maintain it longer. He may need a day or more to have another erection.


Conditions Often Mistaken For Erectile Dysfunction

Other conditions often are mistaken for erectile dysfunction, but they have very different causes and different treatments. They include:

  • Premature ejaculation
  • Delayed or inhibited ejaculation
  • Retrograde ejaculation
  • Lack of desire
  • Infertility

Premature Ejaculation

This is the inability to control or delay ejaculation. This condition is easily mistaken for erectile dysfunction in two ways:

  • A man may ejaculate as soon as his penis enters the vagina and then immediately lose his erection.
  • A man may ejaculate as soon as he gets an erection and then is unable to get another.

Delayed Or Inhibited Ejaculation

This is a condition where a man is able to get an erection but is unable to ejaculate.

Retrograde Ejaculation

Surgery on the bladder and some medicines for an enlarged prostate may force ejaculation back into the bladder. While this condition is not harmful, it may be of concern to men when it first occurs.

Lack Of Desire

Some men believe they should always be interested in sex and ready for it. But the human body doesn’t always work that way. A man who has temporarily lost interest in sex – because of personal stress, depression, a relationship issue, or another reason – may not be able to get an erection because he is not aroused enough for it to happen. He also may get an erection but lose it before ejaculation, because he is too preoccupied with other issues.


Infertility in a man means that he has been unable to father a child after 12 months of regular sexual intercourse without birth control. The ability or inability to achieve an erection is not linked to fertility or infertility.

What Can Trigger Erectile Dysfunction?

Some men are more likely to have erectile problems if they are put under emotional or physical strain. In general, seven “triggers” are linked with erectile dysfunction:

  • Illnesses
  • Physical conditions
  • Stress
  • Certain medications
  • Misinformation
  • Poor communication
  • A “vicious circle”

Physical causes are more common in older men, while psychological causes are more common in younger men.

  • Medications are the cause in an estimated 25 percent of erectile dysfunction cases.
  • Various illnesses account for up to 75 percent of those people with ED. For example, up to 35 percent of diabetic males may experience impotence at some stage


Illnesses that may affect erections include:

  • Diabetes
  • High blood pressure
  • Heart conditions
  • Poor circulation
  • Kidney failure
  • Thyroid deficiency
  • Multiple sclerosis
  • Chronic alcoholism
  • Spinal cord injury
  • Depression

Physical Conditions

Some conditions within the body may cause erectile dysfunction, especially if combined with stress or another trigger. These conditions include:

  • The way you’re made. Some men are born with a particularly sensitive blood supply to the penis, which tends to react to stress by closing up, restricting blood flow and causing erectile dysfunction. This is similar to the sensitivity that makes men with a particularly sensitive lining of the stomach develop peptic ulcers under stress.
  • Damage to your blood vessels or nerves because of a health condition. Men with conditions such as atherosclerosis (“hardening of the arteries”), diabetes, or high blood pressure may find it harder to get an erection or maintain it.
  • Low levels of testosterone. However, low testosterone levels, which tend to occur with aging, are more closely associated with a lowering of the sex drive.
  • Prostate surgery. Incontinence and erectile dysfunction are the two most common side effects of prostate surgery. Erectile dysfunction can occur if nerves are damaged during surgery.

Certain Medications

Medications that may affect erections include:

  • Nicotine (as in excessive smoking)
  • Alcohol
  • Cocaine, heroine, amphetamines, and other illegal drugs
  • Tranquilizers and sleeping pills
  • Antidepressants
  • Blood pressure medication (beta-blockers)
  • Heart medications (such as digoxin)
  • Some peptic ulcer medication (such as cimetidine)


Stress related to a job, marriage, or finances is a common cause of erection problems. Ongoing stress may result in erectile dysfunction, which in turn increases stress.

Misinformation, False Beliefs

Sex is still wrapped up in myths and misinformation. Men and women who are unaware of normal changes in sexuality may react with fear and worry when something goes “wrong.” Unrealistic expectations – like trying to bring a partner to orgasm every time during intercourse – can make sex a task rather than a pleasure.

Nice To Know:

For many, sex is a taboo subject and is linked to strongly held beliefs. Many of those beliefs are false, unfortunately, but are passed from one generation to the next without question. Examples are:

  • “A real man should always be ready with an erection.”
  • “Only women show emotions.”
  • “If a main loses an erection, he is a failure in bed.”

Men who accept such false beliefs put themselves under unreasonable pressure, and this can affect their ability to have an erection.

Poor Communication

Sex is a form of communication. Couples who cannot talk to each other are not likely to be able to make love to each other. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. By keeping these worries to themselves, men become vulnerable to losing their erections.

Men who cannot express and resolve feelings of anger, frustration, or hostility towards their partner may hold back their erection as a weapon in the marital conflict.

The Vicious Circle

Losing an erection every once in a while happens to virtually everyone and should not be cause for alarm. Men who realize that this experience is normal and who keep it in perspective often will recover their erections soon afterwards. Those who continue to have problems could be experiencing a physical condition that needs correction, or could be caught in “the vicious circle of failure.”

Men who are unsure of themselves, feel sexually insecure, have unrealistic expectations, and cannot share their anxieties with their partners are more likely to lose confidence in themselves. They may think they are getting old, and they expect more failure. Expecting failure can only cause failure, which reinforces the self-doubt. This vicious circle gets firmly established by negative reactions from the man, his partner, or both.

Nice To Know:

I was taught that too much sex and masturbation could cause a man to have erectile problems as he gets older. True?

No. Erectile dysfunction has nothing to do with how much sex you’ve had. You can’t “overuse” your sexuality.


Where To Find Help for Treatment for Erectile Dysfunction

The best person to approach is your own doctor, who might be able to help you or who can recommend someone else. You may be referred to a urologist, a medical specialist with advanced training to deal with issues surrounding erectile dysfunction.

What To Expect In A Physical Examination

Because erectile dysfunction is so common and so treatable, you should try to put aside any embarrassment and answer your doctor’s questions frankly.

Your physician will perform a thorough physical examination looking for possible clues of any unrecognized illnesses or possible hormonal problems.

A physical examination should include:

  • An exam of your penis and testicles. This may include a penile blood pressure test with a special stethoscope. Your doctor may suggest more sophisticated tests, such as a nerve function test, an ultrasound study, and an X ray study.
  • digital rectal examination to check your prostate gland.
  • Blood tests to exclude various medical conditions including kidney, liver, thyroid and adrenal gland studies as appropriate, and the hormone testosterone level.
  • A test to discover whether you have erections while you sleep. Most men normally have erections while they sleep. One such test is performed with a small plastic ring that you place over your penis before bed. If you have an erection during the night, the small plastic filaments connecting this ring will break. A more common method is the Nocturnal Penile Tumescence (NPT) monitoring study. This allows a continuous recording of your penis during sleep with a small electronic recorder placed at your bedside.

If no erections occur while sleeping, then it is more likely that the problem is a physical one rather than due to psychological problems. However, these tests are not completely reliable.

The Role Of Counseling

If tests do not point to a physical cause, many men find the help they need through sexual counseling. You should choose a therapist who is a licensed and qualified psychiatrist, psychologist, physician, or social worker. For best results, your partner should be included in the counseling.

How Is Erectile Dysfunction Treated?

Men who experience erectile dysfunction have never had so many treatment options. Various therapies are available to successfully treat underlying physical causes and related emotional difficulties.

When the medication Viagra was recently introduced to the market, it was perceived by many to be a “cure-all” for erectile dysfunction. ButViagra is not for everyone. Here is why other therapies are important:

  • In some cases, simple lifestyle changes may be all that is necessary.
  • Some men, such as those with a heart condition, cannot takeViagra and need other options.
  • Erectile dysfunction may be linked to deeper emotional or relationship issues that would require counseling in order to address the underlying cause.

A doctor will decide on treatment based on what is causing the erectile dysfunction.

  • The first line of treatment for many men involves lifestyle changes.
  • Next, the doctor may prescribe Viagra or another medication and may also recommend counseling for the man and his partner.
  • If a man is unable to take medication, or if the medication is not effective, the doctor may suggest injections into the penis, or vacuum devices.
  • If a man has a severe blood vessel disorder, surgery may be considered.
  • Implants are generally the last line of treatment.

Treatment options include:

  • Lifestyle changes
  • Sex therapy and counseling
  • Viagra
  • Other medications
  • Intracavernous injections
  • Vacuum devices
  • Surgery
  • Implants

Lifestyle Changes

Cutting down on smoking, alcohol consumption, and drug abuse should be among the first lines of treatment, as they can affect potency. In addition, men can develop erectile problems as a side effect of medication they are taking for an unrelated condition. They may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects.

Sex Therapy And Counseling

The focus of therapy is to educate a man and his partner, correct false beliefs, and improve the couple’s communication skills. Sex therapy needs commitment and the involvement of a cooperative partner. It can take time.

The counseling sessions may involve therapeutic tools that include:

  • Various exercise to help couples explore each other’s body, share their feelings, and experience pleasures they can enjoy together without erections, orgasms, or intercourse being the focus of attention. These exercises are designed to ease tension, relieve performance pressure, and break the circle of failure.
  • The “ladder concept,” which focuses on men’s and women’s sexual response over seven different stages, with erection as only one of those stages. This serves to take the mind off erections and to concentrate on other aspects of sexual relations.
  • Redefinition of “success.” Unrealistic or unreachable goals can only lead to failure. If success is redefined in terms of pleasure and fun rather than performance, the couple can recapture a successful relationship.


Viagra has been hailed as a “wonder drug” in the treatment of erectile dysfunction, although it isn’t for everyone. Viagra is the brand name of a drug called sildenafil and has been approved by the U.S. Food and Drug Administration (FDA). It works by increasing the activity of a chemical in the penis called nitric oxide, which increases blood flow and creates an erection. Viagra must be combined with sexual activity (foreplay) in order to work properly.

Viagra is available by prescription only and comes in three dosages (25 mg, 50 mg, and 100 mg). Your doctor may want you try several dosages in order to find the right one for you. The tablet is taken one hour before sexual activity.

Side effects of Viagra are generally mild and may include headaches, hot flashes, heartburn, diarrhea, and dizziness. It also can cause increased sensitivity to light or a minor change in your vision that may temporarily prevent you from distinguishing the color blue from green.

Need To Know:

Men who take nitroglycerin for a heart condition (as either tablets, spray, or patches) should NOT take Viagra. The two medicines, when combined, can cause a significant lowering of blood pressure. Some men have died from combining Viagra and nitroglycerin.

Other Medications

  • Uprima is a different drug for erectile dysfunction that has recently been approved by the FDA. It acts on the central nervous system and in the brain. It facilitates erections within 30 minutes.Uprima must be combined with sexual activity (foreplay) to work properly.

    Uprima is available by prescription only and comes in two doses (2 mg and 4 mg). It may require several different doses before the right dose is identified. Side effects of Uprima are mild and infrequent, and include nausea, headache, dizziness, and, rarely, fainting.

  • If your testosterone level is low, testosterone medication is available to restore the testosterone to adequate levels which may be helpful in improving erections. An adequate level of testosterone in the blood is normally needed to get an erection. These medicines are available in pill form or as an adhesive patch that you wear on your skin. Some patches are designed to be worn on your scrotum (testosterone absorption is greater through scrotal skin), while others can be worn elsewhere on your body.

    A new gel is available that can be applied daily to increase testosterone levels. This gel works like the testosterone patch, in which the medication is absorbed through the skin into the body.

  • Yohimbine is a drug that has been used as an aphrodisiac for many years. Given at the right dose, it can enhance erections and increase sexual interest. It must be given under close medical supervision, however, as it could interact with other drugs and cause severe side effects.
  • A new gel is available that can be applied to the penis to help impotent men have an erection. The gel contains a hormone-like substance called alprostadil and an agent known as SEPA that helps deliver the alprostadil through the skin of the penis. However, many users experience an uncomfortable sensation, and the potential effects of the gel on female partners are unknown.
  • MUSE is a system to insert alprostadil as a suppository into the urethra of the penis with a plastic applicator. The alprostadil is absorbed into the penis and can cause an erection.

Intracavernous Injections (Injections Into The Penis)

Intracavernous injections are a fast and effective means of restoring an erection. Medications such as alprostadil are injected into the spongy tissue inside the penis. These medications act by releasing chemicals in the penis that cause increased blood flow and accumulation at a high pressure, which makes the penis larger and rigid.

The hardness and duration of the erection produced by these drugs depends on the choice of the drug and the dose. After a few chemically induced erections, many men find they can achieve erection again without the medication. Others may find they only are able to function with the injections, but are pleased to have something that will always work.

The doctor gives the first few injections, but men are taught later how to inject themselves at home. Most describe the discomfort from the injection as mild.

The only significant side effect, which is rare, is an erection that lasts for too long (the medical term for this is priapism). This is a serious condition that requires immediate medical attention. Immediate treatment is to apply ice for about 10 minutes to the inner thighs to help reduce the blood flow. Otherwise it can be successfully treated at the hospital with medication and by draining excess blood from the penis.

Nice To Know:

Injections work best for men with erectile dysfunction due to:

  • Psychological factors, such as the vicious circle of failure
  • Neurological problems, such as diabetes or multiple sclerosis
  • Vascular problems, such as high blood pressure
  • Surgery, such as prostate surgery or colostomy

Vacuum Devices

Mechanical devices are available to stimulate the natural mechanism of erection by creating a vacuum to suck the blood inside the penis, then putting a rubber constriction band around the base of the penis to stop blood from leaking out. Vacuum devices appeal to men who do not want to take oral or injected medicine. However, the erection produced by these devices can be of poor quality and flaccid at the base. In addition, the sensation felt by the man during intercourse and ejaculation can be reduced.


In men with narrowing of the arteries to the legs, the blood supply to the penis may also be affected. Surgery may help. The choice of procedure depends on various factors. A bypass operation, similar to that used in heart surgery, can provide extra blood supply to the penis and restore potency.


In men who are not helped by other treatment options, implants can be placed in the penis. Implants are surgically placed inside the spongy cylinders of the penis. There are two main types:

  • A semi-rigid implant is made of two silicone rubber rods, with a firm shaft and a flexible base. It gives a permanent erection, but the flexible part makes it possible to bend it between the legs when an erection is not needed.
  • An inflatable implant is a more complicated device. Fluid is pumped from a reservoir into two inflatable cylinders that have been surgically inserted in the erectile bodies of the penis. This implant produces an erection similar to a naturally occurring erection with normal sensation and normal appearance. The penis can be made flaccid again by releasing the fluid back to the reservoir. These devices are very reliable, and satisfaction rates exceed 90 percent.

With the advent of newer medications for ED, implants are not as widely used today. But they remain a viable option for men whose erectile dysfunction is a long-term condition (for example, as a complication of prostate surgery).

As with any surgical procedure, infection can be a problem. Sometimes, a low grade infection persists, which causes discomfort, but may respond to antibiotics. Otherwise the implant needs to be replaced, which is quite a complicated procedure, but does have a high success rate.

How To Stay Potent

As with all other medical conditions, prevention is better than cure. To prevent erectile problems, take these steps:

  • Preserve your well-being. Illnesses, along with their drug or surgical treatment, can cause erectile problems.
  • Stick with healthy habits. Avoid smoking, heavy alcohol use, and illegal drugs – they all can affect potency. Get regular light physical exercise, keep your weight under control, and avoid a high-fat diet.
  • Avoid long periods of sexual abstinence. Long periods of sexual inactivity can make it difficult to resume activity again. So despite today’s busy lifestyles, make time for sex in your relationship.
  • Set realistic sexual expectations. Try to concentrate on fun. Spread your sexual feeling over your whole body, not just your penis, and expand your pleasure activities beyond intercourse.
  • Stay aware and educated. Get to know your own and your partner’s bodies. Learn about sex in general. Try to explore and experiment, and ask your partner for feedback.
  • Don’t keep worries to yourself. If you are anxious about your sexual performance, talk with your partner, a close friend, or your doctor.

Impotence: Frequently Asked Questions

Here are some frequently asked questions related to impotence.

Q: Isn’t erectile dysfunction just a normal part of aging?

A: Although sexual response changes with age, erectile dysfunction isn’t normal in men of any age. The truth is that sexuality has no age limit.

Q: Will my insurance cover the cost of medical treatment for erectile dysfunction?

A: Most insurance plans cover consultations, office visits, and treatment. Certain diagnostic tests and certain treatments may not be covered, and plans that cover Viagra may limit the number of tablets per month. The best advice is to check with your individual insurance carrier.

Q: After 15 years of marriage, I’m suddenly experiencing erectile dysfunction. Does this mean I’ve got a deep-seated problem in my relationship with my wife?

A: Although marital problems can contribute to erectile dysfunction, it’s usually due to other factors. Your first step should be to have a complete physical exam to detect any physical causes. Counseling can play an important role in uncovering any psychological causes, which may or may not be related to your marriage.

Q: I’ve heard erectile dysfunction can be helped with a sexual device called a “cock ring.” What is this?

A: A “cock ring” is a stretchable rubber band that fits tightly around the base of an erect penis, to prevent blood from leaving and to prolong an erection. These constrictive bands are similar to the bands used with mechanical suction devices. They can help some men, but it is important not to leave the band in place for more than 30 minutes. “Cock rings” are sold in stores that carry sexual paraphernalia.

Q: My relationship with my wife is solid. Why should I consider counseling as part of my treatment for erectile dysfunction?

A: Counseling isn’t just for individuals whose marriage is shaky. It can be of great help to both partners in understanding the facts and myths surrounding erectile dysfunction and its treatment. In fact, it can bring both of you even closer together.

Impotence: Putting It All Together

Here is a summary of the important facts and information related to impotence.

  • Erectile dysfunction is common and treatable.
  • Treatment should involve a man’s partner as well, since erectile dysfunction can have an impact on both of them and their relationship.
  • Although there is usually a mind-body connection with erectile dysfunction, the majority of cases have a physical cause.
  • Various “triggers” can cause erectile dysfunction; sometimes it is the result of two or more of these triggers working together.
  • A wide variety of treatments are available for erectile dysfunction, including medication, lifestyle changes, counseling, mechanical devices, and surgery.
  • Because prevention is always better than cure, men should maintain healthy habits to help prevent erectile problems.

Impotence: Glossary

Here are definitions of medical terms related to impotence.

Alprostadil: A chemical applied to the penis by gel, urethral suppository, or injection, which increases the flow of blood to the penis and produces erection.

Aphrodisiac: A substance that arouses sexual desire.

Corpus Cavernosum: The two erectile bodies inside the penis; they are spongy tissue made up of smooth muscle and blood vessels.

Digital Rectal Examination: An exam in which a doctor puts a gloved finger inside the rectum to check a man’s prostate gland.

Ejaculation: The release of semen from the penis; also commonly called orgasm or climax.

Erectile dysfunction (impotence): The inability to get an erection that is hard enough for a man to have intercourse or the inability to keep an erection long enough to ejaculate inside the vagina.

Testosterone: The male hormone, secreted by the testicles, that controls the function of the penis and a man’s sex drive.

Uprima: The brand name of a drug called apomorphine, which stimulates centers in the brain to enhance and facilitate erection.

Urethra: The passage that runs from the bladder through the penis, through which urine and semen are passed from the body.

Viagra: The brand name of a drug called sildenafil, which increases blood flow in the penis and creates an erection.

Impotence: Additional Sources Of Information

Here are some reliable sources that can provide more information on impotence.

Impotence World Association provides education and information. For a list of Impotence Anonymous chapters, call 1-800-669-1603, or send a self-addressed, stamped envelope to IWA, P.O. Box 410, bowie, MD 20718-0410 or 

For more information about Viagra, contact the FDA’s Drug Information Branch at 301-827-4573.

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