Text size:

Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for satisfactory sexual function. Erectile dysfunction can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.

A normal erection requires a complicated sequence of events involving psychological stimulus from the brain, adequate levels of the male sex hormone called testosterone, a normal nervous system and healthy blood vessels in the penis chambers. Erectile dysfunction can occur when any of the events is disrupted.

Prevalence of Erectile Dysfunction

The National Institutes of Health (NIH) estimates that erectile dysfunction affects as many as 30 million men in the United States. Incidence increases with age: About 4 percent of men in their 50s and nearly 17 percent of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47 percent for men older than 75. But erectile dysfunction is not an inevitable part of aging and is treatable at any age.

Erectile dysfunction is being called impotence less often so that it will not be confused with other, nonmedical meanings of the term.

Causes of Erectile Dysfunction

Erectile dysfunction usually has a physical cause, such as disease, injury or side effects of medicines. The most common cause of the development of ED is the presence of medical conditions such as high blood pressure, diabetes mellitus, high cholesterol levels and cardiovascular disease. These medical conditions, acting over time, can lead to a hardening of the penile blood vessels, causing restriction of blood inflow through the blood vessels.

Lifestyle behaviors that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. These include smoking, drinking alcohol excessively, being overweight, eating unhealthy and not exercising. Surgery or injury to the penis, spinal cord, prostate, bladder or pelvis can lead to erectile dysfunction. In addition, erectile dysfunction can be a side effect of many common medicines, such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and ulcer drugs.

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure can also cause erectile dysfunction. Even when erectile dysfunction has a physical cause, psychological factors may make the condition worse. Hormonal abnormalities, such as low levels of testosterone, are a less frequent cause of erectile dysfunction, though it is a natural process for the level of circulating testosterone to decrease as a man ages.

When behavior or medication modifications fail to effectively treat erectile dysfunction in selected patients, the first line of treatment in select patients is use of oral medications known as phosphodiesterase-5 inhibitors (PDE-5). For men who fail to respond to oral medications a physician may consider locally injected drugs, vacuum devices, and surgically implanted prosthetic devices. In rare cases, surgery involving veins and/or arteries may be considered.

Testing for Erectile Dysfunction

  • Medical history questionnaire
  • Physical exam
  • Blood tests

Treatment for Erectile Dysfunction

Erectile dysfunction can be treated at any age with a wide variety of methods. Treatment depends on the patient's health and the underlying cause of the problem.

  • Lifestyle and behavior modifications
  • Medication changes
  • Psychological counseling
  • External vacuum erection devices
  • Oral medications for erection (PDE-5 Inhibitors)
  • Oral testosterone
  • Intra-urethral suppositories
  • Intra-cavernosal injections
  • Implant of penile prosthesis
  • Surgery for penile revascularization


Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.

Share