(ED; Impotence; Male Erectile Disorder)
Erectile dysfunction (ED) is trouble getting or keeping an erection of the penis. The penis is not firm enough to have sex.
An erection happens when blood fills the penis. Some blood vessels open wide to let blood flow into the penis. Other blood vessels shrink to keep the blood from leaving the penis. The change in the blood vessels is controlled by nerves.
ED may be caused by:
- Blood vessel injury or disease
- Harm to nerves that control blood vessels or feeling in the penis
- Stress that change how the nerves work—more likely with sudden ED
- Hormone problems such as low testosterone or thyroid disease
- Certain medicines such as those that treat high blood pressure, mental health problems, or heart rhythm problems
- Problems in the penis caused by Peyronie disease, hypospadias, or penile fracture
ED is more common in those aged 40 years and older. The risk increases with age. Things that increase the risk of ED are:
- Heart disease risk factors, such as:
- Peripheral neuropathy
- Prostate problems
- Surgery on related nerves, spinal cord, blood vessels, or prostate
- Too much alcohol
- Use of illegal drugs
- Certain medicines
The main symptom of ED is not being able to get or keep an erection long enough to have sex.
The doctor will ask about symptoms and health past. A physical exam will be done. This will include a genital and rectal exam.
The doctor will ask about the quality of erections. This may include questions about the time of day, how hard the erection is, and how long it lasts. The doctor may also ask about the person's mental state, desire, arousal, ejaculation, and orgasms. The answers can help point to the source of the problem.
A test can be done at home to check for erections during sleep. Erections during sleep may mean the cause is psychological. Problems with an erection during sleep points to a physical cause.
Other tests may include:
- Blood tests—to check for health problems such as diabetes, high cholesterol, or low testosterone
- Doppler ultrasound—to check blood flow in the penis
ED care may involve one or more of these:
To help lower the risk of ED:
- Follow any care plans to treat high blood pressure, diabetes, or depression.
- Keep your weight in a healthy range.
Some changes in daily habits can improve tissue health and blood flow. General steps are:
- Weight loss, if needed. This can also help balance hormones
- Quit smoking
- Regular physical activity
- Limit alcohol to 2 drinks or less a day
- Stop illegal drug use
- Relaxation habits and stress management
- Erectile dysfunction. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/erectile-dysfunction.
- Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction.
- Erectile dysfunction. Urology Care Foundation website. Available at:https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed).
- Najari BB, Kashanian JA. Erectile dysfunction. JAMA. 2016;316(17):1838.
- April Scott, NP
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