Overview

Erectile dysfunction means not being able to get and keep an erection firm enough for sexual activity. It also is called impotence.

Having erection trouble from time to time isn't always a cause for concern. But if erectile dysfunction is ongoing, it can cause stress, affect self-confidence and add to challenges with a partner. Problems getting or keeping an erection can be a sign of a health condition that needs treatment and a risk factor for heart disease.

If you're worried about erectile dysfunction, talk to your healthcare professional, even if it's awkward. Sometimes, treating an underlying condition can fix erectile dysfunction. Or you might need medicines or other direct treatments.

Symptoms

Having trouble getting an erection once in a while is common. Erectile dysfunction symptoms are ongoing and often get worse over time. They might include:

  • Trouble getting an erection.
  • Trouble keeping an erection.
  • Wanting sex less.

When to see a doctor

Your main healthcare professional is a good place to start when you have erectile issues. See your healthcare professional if:

  • You worry about your erections or you have other sexual problems, such as ejaculating sooner than you want. This is called premature ejaculation. Ejaculating later than you want is called delayed ejaculation.
  • You have diabetes, heart disease or another health condition that might be linked to erectile dysfunction.
  • You have other symptoms with erectile dysfunction.

Causes

Male sexual arousal is complex. It involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Also, stress and mental health concerns can cause erectile dysfunction or make it worse.

Sometimes the cause of erectile dysfunction is both physical and mental. For instance, a minor physical condition that slows your sexual response might cause worry about keeping an erection. The anxiety can add to erectile dysfunction.

Physical causes of erectile dysfunction

Common physical causes of erectile dysfunction include:

  • Heart disease.
  • Clogged blood vessels, also called atherosclerosis.
  • High cholesterol.
  • High blood pressure.
  • Diabetes.
  • Obesity.
  • Metabolic syndrome, which involves higher blood pressure, high insulin levels, body fat around the waist and high cholesterol.
  • Parkinson's disease.
  • Multiple sclerosis.
  • Certain prescription medicines
  • Tobacco use.
  • Peyronie's disease, which can cause pain during sex, a bent penis to bend, a penis that gets shorter with erection or a lump or bump in the penis.
  • Overuse of alcohol and use of illicit drugs.
  • Sleep conditions.
  • Treatments for prostate cancer or enlarged prostate.
  • Surgeries or injuries that affect the pelvic area or spinal cord.
  • Low levels of the hormone testosterone.

Mental health causes of erectile dysfunction

The brain plays a key role in getting sexually excited, which starts an erection. Things that can get in the way of sexual feelings and cause or add to erectile dysfunction include:

  • Depression, anxiety or other mental health conditions.
  • Stress.
  • Issues with a partner.

Risk factors

As you get older, erections might take longer to start and might not be as firm. You might need more direct touch to your penis to get and keep an erection. But erectile dysfunction is not a typical part of aging.

Risk factors that can add to erectile dysfunction include:

  • Medical conditions. Diabetes or heart conditions are big risk factors.
  • Tobacco use. This lowers blood flow to veins and arteries. Over time, tobacco use can cause ongoing health conditions that lead to erectile dysfunction.
  • Being overweight. Being obese, especially, can lead to erectile dysfunction.
  • Certain medical treatments. These include prostate surgery or radiation treatment for cancer.
  • Injuries. This is especially true if injuries damage the nerves or arteries that control erections.
  • Medicines. These include antidepressants, antihistamines, and medicines to treat high blood pressure, pain or prostate conditions.
  • Mental health conditions. These include stress, anxiety and depression.
  • Illicit drug and alcohol use. This is especially true for long-term drug use or heavy drinking.

Complications

Complications from erectile dysfunction can include:

  • A poor sex life.
  • Depression, stress or anxiety.
  • Embarrassment or low self-esteem.
  • Relationship issues.
  • Not being able to get your partner pregnant.

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any health conditions. For instance:

  • Work with your healthcare professional to manage diabetes, heart disease or other ongoing health conditions.
  • Get regular checkups and medical screening tests.
  • Stop smoking, limit or don't drink alcohol, and don't use illicit drugs.
  • Exercise regularly.
  • Find ways to ease stress.
  • Get help for anxiety, depression or other mental health issues.
By Mayo Clinic Staff