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Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.
Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.
If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.
Erectile dysfunction symptoms might include persistent:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.
Tests for underlying conditions might include:
- Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
- Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
- Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
- Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (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 depression and other possible psychological causes of erectile dysfunction.
The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.
Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.
Oral medications are a successful erectile dysfunction treatment for many men. They include:
Tadalafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). In combination with sexual stimulation, tadalafil works by increasing blood flow to the penis to help a man get and keep an erection.
Tadalafil is also used to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia-BPH). It helps to relieve symptoms of BPH such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently (including during the middle of the night). Tadalafil is thought to work by relaxing the smooth muscle in the prostate and bladder.
Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily.
If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Sildenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV).
All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.
Cialis vs. Viagra quick comparison
- Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED).
- Adcirca is another brand name of tadalafil.
- Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.
- One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about 4 to 6.
What are Cialis and Viagra?
Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors that also includes vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra).
Penile erection is caused by the engorgement of the penis with blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis. Cialis and Viagra inhibit an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, Cialis and Viagra prevent the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.
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 normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.
The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.
Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.
Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:
- Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil, Bidil)
- Have heart disease or heart failure
- Have very low blood pressure (hypotension)
Other medications for erectile dysfunction include:
- Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
- Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You 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 a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
- Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
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 (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used 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. You then remove the vacuum device.The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
- Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.
Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.
Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.
Discuss an exercise plan with your doctor.
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
Before using any supplement, check with your doctor to make sure it’s safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.
The Food and Drug Administration (FDA) has issued warnings about several types of “herbal viagra” because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.
Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.
What is erectile dysfunction (ED)?
Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often.
Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.
What causes an erection?
ED can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a man is sexually excited, muscles in the penis relax. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid.
An erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:
- cardiovascular disease
- hypertension, or high blood pressure
- high cholesterol
- low testosterone levels or other hormone imbalances
- kidney disease
- increased age
- relationship problems
- certain prescription medications, such as those used to treat high blood pressure or depression
- sleep disorders
- drug use
- consuming too much alcohol
- using tobacco products
- certain health conditions, such as Parkinson’s disease or multiple sclerosis (MS)
- damage to the pelvic area through injury or surgery
- Peyronie’s disease, which causes scar tissue to develop in the penis
ED can be caused by only one of these factors or by several of them. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.
Erectile dysfunction treatment
Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.
Find Roman ED medication online.
Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:
- avanafil (Stendra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis.
Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.
Medications used for other conditions may cause ED. Talk to your doctor about your medications and whether they could be causing your symptoms. There may be others that you can take instead. Never stop taking medications without first talking to your doctor.
Medications for ED can cause side effects. If you’re experiencing unpleasant side effects, talk to your doctor. They may be able to recommend a different medication. Get more information on the medications used to treat ED.
A number of psychological factors can cause ED, including:
- post-traumatic stress disorder (PTSD)
If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:
- major stress or anxiety factors
- your feelings around sex
- subconscious conflicts that could be affecting your sexual well-being
If ED is affecting your relationship, consider speaking with a relationship counselor as well. Relationship counseling can help you and you partner reconnect emotionally, which may also help your ED. Explore the effects of stress and anxiety on ED.
This treatment uses the creation of a vacuum to stimulate an erection. Blood is drawn into the penis as the device is used, leading to an erection.
A vacuum pump device consists of a few different components:
- a plastic tube, which you place over your penis
- a pump, which works to create the vacuum by drawing air out of the plastic tube
- an elastic ring, which you’ll move to the base of your penis as you remove the plastic tube
The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. It can be left in place for 30 minutes. Read more about vacuum pumps and how to use them.
Erectile dysfunction symptoms
You may have ED if you regularly have:
- trouble getting an erection
- difficulty maintaining an erection during sexual activities
- reduced interest in sex
Other sexual disorders related to ED include:
- premature ejaculation
- delayed ejaculation
- anorgasmia, or the inability to achieve orgasm after ample stimulation
Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment.
Erectile dysfunction tests
Testing for ED can involve a variety of steps, including a physical examination and taking your health and sexual history. Additional tests may be performed to determine if your symptoms are caused by an underlying condition.
You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate.
Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED.
Some questions that you may be asked include:
- How long have you been experiencing ED? Did it come on suddenly or gradually?
- Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
- How often do you have sex? Has this frequency changed recently?
- How firm are your erections? Is this affected by particular situations or types of stimulation?
- Do you wake up in the morning or in the middle of the night with erections?
- How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
- Have you recently been experiencing a lot of stress?
- What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
- Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?
Your doctor may perform additional testing to help diagnose your ED. Tests can include:
- Ultrasound. An ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
- Nocturnal penile tumescence (NPT) test. A portable, battery-powered device, worn on the thigh, is used to evaluate the quality of your nocturnal erections. Data is stored in the device, which your doctor can access later.
- Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts.
- Urine tests. Urine tests can be used to check for diabetes or other underlying health conditions.
- Blood tests. Blood tests can be used to check for conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone.
These tests can help your doctor guide your treatment as well as determine if an underlying condition may be causing your ED. Find out more about how blood tests can be used to diagnose ED.
Erectile dysfunction exercises
Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:
- Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
- Now that you know where these muscles are, contract them for 3 seconds. Then release them.
- Repeat this exercise 10 to 20 times in a row, three times a day.
A small 2005 study compared two groups of men with ED. The first group of men performed regular pelvic floor muscle exercises with a physiotherapist. They also received biofeedback and advice on lifestyle changes. The second group only received advice on lifestyle changes.
Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscles exercises. Men in the second group saw little improvement after 3 months.
For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total had elapsed, 40 percent of all participants (including some men who had belonged to the second group) had regained normal erectile function.
A 2019 literature review also concluded that pelvic floor exercises were effective at treating both ED and premature ejaculation. However, the ideal exercise plan (in terms of conditions such as frequency and intensity) wasn’t identified.
You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.
Moderate to vigorous exercise is not only good for your overall health, but also can increase blood flow, possibly helping with ED. Examples include running and swimming.
A review of 10 studies examined the effect of aerobic exercise on ED. From their review, investigators concluded that 160 minutes of weekly exercise for 6 months could lead to a decrease in erectile problems.
Another study examined physical fitness and testosterone levels in 87 men with ED. Researchers found that testosterone levels were negatively correlated with levels of body fat and abdominal fat. This suggests that exercise may increase testosterone in addition to reducing body fat.
Before you start a new exercise plan, you should always discuss it with your doctor. This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity. Learn more about exercise and ED.
Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to ED, practicing yoga may be an effective way to ease ED symptoms.
In fact, a 2010 study of 65 men between 24 and 60 years old found that sexual function increased significantly after a 12-week program of yoga sessions. Discover five yoga poses that could help with ED.
Erectile dysfunction foods
ED is often related to problems with blood flow. Maintaining your blood vessel health may be beneficial in both preventing and treating ED. This can be achieved through making certain lifestyle choices, such as eating a healthy diet.
Take these simple steps to help reduce your risk of developing ED:
- Focus on eating whole grains, vegetables, and fruits.
- Limit your consumption of red meats, full-fat dairy, and processed sugars.
- Drink alcohol in moderation.
Several specific foods, from cocoa to watermelon, may help with ED. Find out what other foods you may want to add to your grocery cart.
For some men, natural remedies may help treat ED.
Herbs and supplements
Certain herbs and supplements have been shown to treat ED, with varying degrees of success, including:
- Asparagus racemosus
- dehydroepiandrosterone (DHEA)
- ginseng, such as Korean red ginseng
Horny goat weed and zinc may help as well.
Speak with your doctor before buying herbs and supplements, and proceed with caution. Many aren’t regulated, which means they might contain additional ingredients not listed on their labels.
Additionally, some supplements, such as yohimbe, are associated with potentially dangerous side effects.
Your doctor may be able to recommend reputable brands as well. Avoid purchasing products online, unless your doctor confirms that they’re safe. Get more expert advice on herbs for ED.
Acupuncture is a type of traditional Chinese medicine in which needles are inserted into the skin at specific locations, or acupoints. Acupuncture is believed to work through nerve stimulation, which then has an effect on the release of neurotransmitters.
It’s unclear how acupuncture works to treat ED. Studies on its efficacy are limited, and the ones that do exist are often inconclusive. Some evidence from a 2019 review indicates that acupuncture may help to treat psychological ED.
When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows Food and Drug Administration (FDA) guidelines for needle disposal and sterilization. Learn more about the use of acupuncture in treating ED.
Prostatic massage, a form of massage therapy, may be used for ED. Prostatic massage is often used in combination with other treatments.
During prostatic massage, a practitioner will massage the tissues in and around the groin to promote blood flow to your penis. You may need to undergo a massage several times a week. The length of massage treatment depends on your symptoms.
So far, there have only been limited studies on prostatic massage and its effectiveness. Get tips on finding a practitioner, and more, with the help of this short guide.
The bottom line
Multiple options exist for people looking for natural ways to treat their ED. Try one of the options above or even a combination of them. Remedies like acupuncture and massage can even be paired with Viagra and other traditional medications. Find out more about the effect of lifestyle changes on ED.
In cases where medications aren’t effective, your doctor may recommend surgical treatment. There are two types of procedures that may be used: implants and vascular surgery.
A penile implant, also referred to as a prosthesis, can be placed in the penis. There are two different types. An inflatable implant allows you to use a pump to make your penis larger, while a malleable implant allows you to adjust the position of your penis manually.
Vascular surgery repairs arteries that may be blocked. This can help to restore adequate blood flow to the penis. Younger men are typically better candidates for this type of procedure.
Every surgery has its benefits and drawbacks. Be sure to discuss these with your doctor if you decide to undergo surgery for ED. Check out this guide to penile implants, learn how they’re placed, and discover what recovery is like.
Erectile dysfunction and diabetes
ED and diabetes can occur together. In fact, the risk of developing ED is approximately 50 percentTrusted Source in men who have diabetes. But why is this?
Diabetes affects how your body processes glucose. When glucose isn’t stored correctly, excess glucose can be found in your blood, leading to high blood sugar. There are two major types of diabetes: type 1 diabetes and type 2 diabetes.
Having high amounts of sugar in your blood can lead to damage of the blood vessels and nerves. This damage can also affect the blood vessels and nerves located around the penis, leading to difficulties attaining or maintaining an erection.
If you have diabetes, it’s important that you work with your doctor to keep your blood sugar under control. This can help to prevent damage that can lead to ED. Explore the connection between ED and type 2 diabetes.
There are many risk factors that may increase your likelihood of developing ED. These risk factors are often related to blood flow and circulation. Other risk factors can include injuries.
One important risk factor for ED is increasing age. As you get older, you may find that it’s more difficult to get or maintain an erection. You may also notice that you may require more direct stimulation to get an erection.
Additional risk factors for ED include:
- having a medical condition such as cardiovascular disease or diabetes
- having a psychological condition such as anxiety or depression
- having overweight, particularly obesity
- sustaining an injury to or having surgery on your pelvic area
- taking certain medications, such as antidepressants or blood pressure medications
- undergoing specific medical treatment, such radiation therapy for cancer
- using tobacco products, drugs, or alcohol
Around 30 million U.S. men have ED. The prevalence of ED increases with age. It’s estimated that mild or moderate ED affects 10 percent more men each decade of life (60 percent of men in their sixties, for example). However, ED can also occur among younger men.
One study found that 1 in 4 men seeking their first treatment for ED were under 40 years old. A stronger correlation between smoking, drug use, and ED was observed in these men when compared with older men. This suggests that lifestyle choices are an important factor for ED in younger men.
Although the risk of ED increases with age, ED isn’t inevitable. In general, the healthier you are, the better your sexual function. Learn more about aging and ED.
In many cases, you can improve your ED symptoms. Many medications and treatments are available. Certain devices, such as vacuum pumps, can also help you temporarily manage your symptoms so that you can continue to engage in sexual intercourse.
Your treatment plan will depend on a variety of factors, including the severity of your ED and whether it’s caused by a specific health condition. Your doctor will work closely with you to explain the benefits and risks associated with each type of treatment.
It’s important to remember that ED is a common condition. If you’re experiencing symptoms of ED, you should discuss them with your doctor as soon as possible. That way, they can rule out underlying causes and begin a treatment plan.
There are several steps you can take to help prevent ED. Many of these steps involve making healthy lifestyle changes. Therefore, they’re not only good for preventing ED, but also for improving your overall health.
Follow the advice below to help prevent ED:
- Keep medical conditions such as heart disease and diabetes under control.
- Make sure that you get regular exercise.
- Maintain a healthy weight.
- Focus on eating a healthy diet.
- Find ways to reduce or manage stress.
- Seek help if you’re experiencing anxiety or depression.
- Quit smoking.
- Only use alcohol in moderation.
- Avoid using drugs that haven’t been recommended by your doctor.
You should also be sure to keep up with your regular checkups. Your doctor will monitor important clinical measurements, such as your blood pressure and cholesterol levels. This can help with early identification and treatment of conditions that can potentially lead to ED. Find out more ways to prevent ED.