Erectile Dysfunction

When did you first notice symptoms of erectile dysfunction?

How to Identify Safe Supplements

A healthcare provider can diagnose ED and determine its cause. They’ll review your medical history and perform a physical exam. They’ll also ask you questions about your personal and sexual history. These questions may make you feel embarrassed or awkward. But it’s important to be honest with the provider in order to quickly determine the cause. What exactly happened sex tablet for women when you first had erectile dysfunction symptoms? Do or did you experience erections at night or during the morning? What sexual positions do you regularly engage in? The provider may also ask to talk with your sexual partner. Your partner may be able to offer additional insight on potential causes. The provider may order tests to confirm their diagnosis and determine the cause of your ED. It depends on what your healthcare provider suspects is causing erectile dysfunction. Tests that measure if the nerves in your penis respond to vibrations (penile biothesiometry).

• History of ED treatments: From early aphrodisiacs to modern pharmacological advances.
• The role of nitric oxide: A key signaling molecule that relaxes penile smooth muscle.
• Phosphodiesterase type 5 (PDE5): The enzyme targeted by sildenafil and similar drugs.
• How vacuum pumps work: Creating a vacuum to pull blood into the penis, then using a ring.
• Types of penile implants: Include malleable (bendable) and inflatable (hydraulic) devices.
• The placebo effect in ED: Psychological factors can significantly influence treatment outcomes.
• The link between ED and heart disease: ED can be an early warning sign of cardiovascular issues.
• The impact of antidepressants: Many SSRIs can cause or worsen erectile dysfunction.
• The impact of blood pressure medications: Some antihypertensives can contribute to ED.
• Hormonal causes of ED: Including low testosterone, high prolactin, or thyroid issues.

Drugs that temporarily make your penis erect (vasoactive injection). Before testing, your provider will explain what’s involved with a test and answer any questions you have. If you don’t feel comfortable, you can decide not to do the test at any time.

The first step in treating erectile dysfunction is identifying the underlying cause. A healthcare provider will help determine the best treatment for you. Vigorous cardiovascular exercise for at least 45 minutes three times per week may help reverse some cases of mild ED. Cardiovascular exercises may include brisk walking, jogging, swimming, bicycling and jumping rope. For men with mild ED, quitting smoking can lead to improvement after several months. Oral medications that help increase blood flow to your penis, including sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) or avanafil (Stendra®). Oral medications start to work within an hour. Penile low-intensity focused shockwave therapy (LiSWT).

This noninvasive treatment improves blood flow by using sound waves.

It can take two months to see improvement. Medications you inject directly into your penis to create an erection, including alprostadil (Caverject®), papaverine (Papacon®), phentolamine (Regitine®) or a combination of multiple medications.

The bottom line

Only sometimes being able to get an erection before sexual intercourse. Being able to get an erection before sexual intercourse but not being able to maintain it during sexual intercourse. Requiring a lot of stimulation to maintain an erection. There are many possible causes of ED, including conditions that affect your: Your circulatory system includes the blood vessels that carry blood throughout your body. Your penis needs adequate blood flow to become erect and maintain an erection.

By Mode of Administration

Your penis also relies on a series of valves to close when it fills with blood — in some cases, these valves stop working as they should. Your nervous system includes your brain, spinal cord and nerves. They work together to send electrical impulses that help your body move and feel, including your penis. Your endocrine system includes the glands that create and release hormones. Hormones help tell your body to perform certain functions. Injectable medications start to work within 10 minutes. Penis pumps start to work almost immediately. Testosterone replacement therapy, which is available as a gel, injection, patches and pellets.

• Acetaminophen: Pain reliever and fever reducer, with minimal anti-inflammatory effects.
• Ibuprofen: Nonsteroidal anti-inflammatory drug (NSAID) used for pain, fever, and inflammation.
• Naproxen: NSAID effective for chronic pain and inflammatory conditions.
• Aspirin: Anti-inflammatory, analgesic, and antiplatelet agent.
• Diclofenac: NSAID used for arthritis and acute pain management.
• Celecoxib: COX-2 inhibitor for arthritis with less gastrointestinal risk.
• Indomethacin: NSAID used for gout and inflammatory conditions.
• Meloxicam: NSAID with selective COX-2 activity for arthritis.
• Ketorolac: Potent NSAID used short-term for moderate to severe pain.
• Piroxicam: Long-acting NSAID for arthritis and musculoskeletal conditions.
• Etodolac: NSAID used for osteoarthritis and rheumatoid arthritis.

Testosterone replacement therapy starts to work within four weeks.

In case of emergency/overdose

Are you currently taking any medications, including prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements and nonmedical drugs? Has a healthcare provider ever diagnosed you with depression or anxiety? How often are you able to get erections? How long are you able to maintain an erection? Do you lose your erection because you ejaculate sooner than you would like? A penile implant is a procedure in which a surgeon places a device into your penis to make it hard. The device doesn’t affect sensation, peeing or orgasm. ED will not likely go away on its own without changes to your lifestyle or some kind of treatment.

Alternative medicine

It’s important to talk to a healthcare provider if you have problems getting and maintaining an erection. Healthcare providers separate ED into several categories: Vascular ED includes causes that affect the blood vessels that send blood to the tissues in your penis that allow you to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED. Neurogenic ED occurs as a result of nerve problems, which prevent signals from traveling from your brain to your penis to create an erection. This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis and multiple sclerosis (MS).

Jet lag research

Hormonal ED refers to ED that happens as a result of testosterone deficiency, or in some cases as a result of thyroid issues. Psychogenic ED involves psychological conditions (conditions that affect your thoughts, feelings or behavior) that can cause ED. Erectile dysfunction is the most common sex-related condition that males report to healthcare providers, especially as they age and develop other health issues. Providers and medical researchers estimate that erectile dysfunction affects over 50% of males between the ages of 40 and 70. And those numbers may be higher — many don’t seek help for the condition due to embarrassment or shame. The outlook for ED is good and it’s a very treatable condition.

Treatment of Erectile Dysfunction

Testosterone may help open up (vasodilate) your blood vessels, which helps blood flow to your penis. Injuries (trauma) to your penis and surrounding areas can also cause ED. Injuries to your pelvis bones (hip bones, sacrum and tailbone), bladder, prostate and spinal cord. Pelvic surgery, including prostate, colon or bladder cancer surgery. Erectile dysfunction is a common side effect of many prescription drugs.

Altitude sickness

Common medications that list ED as a potential side effect include: Substances that have addiction potential may cause ED, including: These substances can affect and suppress your central nervous system. They can also cause severe damage to your blood vessels, which may lead to permanent erectile dysfunction. Fear of sexual intercourse or intimacy (genophobia). Conditions that affect your body’s ability to deliver blood to your penis are the most common cause of ED. You may have a greater risk of getting ED if you: Have a body mass index (BMI) over 25. Though there aren’t cures for some causes of ED, many treatment options can help you get and maintain an erection hard enough for sexual intercourse. Certain lifestyle changes can help lower your risk of developing erectile dysfunction, including: Being more physically active, especially doing cardiovascular exercises like running, jogging or bicycling. Eating healthy foods with low saturated fats, such as fruits, vegetables and whole grains.

What Treatments Might Not Work for Erectile Dysfunction?

Erectile dysfunction (ED) is a type of penile disorder. It affects your ability to get and maintain an erection firm enough for sexual intercourse. Your feelings play a major role in getting and maintaining an erection. Feeling relaxed, confident and aroused is essential. But it’s normal to sometimes have erection issues.

Recreational use

Erection problems can occur if you feel nervous, anxious, frustrated or tired. Drinking alcohol and/or using substances can also have an effect. It can also result from other conditions or as a side effect of certain medications or cancer treatments. If you’re having difficulty getting or maintaining an erection, it’s a good idea to schedule an appointment with a healthcare provider for further discussion. In many cases, ED can be the first symptom of another underlying problem, including heart disease. Talk to a primary care physician or a urologist if you suspect you have erectile dysfunction. They can help diagnose ED, identify its cause and recommend the best treatment option for you. A urologist is a healthcare provider who specializes in diagnosing and treating conditions that affect your reproductive system and urinary system. Go to your nearest emergency room if you’re taking medication for erectile dysfunction and have a painful erection that lasts longer than two to four hours. This may be a sign of priapism, which can cause permanent damage to your penis without treatment. Is it normal to have erectile dysfunction? How do you know I have erectile dysfunction?

• Sildenafil dosage: Typically 25mg, 50mg, or 100mg taken about one hour before sex.
• Tadalafil dosage: 10mg or 20mg on-demand, or 2.5mg/5mg daily.
• Vardenafil dosage: Typically 5mg, 10mg, or 20mg taken about 60 minutes before sex.
• Avanafil dosage: Typically 50mg, 100mg, or 200mg taken about 15-30 minutes before sex.
• Alprostadil injection dosage: Typically starts at 2.5 mcg, titrated upward.
• Alprostadil suppository dosage: Typically 125 mcg, 250 mcg, 500 mcg, or 1000 mcg.
• Testosterone gel dosage: Typically 1-2 pumps or packets applied daily.
• Testosterone injection frequency: Typically every 1-2 weeks for cypionate/enanthate.
• Yohimbine dosage: Typically 5.4mg three times a day, but not standardized.
• Compounded TriMix dosage: Highly variable and customized by a compounding pharmacist.

What ED treatment option do you recommend? Can erectile dysfunction cause other conditions that affect my sexual health?

What special precautions should I follow?

Read 5 natural ways to overcome erectile dysfunction. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Erectile dysfunction (ED) is the inability to get or maintain an erection long enough to have sexual intercourse.

Bottom line

There are many different causes, which may include conditions that affect your blood vessels, neurological conditions, mental health conditions and injuries. A healthcare provider can diagnose and treat erectile dysfunction. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Can you recommend a support group for people who have erectile dysfunction? Am I a candidate for a penile implant procedure? Erectile dysfunction can cause you to feel many different emotions. You may feel embarrassed, frustrated, guilty, ashamed, angry or “less than.” This can lead to more serious long-term emotions, like anxiety and depression.

But you don’t have to live with these feelings. ED is common, and it doesn’t reflect your worth as a person. Erectile dysfunction is a sensitive topic for many people.