Erectile Dysfunction: Symptoms, Causes and Treatments and FAQs

What is an Erection, and How Does it Happen?

The penis is usually flaccid at rest, meaning it is soft and hangs loosely. However, during an erection, it temporarily becomes stiff and straight and increases in size due to the increased blood supply to the penis. Sexual arousal is the most common reason for an erection. It can occur through stimulation such as watching, reading, or fantasizing about something sexual. It also happens when you touch yourself or engage in sexual activity with a partner. It is also normal to experience erections in the morning after waking up or randomly during the day without any sexual stimulation. Fluctuations in testosterone levels can cause random erections.

The penis comprises two chambers, the corpora cavernosa, which contain a maze of blood vessels shaped like a sponge. It is surrounded by a membrane called the tunica albuginea. When you are aroused, the brain sends nerve messages to the penis, causing the corpora cavernosa muscles to relax and allowing blood flow in the blood vessels. The increased blood flow causes the penis to become firm, erect, and larger, thus creating an erection. The tunica albuginea membrane traps the blood in the corpora cavernosa to sustain the erection. The primary purpose of an erection is to help you have penetrative sex. It is normal to experience up to 11 erections in a day and 3-5 at night, but there is no set figure for it.  

What is Erectile Dysfunction (ED)?

If you are facing difficulty getting and keeping an erection firm enough for sexual intercourse, you are probably experiencing erectile dysfunction. Also referred to as ED or impotence, it is one of the most common sexual problems in men. It is normal to have erection difficulties occasionally due to stress, lifestyle or diet changes. But, if it has been happening for a long time, it is concerning, and you should seek help. Erectile dysfunction is often a symptom of an underlying health condition or emotional troubles that need immediate attention. Receiving a diagnosis and treatment for it can help resolve your erectile dysfunction.

Many people feel embarrassed to consult a doctor for erectile dysfunction. But, delaying treatment can directly impact your quality of life. It can cause an unsatisfactory sexual life, leading to a strained relationship with your partner. Over time, you can feel embarrassed, stressed, anxious, depressed, and lose your self-esteem and confidence. If you and your partner are planning a baby, erectile dysfunction can make it challenging to achieve a pregnancy. This situation can take a toll on the mental well-being of both partners. The good news is that the majority of ED cases are treatable. So, if you suffer from ED, it is best to take professional help and prevent the condition from worsening.

Also Read: Temporary Erectile Dysfunction: Treatment, Causes, and Diagnosis

What is the Difference Between Premature Ejaculation (PE) and Erectile Dysfunction (ED)?

Premature ejaculation, or PE, is another common sexual health problem in men. It is also known as rapid ejaculating, premature climaxing, or early ejaculating. During penetrative intercourse, when a man ejaculates sooner than desired, it is called premature ejaculation. In comparison, erectile dysfunction is a problem with getting or maintaining an erection hard enough for sex. Although erectile dysfunction and premature ejaculation are different disorders, they often occur together.

What are the Symptoms of Erectile Dysfunction?

Erectile dysfunction is usually self-diagnosable. Although this condition develops over time, it is possible to experience sudden ED. You are probably having erectile dysfunction if:

• You have difficulty getting an erection: It is one of the first warning signs of erectile dysfunction. You will notice you cannot start an erection as quickly as before. It may also take more stimulation and time to get the penis firm enough for penetrative sex.
• You have trouble maintaining the erection: Apart from difficulty getting an erection, finding it hard to keep it as long as your past erections are also a significant sign of erectile dysfunction. You may lose your erection in the middle of having sex.
• You do not desire sex as much as you used to: Testosterone is the primary sex hormone in males that regulates sex drive, also known as libido. A lack of it can affect your urge to have sex, and as a result, getting erections will be more challenging too. Secondly, if you suffer from erection problems, you may avoid sex due to the associated guilt and embarrassment.
• You have not had early morning erections in a while: The testosterone levels are the highest in the morning, causing morning erections in men without physical stimulation. Morning erections signify that the blood vessels carrying the blood to the penis are healthy. But if your morning erections have drastically reduced, it is an early sign of erectile dysfunction.
• You have lost sensitivity in the penis: The penis contains various nerve endings sensitive to touch. But if stimulation is not helping the penis get erect quickly, your penis sensitivity may have reduced. Although this symptom is mainly related to ageing, other factors such as low testosterone levels, health conditions, or injuries can lead to penis numbness earlier.

What are the Causes of Erectile Dysfunction?

Various factors play a role in male sexual arousal: the nervous system (brain and nerves), hormones (testosterone), blood vessels, muscles, and emotions. If there are problems with any of these elements, it can contribute to erectile dysfunction.

Physical Causes of Erectile Dysfunction:

• Vascular Diseases: These diseases affect the blood vessels in the body. The most common ones include heart disease, high cholesterol, high blood pressure, and atherosclerosis (clogged blood vessels). They restrict the blood flow to the penis, thus making it difficult to achieve an erection.
• Neurological Diseases: The nervous system, including the brain, spinal cord, and nerves, plays a vital role in starting an erection. During arousal, the nerves in your brain and pelvic region send impulses to the penis. It causes the blood vessels in the penis to expand, thus increasing the blood flow and causing an erection. Neurological conditions such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, stroke, epilepsy, spinal cord injuries, and treatment for prostate or bladder cancer can damage the nervous system. They can interrupt this process and make it difficult for you to get or sustain an erection.
• Diabetes: Poor blood sugar control can damage the nerves and blood vessels and reduce the blood supply to the penis, making it hard to get an erection.
• Chronic Kidney Disease: Kidney disease narrows the blood vessels in the body, including the ones leading up to the penis. It also causes hormonal changes, nerve damage, and poor circulation. All of this combined makes it difficult to get an erection.
• Metabolic Syndrome: This condition involves increased blood pressure, high insulin levels, central body fat and high cholesterol, all leading to ED.
• Liver Cirrhosis: It is advanced liver damage that causes low testosterone levels, decreased libido, infertility, and testicular atrophy—all contributing to problems with erection.
• Hormonal Imbalances: Testosterone is responsible for sex drive, size of testicles, erection, and production of sperm. Low testosterone levels in the body can impact all of these functions, including getting proper erections.
• Thyroid Conditions: Thyroid problems, including hypothyroidism and hyperthyroidism, can create hormonal imbalances, causing difficulty in getting and keeping an erection.
• Peyronie's Disease: Repeated injury to the penis during physical activity or sex can cause Peyronie's disease, wherein fibrous scar tissue develops on the penis and causes curved, painful erections.
• Sleep Disorders: Sleep apnea and insomnia can cause sleep deprivation. Lack of quality sleep can cause hormonal (testosterone) imbalances, low oxygen, stress, and fatigue in the body. Thus, there is a direct correlation between sleep and ED.
• Penile Fracture: Penile fracture can happen due to forceful bending of the penis during intercourse, a sharp blow to the erect penis during a fall, a car accident, other mishaps, and traumatic masturbation. Erectile dysfunction is one of the most common complications of penile fracture.
• Medications: Erectile dysfunction is a common side-effect of over 200 types of prescription drugs. These drugs can impact the hormones, nerves and blood circulation, eventually causing ED. Some of these common medications include:
• Diuretics (drugs that help the body release more sodium and water)
• Antihypertensives (drugs used to treat blood pressure)
• Antihistamines (drugs used to treat common allergies such as allergic rhinitis, common cold, and influenza)
• Antidepressants (drugs used to treat depression, anxiety, chronic pain conditions and addictions)
• Parkinson's disease drugs
• Antiarrhythmics (drugs used to treat irregular heart rhythm)
• Tranquillisers (sedative drugs used to treat severe anxiety or insomnia)
• Muscle relaxants (drugs used to treat back, neck, and other musculoskeletal pain)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (drugs used to treat pain conditions, inflammation, and high temperature)
• Histamine H2-receptor antagonists (drugs used to treat and prevent duodenal ulcers, gastric ulcers and Zollinger-Ellison disease)
• Hormone therapy
• Chemotherapy medications (drugs used to treat cancer)
• Prostate cancer drugs
• Anti-seizure medications
• Medical Treatments: Treatments for prostate cancer or enlarged prostate, radiation therapy to the pelvic region, surgeries or injuries affecting the pelvic area or spinal cord may contribute to erectile dysfunction.

Psychological Causes of Erectile Dysfunction:

• Anxiety: Although anxiety is a mental health condition, it also has physical effects on the body. It can cause fatigue, increased heart rate, high blood pressure, and hormonal imbalances. It can affect your sexual performance, including low sex drive and ED.
• Depression: When you are depressed, there is a chemical imbalance in your brain. Thus, the brain's efficiency in sending signals to increase the blood flow in the penis for erection reduces. You also don't desire sex or feel easily aroused during sexual activity. Thus, depression affects your sexual ability and performance.
• Stress: Stress can result from various life events such as the death of a relative, loss of job, chronic illness, accidents, taking care of the elderly, or traumatic events such as theft or abuse. Similarly, work-related stress due to an unsatisfactory job, long working hours, less pay, or discrimination at work is relatively common. When the body is stressed, the production of stress hormones increases. It interferes with your sexual desire and brain signals to the penis. It also becomes difficult for the muscles and blood vessels in your penis to relax and allow blood flow.
• Relationship Problems: If you and your partner are not on good terms and have constant arguments, physical abuse, and other differences, it can affect your sexual desire and sexual function.

What are the Risk Factors of Erectile Dysfunction?

The following factors may put you at a greater risk of getting physical and psychological health conditions that contribute to erectile dysfunction:

• Older age
• Obesity
• Tobacco use
• Alcohol consumption
• Drug use
• Lack of physical activity

How is Erectile Dysfunction Diagnosed?

If you are experiencing erectile dysfunction, you can talk to your primary care provider. Depending on your symptoms, they may refer you to a urologist, a sexual health specialist for males. During your first appointment, you can expect your doctor to take your medical and sexual history and physical exam. They may conduct more tests to diagnose the exact underlying cause of your ED.

Medical and Sexual History

Your doctor will first talk to you about your condition to understand if the causes are physical, psychological, or both. They will ask about your past and current medical histories, such as your medical conditions, surgeries, medications, injuries, and lifestyle habits. Your sexual history will comprise questions on your symptoms, sex drive, mental health, and relationships. Remember to be honest with your doctor so that they can achieve an accurate diagnosis. You can expect your doctor to ask you some of the following questions:

• What are your ED symptoms?
• Have you been experiencing ED for a long time, or did it happen suddenly?
• Have you seen changes in your sexual desire, ejaculation, or orgasms?
• Do you experience night or morning erections?
• Can you describe your current erections? What are their frequency, quality and duration?
• How firm are your erections? What arouses you?
• How is your current relationship? Have you been facing any problems?
• How often do you have sex? Has the frequency changed recently?
• What sexual techniques do you use?
• Do you have any medical conditions?
• Have you had any surgery or injury in your pelvic area?
• Do you currently take any medications (including prescription, over-the-counter, herbal, and dietary supplements)?
• Have you been diagnosed with anxiety or depression?
• Have you recently been under a lot of stress?
• What time do you usually sleep? How many hours of sleep do you get every night? How is your quality of sleep?
• Do you use tobacco, drink alcohol, or take any drugs?

Physical Exam

Your doctor will check your penis, testicles, and the surrounding region for unusual physical changes. They will assess your nerve function and check for signs of reduced blood in the pelvic area. They may also look for signs of hormonal problems, such as hair loss or larger-than-normal breasts. They will measure your blood pressure, listen to your heartbeat and breathing, and check your pulse to understand if the blood flow is normal.

Blood and Urine Tests

Depending on your medical history, sexual history, and physical examination, your doctor may order additional tests to determine if any underlying conditions are the reason for your ED. Blood and urine tests can check for health conditions such as diabetes, heart disease, kidney disease, thyroid conditions, and low testosterone levels. Your doctor may suggest you take some of these tests:

• Complete blood count (CBC)
• Liver and kidney function tests
• Lipid profile
• Thyroid function test
• Hormone blood tests
• Urinalysis

Ultrasound

An ultrasound test can evaluate the blood flow in your penis and check for signs of a venous leak, atherosclerosis (hardening of arteries) or tissue scarring. For this test, the doctor will hold a wand-like device over your flaccid as well as an erect penis. The sound waves from the device will produce images of the blood vessels in the penis.

Overnight Erection Test

Men usually have 3-5 erections every night during their sleep. Your doctor will do an overnight erection test, also known as a nocturnal penile tumescence test, to assess your night erections. They will give you a battery-powered device that you will wear on your thigh or penis before sleeping. It will measure the number of erections and their quality. Your doctor can access this data later. A simpler version of the test involves wearing a plastic ring around your penis, which will break if you have an erection. This type of test is not as used as before.

Injection Test

During the injection or intracavernosal test, your doctor will inject medication into the base of your penis. It should help you get an erection. They will assess how firm your erection is and how long it lasts. If you do not get an erection, there could be problems with your blood flow. This test is often done in combination with the ultrasound test.

What is the Medical Treatment for Erectile Dysfunction?

Your doctor will prepare a treatment plan depending on the underlying cause of your erectile dysfunction, the severity of your ED, age, and expectations. Erectile dysfunction treatment may be a combination of the following modalities:

Medications

Your doctor may prescribe oral medications, one of the most preferred and effective methods to treat erectile dysfunction. These pills relax the muscles in the penis to allow better blood flow for getting an erection. There are a few different ED medications that vary in composition, effectiveness, and potential side effects. Your doctor will prescribe one of the following medications keeping in mind your health conditions and current medicines.

• Avanafil (Stendra): This medication should be taken 30 minutes before sex, and its effect can last up to 6 hours. You can consume it with or without food.
• Sildenafil (Viagra): This medication should be taken an hour before sex, and its effect can last up to 4-5 hours. It is better to take it on an empty stomach.
• Tadalafil (Cialis): This medication should be taken 1-2 hours before sex, and its effect can last up to 36 hours. You can consume it with or without food.
• Vardenafil (Levitra, Staxyn): This medication should be taken an hour before sex, and its effect can last up to 4-5 hours. You can consume it with or without food.

However, these oral medications may not be as effective or safe for certain people. Your doctor may not recommend these medications if you have extremely low or high blood pressure, severe liver disease, kidney disease, or retina disease. Similarly, those who are taking nitrate drugs should not use them too.

You may or may not experience side effects of ED medications, including flushing, headache, indigestion, visual changes (temporary blue-green tinge to vision, sensitivity to light, or blurred vision), back pain, and stuffy or runny nose. More severe side effects can occur in rare cases, such as hearing or vision loss or an erection lasting more than four hours.

Penile Injections and Suppositories

If oral medications are not effective or safe for you, your doctor may suggest you use penile injections or suppositories. The most common medications are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®). They relax the blood vessels in the penis and help increase the blood flow, thus triggering an erection in a few minutes.

Your doctor will teach you to use penile injections. You will inject the medication on the side of the penis using a tiny needle and syringe. Scarring (fibrosis), pain, and prolonged erections are the most common side effects of this method. If you are using suppositories, you will insert small pellets inside the penis through the urethra. This method is less effective than penile injections.

Talk Therapy

If your erectile dysfunction is related to stress, depression, anxiety or other mental health conditions, your doctor will recommend you to a sexologist. The therapist will conduct talk therapy sessions to provide a safe space to discuss your problems. They will help you navigate solutions to better your mental health and overall well-being. It, in turn, can improve your sexual function and performance. If your relationship problems are the cause of your ED, it can help to take couples therapy.

Vacuum Pumps

Vacuum pumps or vacuum erection devices help draw blood into the penis and create an erection. They contain three components: a plastic tube, a pump, and an elastic ring.

You first place the cylindrical plastic tube over your penis and then use the pump to create a vacuum by removing air from the plastic tube. Then, you will remove the plastic tube and move the elastic ring to the base of your penis. You can keep the ring on for around 30 minutes, which will help sustain the erection by preventing blood circulation.

You may need to discontinue its use if the ring causes pain, skin irritation, bruising, or loss of sensitivity in the penis. This device is available without a prescription but always talk to your doctor before using one.  

What is the Surgical Treatment for Erectile Dysfunction?

When all the other methods to treat erectile dysfunction do not help, your doctor may suggest surgery. There are two types of surgeries for treating severe ED: penile implants and vascular reconstruction surgery.

Penile Implants

Penile implants, also known as prostheses, help in getting an erection. There are two types of implants:

• Malleable implants: The surgeon will surgically place these bendable implants inside the penis. It allows you to manually move your penis and adjust it into a suitable position for having sex. However, your penis size remains the same with these implants.
• Inflatable implants: The surgeon will place a pair of tubes inside the penis and a pump in the scrotum. Whenever you want to have sex, you can squeeze the pump to make your penis firm and erect. With these implants, your penis size may slightly increase.

There are a few complications of penile implants—it makes you susceptible to infections, it may auto-inflate or break at times, or the pump may shift. Surgeries for urological conditions such as an enlarged prostate or bladder cancer can be complex with penile implants.

Vascular Reconstruction Surgery

Vascular surgery repairs the blocked arteries in the penis to improve the blood flow needed for an erection. If you are suffering from a venous leak, this surgery can help block the veins to prevent blood from leaking out of the penis. However, this surgery is rare and is usually reserved for younger people who have ED due to an injury.

What are the Alternative Treatments for Erectile Dysfunction?

If medical treatments are not for you, your doctor may suggest alternative ways to manage erectile dysfunction.

Exercise

Regular exercise has many benefits for your overall health. It improves blood circulation, balances hormones, enhances mood, promotes better sleep, helps in weight management, and combats health conditions. When you are in good shape, it will automatically have a positive impact on your sexual health as well.

You should talk to your doctor about the most suitable workout plans if you are a beginner. They may recommend aerobic exercises such as walking, running, or swimming. Kegel exercises that target the pelvic floor muscles can also help with ED.

Relaxation Techniques

Relaxation techniques such as deep breathing, yoga, massage, meditation, tai chi, and aromatherapy can help reduce the stress that contributes to erectile dysfunction. When the mind and body are relaxed, it will improve not only your erections but also your sexual desire, performance, confidence, and orgasm.

Diet

What you eat impacts your bodily functions. An unhealthy diet can lead to weight gain, hormonal imbalances, obesity, and chronic conditions such as high blood pressure, heart disease, and diabetes. It, in turn, can impact your sexual function. Therefore, eating a healthy and balanced diet can reduce your risk of developing the conditions that lead to ED.

Supplements

You may opt for natural sexual performance supplements after consulting your doctor. Some of them include the following:

• Dehydroepiandrosterone (DHEA)
• L-arginine
• L-carnitine
• Ginseng
• Shatavari
• Ashwagandha
• Yohimbe

How to Prevent Erectile Dysfunction?

While it may not be possible to prevent all causes of erectile dysfunction, you can significantly reduce its risk through healthy lifestyle changes, diet modifications, and routine health checkups. Some of the tips include:

• Exercise regularly
• Do relaxation techniques such as yoga or meditation
• Eat a balanced and healthy diet
• Quit all forms of tobacco and drug use
• Stop drinking alcohol or limit its intake
• Have a regular sleep schedule
• Maintain a healthy weight
• Get help if you are stressed, anxious, or depressed
• Go for regular health checkups and screenings
• Manage your medical conditions such as hypertension, high cholesterol, or diabetes

Conclusion

Erectile dysfunction is a fairly common condition among men. It prevents them from getting and sustaining a firm erection desired for sex. Some may experience erection problems for a short while due to stress or lifestyle changes. But if this problem persists for over a few weeks, you must reach out to a doctor.

While it may be embarrassing to talk to your doctor about it, seeking help is necessary. ED often occurs due to an underlying psychological or physical condition that requires treatment. Your doctor can diagnose the cause and suggest a suitable treatment plan. In most cases, erectile dysfunction is easily treatable.

If you are in a relationship, erectile dysfunction can impact your partner too. They may feel confused, anxious, undesirable, or suspicious that you may be unfaithful. Do not hesitate to be honest with your partner about your condition and seek their support in your treatment. You can also take couple therapy and engage in other forms of intimacy to help your relationship.

Frequently Asked Questions (FAQs)

1. How young can you develop erectile dysfunction?

Ans. Persons of all ages can experience erectile dysfunction, but this condition is more common among older age groups.

2. Is erectile dysfunction permanent?

Ans. It is possible to treat most cases of erectile dysfunction with a proper diagnosis, treatment, and support. However, whether or not it will cure permanently depends on its cause.

3. Can erectile dysfunction lead to infertility?

Ans. Erectile dysfunction does not directly impact your fertility, but it can make it difficult to conceive a baby.