What is erectile dysfunction?

An erection problem means that you routinely can't get or keep an erection that allows satisfactory sex. You may not be able to have an erection at any time. Or you may not be able to have one that is firm enough or lasts long enough to complete intercourse. The problem is also called erectile dysfunction (ED).

It's not the same as having trouble getting an erection now and then. That's common.

Erection problems can be caused by problems with the blood vessels, nerves, or hormones. They can be caused by diabetes, heart disease, and injuries. Nerve problems also can cause them.

Medicines, alcohol, and tobacco also can cause problems. So can depression, stress, grief, and relationship problems.

It's common to have erection problems at times. When you have them often, "performance anxiety" can make the problem worse. If you can't keep an erection that's firm enough for intercourse, or if you have an orgasm right after entering your partner, you may feel frustrated. Many causes of erection problems can be treated.

The only symptom of an erection problem is being unable to get and keep an erection that is firm enough or lasts long enough to have sex. But even with an erection problem, you may still have sexual desire and be able to have an orgasm and to ejaculate.

Treatment for an erection problem depends on the cause of the problem. The cause may be mental or physical. Or it might be a mix of both.

Treatment can include having you:

• Avoid tobacco and drugs and limit alcohol.
• Talk about the issue with your partner, do sensual exercises, and get counseling.
• Ask your doctor about changing any medicines that may be causing the problem. In some cases, you may be able to use a different medicine.
• Take testosterone or another treatment to fix a hormone problem, such as low testosterone, if tests show that you have one.
• Take pills that help you get an erection. These pills are called PDE-5 inhibitors. They include sildenafil (such as Viagra), tadalafil (such as Cialis), and vardenafil (such as Levitra). Check with your doctor to see if it's safe for you to take one of these medicines with your other medicines. These pills can be dangerous if you take nitroglycerin or other medicines that contain nitrates (for heart disease).
• Use medicines that are injected or inserted into the penis.
• Use vacuum devices. These devices have a tube that you place around the penis. You pump the device to create a vacuum that leads to an erection.
• Have surgery to place an implant in the penis.

It's important to involve your partner in your decision, no matter which treatment you choose.

To diagnose an erection problem, your doctor may:

• Review your risk factors. This includes things like any medicines you take and how much you drink.
• Ask questions about your sexual function, including how often you have erection problems.
• Do a complete physical exam of the belly, penis, prostate, rectum, and testicles.
• Do lab tests for testosterone and other hormones and for blood sugar.

Your doctor may start treatment with pills. But you may get more tests if pills don't work or your doctor thinks that testing is needed.

Tests can help your doctor find out whether physical factors are causing your erection problem. These may include lab tests for:

• Testosterone. A low level may reduce sexual desire.
• Thyroid hormone.
• Blood sugar. A high level may indicate diabetes. This can cause erection problems.

If your doctor thinks you have a mental health issue, a mental health evaluation may be recommended.

You may use medicine to treat erection problems. But this can be dangerous.

Talk with your doctor about whether medicines for erection problems are safe for you if you:

• Have heart disease.
• Have heart failure or low blood pressure.
• Are taking medicine for high blood pressure.

PDE-5 inhibitors

PDE-5 inhibitors should never be used if you may need to take a nitrate-containing medicine, such as nitroglycerin. Taking nitroglycerin and a PDE-5 inhibitor within 24 hours (or 72 hours for long-acting tadalafil) of each other may greatly lower your blood pressure. This could lead to a heart attack, stroke, or death.

These medicines include sildenafil (such as Viagra), tadalafil (such as Cialis), and vardenafil (such as Levitra).

Taking PDE-5 inhibitors can also cause low blood pressure if:

• You use a combination of drugs for high blood pressure.
• You take alpha blockers. These drugs are used to lower blood pressure and to treat an enlarged prostate.

For these reasons, you also shouldn't take PDE-5 inhibitors with these medicines without talking to your doctor. The combination could cause a dangerous drop in blood pressure.

Tests for heart disease

If you take a PDE-5 inhibitor and are going to have a test for heart disease, make sure that your doctor knows that you take it.

• You should not take sildenafil (such as Viagra), vardenafil (such as Levitra), or tadalafil (such as Cialis) for 24 hours before the test.
• Do not take long-acting tadalafil (such as Cialis) for at least 72 hours before the test.

Then if you have a problem during the test, it will be safe to use nitrate-containing medicines such as nitroglycerin.

Sometimes you can treat occasional erection problems at home. Look at relationships and events that may be causing sexual problems. Talk with your partner outside of the bedroom about your sex life. Sensual exercises may help. Not smoking and drinking less alcohol may also help. Seek professional help if you keep having problems.

You have erection problems if you can't get or keep an erection that is firm enough for you to have sex. Erection problems are also called erectile dysfunction or impotence.

It's common to have erection problems every now and then. This is normal. These problems can occur at any age. But they are more common as you get older, when you are more likely to have other health problems. Treatment can help if you are older or younger.

Erection problems may be caused by physical problems related to the blood vessels, nerves, and hormones. Or they may be caused by mental health issues.

Normally, an erection occurs when your imagination or senses (vision, hearing, touch, smell, taste) are stimulated. You then get aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis.

Causes of erection problems may include:

• Problems with the blood vessels. These problems may prevent blood from filling the penis or from staying there long enough to keep an erection.
• Problems with the nerves. These may prevent arousal signals from traveling from the brain and spinal cord to the penis.
• Other health problems, such as low testosterone levels, diabetes, or high blood pressure.
• Side effects of certain medicines.
• Drinking too much alcohol or smoking.
• Surgery, such as for prostate cancer.
• Mental health issues, such as depression, anxiety, stress, or grief.