Erectile dysfunction, otherwise known as ED or impotence, is the condition of being unable to get or maintain an erection.^[1]

It is a common condition that most males will experience at some stage in their life, though it is most prevalent in older men. ED is usually temporary rather than permanent, although it can also be recurring, depending on whether the cause is short-term and treatable, or ongoing.

The possible causes of ED are numerous. Physical causes of ED include aging, high blood pressure, conditions that affect the blood vessels and/or nerves associated with the penis, and nerve damage to the area which occurs due to injuries, or certain surgeries such as prostate surgery. Psychological causes of ED include depression, anxiety, and relationship issues.

In most cases, erectile dysfunction can be successfully managed, with treatment options depending on the root cause of the disorder.^[1] Treatment may involve forms of sex therapy and counseling, exercises and lifestyle changes, ED drugs, including pills and topical medications, pumps, and ‒ in more severe cases ‒ prosthetics.

Symptoms of erectile dysfunction

The symptoms of erectile dysfunction may include:

An inability to get an erection
An inability to maintain an erection during sexual activity

These symptoms may come and go over time or be situational, for example not present during masturbation but present with a partner.^[2] If symptoms occur regularly or semi-regularly, visiting a doctor is advised.

The onset of ED may be different, depending on whether it is caused by physical or psychological factors:

If the causes of erectile dysfunction are physical in origin, the condition is more likely to appear gradually, with the problem occurring intermittently before becoming more frequent. A person’s sex drive is unlikely to be affected unless the root cause is hormonal in nature.

Psychological causes typically result in the sudden onset of the condition. If a person is able to get and maintain a healthy erection sometimes, for example when masturbating or on waking, it may be a sign that their erectile dysfunction is psychological in origin. If you are affected by unexplained ED, Find a doctor near you anytime doctor.

Causes of erectile dysfunction

Finding a treatment approach that can cure erectile dysfunction usually depends on identifying its root cause.

Erectile dysfunction can be caused by a variety of physical and psychological factors:^[1]

Physical causes of ED

Most cases of erectile dysfunction are caused by physical factors. The most common cause of erectile dysfunction is reduced blood flow to the penis. This happens as a result of a narrowing of the arteries in the penis.

Conditions that can lead to the development of erectile dysfunction include:^[3]^[4]^[5]^[6]

Diabetes, which can affect the function of the blood vessels and nerves
Parkinson’s disease, either as a side-effect of medication or due to the condition itself
Multiple sclerosis, a condition associated with progressive damage of the nerves, including those associated with getting and maintaining erections
Stroke

Other factors which are recognized as physical causes of erectile dysfunction include:

Excessive intake of alcohol or drugs, which can impair the ability to get or maintain an erection.
Medications which cause ED as a side-effect, such as certain kinds of antidepressants, beta blockers and some diuretics
A lack of certain hormones, particularly testosterone. (ED caused by hormone deficiencies is uncommon.)
Damage to the nerves in the penis as a result of surgery to nearby areas, such as prostate surgery, or from an injury, such as a spinal cord injury

Erectile dysfunction after prostatectomy (prostate surgery)

All prostate surgery procedures disrupt the nerves and blood vessels that control the way erections form. For this reason, all prostatectomies will compromise erectile function, at least initially.

Up to 50 percent of men who have had a successful nerve-sparing procedure, i.e. the nerves were left untouched as planned during the procedure, regain their pre-prostatectomy erectile functionality during recovery, within one year.

For men who have not had nerve-sparing procedures, it is usually still possible to recover most or the entire extent of their pre-treatment erectile capability. In cases where spontaneous erections are no longer possible, there are several possible treatment options that may help with overcoming erectile dysfunction after prostatectomy. These include:^[7]^[8]^[9]

Oral medications, such as Viagra®
Topical medications, such as Vitaros©
Vacuum pumps
Implants

All of these medications work by increasing blood flow to the penis, causing an erection. (For more information about remedies for ED after having a prostatectomy, see treatment.)

Psychological causes of ED

A range of mental health issues can lead to the development of erectile dysfunction, including:

Depression
Stress/pressure
Anxiety
Relationship issues

Purely psychological causes for erectile dysfunction are less common, limited to approximately 10 percent of cases.^[10]

Genetics and ED

It is suspected that there is a hereditary component to ED in around one-third of cases.^[11] A 2018 study has proven the link for the first time, finding that certain variations in some people’s genetic structure increase their risk of developing erectile dysfunction.^[11]

This discovery paves the way for the development of new treatments to help relieve ED in cases where its cause may be genetic.

Risk factors for developing erectile dysfunction

Risk factors for erectile dysfunction include:

Aging ‒ the older a person is, the greater the risk of developing ED
High blood pressure
High cholesterol
The use of tobacco products
Injuries to the groin or surgery, such as prostatectomy, which affects the nerves responsible for erections

Risk factors for ED after a prostatectomy – surgical removal of part or all of the prostate

Following a prostatectomy, the risk of erectile dysfunction is influenced by factors including:^[12]

The skill of the urologist or urological surgeon. The greater their surgical experience and success rate at preserving sexual function, the more likely a given procedure is to conclude with this outcome.
Age of the patient. Younger men are more likely than older men to keep or regain their erectile abilities.
Previous sexual profile. The greater a man’s ability to produce erections before the procedure, the more likely he is to keep or regain it after the procedure.

If both bundles of nerves responsible for erections are sufficiently damaged, it may no longer be possible for a man to have spontaneous erections without the aid of devices or medications that assist the bodily process. (For more information about remedies for ED after having a prostatectomy, see treatment.)

Diagnosis of erectile dysfunction

The first step in treating ED is getting a diagnosis of the root cause by visiting a doctor, who will typically begin with questions regarding:^[13]

The symptoms experienced
The length of time symptoms have been present
General physical and mental health
Levels of alcohol and drug intake
Whether any other medication is also being taken

It may also be necessary for a person to answer questions about their sex life. These may include:

Details of current and past sexual relationships
Information about sexual orientation
Whether the dysfunction occurs all the time, intermittently or only in certain situations
Whether ejaculation is possible
Libido, i.e. levels of sexual desire

As narrowed blood vessels are the most common cause of erectile dysfunction, a doctor will usually examine a person’s cardiovascular condition as part of the diagnosis. This may involve testing for high blood pressure, checking for heart irregularities, as well as evaluating their weight or overall level of health.

Blood tests may also be ordered to check for underlying medical conditions that may be causing the condition.

Treatment for erectile dysfunction

In most cases, doctors will be able to suggest and prescribe treatment options. A person may also be referred to a specialist. Treatment methods will depend on the underlying cause of the problem, meaning the chosen method will differ from case to case.

Common treatment options for erectile dysfunction include:

Treatment of underlying conditions

If an underlying condition is causing erectile dysfunction, treating it will generally be the first step towards resolving erectile dysfunction.

If medications used to treat other conditions are thought to be causing erectile dysfunction, a doctor may be able to prescribe alternatives.^[14]

Good to know: The use of prescribed medication should never be discontinued without supervision by a doctor.

Lifestyle changes

A range of lifestyle changes can help treat erectile dysfunction, including:

Losing weight
Reducing stress
Quitting smoking
Reducing alcohol and drug intake or giving them up completely
Getting regular exercise

Exercises for ED

There are a number of exercises that may help to treat ED. These include:

Pelvic floor exercises: Exercises designed to strengthen the pelvic floor muscles, such as Kegel exercises, can be effective in treating or preventing erectile dysfunction.
Yoga: Can be effective in reducing stress and anxiety, psychological problems that can cause erectile dysfunction.
Swimming: A good exercise for improving overall health, which can in turn help treat erectile dysfunction.

Counseling, sex therapy and relationship counseling

If stress, anxiety, or depression are causing erectile dysfunction, counseling may be an effective treatment. If relationship issues are the cause, some form of sex therapy or relationship counseling may prove successful.

Sensate focus, a type of sex therapy, focuses on building intimacy between partners. It involves totally abstaining from sex and intimate touching for a set period of time, then gradually reintroducing it. The method can be effective in overcoming the psychological issues behind erectile dysfunction.^[15]

Relationship counseling, in which partners are prompted to explore the physical and psychological issues behind their sexual problems, may also be an effective method of overcoming erectile dysfunction. Partners are encouraged to become more aware of each other’s needs, allowing them to reach a solution that works for them both.

Oral medications for erectile dysfunction

Oral medications which are used to treat erectile dysfunction come in the form of tablets or pills. The drugs most commonly used to treat ED are called phosphodiesterase-5 (PDE-5) inhibitors.

Phosphodiesterase-5 (PDE-5) inhibitors

These medications work by counteracting phosphodiesterase-5 (PDE-5), a chemical naturally occurring in the body, thereby increasing blood flow to the penis during sexual stimulation.

PDE-5 inhibitors are the most commonly prescribed medication for treating erectile dysfunction. The most common types are:

Sildenafil: Brand name, Viagra®
Tadalafil: Brand name, Cialis
Vardenafil: Brand name, Levitra
Avanafil: Brand name, Spedra

These medications work by artificially dilating the blood vessels in the penis, enabling improved blood flow. The effects of tadalafil last for up to 36 hours, while the other three varieties generally last for around 10 hours. Each should be taken 30 to 60 minutes before engaging in sexual activity and will only take effect when one is sexually aroused.^[14]

A doctor will be able to advise about which type of PDE-5 is most suitable for each person and the health risks and side effects that come with them.

Good to know: Following a prostatectomy, if one, rather than both, sets of the nerve bundles responsible for erections have been damaged (a unilateral nerve-sparing prostatectomy), it is possible to use PDE-5 inhibitors to stimulate an erection.^[16]

PDE-5 inhibitors are associated with several side effects including headaches, a runny nose, hot flushes, an upset stomach, and light sensitivity. In some cases, they can cause more severe vision problems: temporary or permanent blindness which may be a sign of non–arteritic anterior ischemic optic neuropathy (NAION). This eye condition has been linked to all brands of PDE-5 inhibitors. Recent research indicates that there is an approximately two-fold increase in the risk of NAION in men over 50 who have recently used PDE-5 inhibitors, compared to those who have not.^[16] However, the overall risk of PDE-5 inhibitors causing NAION is low, with a risk estimate of 2.27 percent in a 30 day period and 3.52 percent in a 12 month period.^[17] PDE-5 inhibitors are not recommended for people who have already been affected by NAION, or who have a family history of retinal degenerative disorders.

These medications are also known to react with nitrate-containing drugs used to treat heart disease, so it is important to discuss possible interactions with the doctor in cases where PDE-5 inhibitors may be taken in combination with other medications, especially heart medications.

Alprostadil

An efficient medication for assisting erectile function is thought to be alprostadil, a man-made version of prostaglandin E1, a substance naturally made in the body to help produce erections. Generally, due to the fact that it is a relatively new treatment with limited safety data, alprostadil will only be prescribed if other treatments, including counseling, lifestyle changes, and PDE-5 inhibitors, have been ineffective or are unsuitable. It is administered in three main forms:^[18]

As an injection, directly into the base of the penis
As a small pellet, which is placed into the urethra, i.e. the opening on the tip of the penis
As a topical cream, applied to the urethra

Doctors will advise on which form of alprostadil should be used and give instructions on how to properly administer it at home. After application, an erection can usually be achieved in around 15 minutes.

Alprostadil side effects

Alprostadil has significantly fewer and less severe side effects than most oral medications which can be used to treat erectile dysfunction. It works by widening the blood vessels and increasing the blood flow to the penis, causing an erection.

If side effects occur, these are usually non-serious and are limited to prolonged erections, pain, and dizziness.^[19] Another advantage of Alprostadil is that the dosage can be adjusted to determine the duration of an erection.

Topical medications for erectile dysfunction

A commonly prescribed topical medication for ED is Vitaros©, prescription medicine in the form of a cream, containing the active ingredient alprostadil. This is the newest form of alprostadil.^[7]

Vitaros come in a single-use container with a plunger, barrel, and protective cap, containing either 200 or 300 micrograms of alprostadil in 100 mg of cream.^[8] The appropriate dose strength for each person is decided in consultation with their doctor.

Vitaros should be stored in the fridge but can be taken out before use in order to reach room temperature for ease of application. If it is taken directly out of the fridge, it may need to be warmed up for use by massaging the tube in one’s hands.

It is best to urinate before applying Vitaros. Urination after application will result in cream being expelled from the urethra, lessening its erectile effects.

Each tube of Vitaros contains the right amount of medication for a single dose, which should be applied, with clean hands by injecting it into the urethra, using the single-use applicator pump provided. The penis should then be kept upright for 30 seconds so that the cream can be absorbed. Any leftover cream can be rubbed around the tip. Hands should be washed after application.

Vitaros will usually take effect in 5-30 minutes after application. It is not an aphrodisiac, and sexual stimulation will therefore be necessary to achieve an erection. For most people, the effects last between one and two hours. A full, warm sensation in the penis is not a cause for concern and may remain for several hours after use.

Vitaros should not be used more than once within any 24-hour period. A person should not exceed three doses in a week.^[9]

Vacuum pumps

Vacuum pumps can relieve the symptoms of erectile dysfunction. A specialized mechanical pump is used to cause an erection by placing it over the penis and sucking the air out of the pump, drawing blood into the penis. Erections created with the use of a vacuum device require a band to be applied to the base of the penis to trap the blood for the duration of the intercourse. The band can then be removed afterward.

For safety reasons, the rubber band should be removed within 30 minutes.

Implants

A penile prosthesis is a surgical procedure in which a rod is implanted inside the penis in order to simulate an erection. Advanced procedures involve the insertion of an inflatable rod. This is an uncommon treatment method for ED, used only in severe cases, but is generally effective.

Erectile dysfunction prevention

Though it may not always be possible to prevent erectile dysfunction, certain steps can be taken to reduce the risk of the condition. These include:^[20]

Staying healthy, with regular exercise and a balanced diet, including meeting the recommended daily intake of all vitamins and minerals
Stopping using tobacco products
Avoiding drugs and excessive amounts of alcohol
Seeking treatment for conditions such as high blood pressure and diabetes

Complications associated with erectile dysfunction

There are no serious physical complications associated with erectile dysfunction. However, the condition can negatively affect a person’s mental health, causing issues such as:

Stress and anxiety
Low self-esteem
Embarrassment
An unsatisfactory sex life
Problems within a relationship

Erectile dysfunction FAQs

“Erectile Dysfunction (Impotence).” Patient. 01 April 2016. Accessed: 25 August 2017. ↩ ↩ ↩
“Erectile dysfunction (impotence).” NHS Inform. 07 May 2018. Accessed: 24 December 2018. ↩
“Management of sexual dysfunction in Parkinson’s disease.” Therapeutic Advances in Neurological Disorders. November 2011. Accessed: 24 December 2018. ↩
“Sex after stroke.” Stroke Association. November 2017. Accessed: 26 December 2018. ↩
“Erectile dysfunction and diabetes.” NHS. 21 May 2008. Accessed: 26 December 2018. ↩
“Treatment of erectile dysfunction in multiple sclerosis.” Expert Review of Neurotherapeutics. June 2006. Accessed: 26 December 2018. ↩
“Topical Alprostadil (Vitaros©) in the Treatment of Erectile Dysfunction after Non-Nerve-Sparing Robot-Assisted Radical Prostatectomy.” Urologia Journal. 19 February 2018. Accessed: 21 March 2018. ↩ ↩
“Vitaros 3 mg/g cream.” EMC. 16 November 2017. Accessed: 21 March 2018. ↩ ↩
“How to use Vitaros: an introductory guide.” Treated.com. 27 November 2017. Accessed: 21 March 2018. ↩ ↩ ↩
“Erectile dysfunction (impotence).” The British Association of Urological Surgeons. Accessed: 25 August 2017. ↩
“First genetic risk factor for erectile dysfunction identified.” Science Daily. 08 October 2018. Accessed: 26 December 2018. ↩ ↩
“Orgasmic Pain and a Detectable PSA Level after Radical Prostatectomy
.” Reviews in Urology. 2005. Accessed: 24 December 2018. ↩ ↩
“Erectile dysfunction (impotence) – Diagnosis](http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Diagnosis.aspx).” NHS Choices. 23 September 2014. Accessed: 23 August 2017. ↩
“Erectile dysfunction (impotence) – Treatment.” NHS Choices. 23 September 2014. Accessed: 28 August, 2017. ↩ ↩
“Sensate Focus.” Counselling Matters. Accessed: 28 August 2017. ↩
“The PDE-5 inhibitors.” Sexual dysfunction after radical prostatectomy. Reviews in Urology. 2005. Accessed: 17 January 2019. ↩ ↩
“Contemporary treatment of erectile dysfunction: a clinical guide.” Humana Press. 2016. Accessed: 17 January 2019. ↩ ↩
“Alprostadil for erectile dysfunction.” Patient. 22 August 2014. Accessed: 28 August 2017. ↩
“Alprostadil: side effects.” National Institute for Health and Care Excellence (NICE). 2018. Accessed: 24 December 2018. ↩
“Preventing Erectile Dysfunction – What You Should Know.” Urology Care Foundation. Accessed: 28 August 2017. ↩
“A syndrome of erectile dysfunction in young men.” Translational Andrology and Urology. April 2016. Accessed: 26 December 2018. ↩ ↩
“L-Arginine.” MedicinePlus. 17 October 2018. Accessed: 17 January 2019. ↩
“Guidelines on male sexual dysfunction: Erectile dysfunction and Premature ejaculation.” European Association of Urology. 2015. Accessed: 26 December 2018. ↩ ↩
“Behavioural therapies for management of premature ejaculation: a systematic review.” September 2015. Accessed: 26 December 2018. ↩
“How erection problems can affect your relationship.” Patient. 14 June 2018. Accessed: 26 December 2018. ↩
“Penile rehabilitation following radical prostatectomy.” Current Opinion in Urology. November 2008. Accessed: 24 December 2018. ↩
“Does maturbation cause erectile dysfunction (ED)?.” International Society for Sexual Medicine. 2018. Accessed: 26 December 2018. ↩ ↩
“Sex and relationships.” Prostate Cancer UK. 2018. Accessed: 26 December 2018. ↩
“Is internet pornography causing sexual dysfunctions? a review with clinical reports.” Behavioural Sciences. September 2016. Accessed: 17 January 2019. ↩
“Porn use linked to erectile dysfunction.” Medscape. 14 May 2017. Accessed: 17 January 2019. ↩
“Brain structure and functional connectivity associated with pornography consumption: the brain on porn.” JAMA Psychiatry. 2014. Accessed: 17 January 2019. ↩

Eroded–> **Synonyms**

* abraded

* worn

* corroded

* weathered

* eaten away

*⁤ abraded

* degraded

* diminished

* reduced

* ‌lessened

* atrophied * weathered

* eaten away

*⁣ degradated

* diminished

* lessened

* atrophed

What is Erectile Dysfunction?

Symptoms of erectile dysfunction