Erectile dysfunction means that you have trouble getting or keeping an erection for sex. 

To get an ED diagnosis, one or more of these things should be true:

• You can sometimes get an erection, but not every time
• You can get an erection but have trouble maintaining it during sex
• You can’t get an erection at all

People of any age can struggle with ED. You may develop ED for either physical or psychological reasons. Often, it’s a combination of both. Worrying about getting an erection makes it more challenging to get an erection.

It’s important to note that it’s not just a normal part of aging. ED isn’t something you simply have to accept.

Age is one of the top risk factors for ED. ED can happen when you don’t have enough blood flow to the penis. As you get older, arteries can narrow, affecting blood flow. The arteries to the penis are small and can narrow before the larger arteries in the body.

This is why ED can be an early sign of heart disease and blocked arteries. Always talk to your care team if you’re having erection issues.

Other causes of ED include:

• Diabetes (type 1, type 2): High blood sugar can cause blood vessel and nerve damage, which affects the penis
• Issues with nerves: Signals from the brain may not be able to reach the penis because of certain injuries or diseases that affect the nerves
• Cancer treatment: Prostate, bladder, and colon cancer treatment can cause ED
• Some medicines: Some drugs have ED as a side effect, including antidepressants, sedatives, and blood pressure medicine
• Emotional and psychological issues: Depression, anxiety, work stress, and worry about sexual performance can also make ED worse
• Lifestyle factors: Smoking, using illegal drugs, and drinking too much alcohol can contribute to ED

Primary care doctors can make a diagnosis of ED and offer initial treatment.

The first step in diagnosing ED is reviewing your medical and sexual history. It can be embarrassing to talk about sexual issues. But having a healthy sex life is part of having good overall health.

Your doctor may also do a physical exam and order tests such as:

• Blood tests to check hormone levels and for conditions like diabetes
• Imaging tests to record the blood flow to your penis

Your doctor may also suggest a nocturnal erection test at home. This test determines if you’re having erections during the night. If you’re physically able to get an erection, your ED might be due more to psychological issues.

ED treatments

We treat ED in several ways. Sometimes, you might need more than one type of treatment. If treatment isn’t working, your primary care team may refer you to a urologist.

Treatments include:

• Lifestyle changes: Quitting smoking, exercising more, and drinking less can all improve ED.
• Talking to a therapist: If your ED is due to anxiety, a therapist or counselor may be able to help.
• Medicine changes: You might need to swap medicines or to change your dose.
• Taking oral medicine: Several prescription medicines can help you get and maintain an erection. These are generally safe and work well, but your doctor will examine you to make sure it’s safe for you.
• Vacuum erection device (VED): A device placed over the penis uses gentle suction to draw blood into the penis and create an erection. A small band is then placed at the base to help maintain it.
• Injections: There are medicines you can inject or insert into the penis that help with erections.
• Surgery: If other treatments don’t work, surgery may be an option for some people. Urologists can perform surgery to implant penile prosthesis, a mechanical device that helps you achieve an erection with the help of a small pump. Most people with ED won’t need surgery.