Erectile dysfunction (ED) is when a man cannot get or keep an erection. The condition prevents the man from having sex or finishing sex. This condition used to be called impotence. ED can occur at any age, but it is more common in men older than 75 years of age.
ED does not have to be a part of getting older. As a man ages, he may need more stimulation (stroking and touching) to get an erection. He might also need more time between erections. Older men should still be able to get an erection and enjoy sex.
What causes erectile dysfunction?
Erectile dysfunction can be caused by:
- Diabetes (high blood sugar).
- Hypertension (high blood pressure).
- Atherosclerosis (hardening of the arteries).
- Stress, anxiety, or depression.
- Alcohol and tobacco use.
- Some prescription medicines. This includes antidepressants, pain medicine, and high blood pressure medicine.
- Brain or spinal cord injuries.
- Hypogonadism (a condition that leads to low levels of the male hormone, testosterone).
- Multiple sclerosis.
- Parkinson’s disease.
- Radiation therapy to the testicles.
- Some types of prostate or bladder surgery.
Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included.
Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections.
Certain feelings can lead to erectile dysfunction, including:
- Feeling nervous about sex. This could be because of a bad experience or a previous episode of ED.
- Feeling stressed, including work and family stress.
- Feeling depressed.
- Feeling self-conscious about your body or performance.
- Thinking your partner is reacting negatively toward you.
How is erectile dysfunction diagnosed?
ED is usually easy to diagnose. If you are tempted to self-diagnose, talk to us first. We want to make sure it is not related to another health condition.
We will perform a physical exam and ask questions about your symptoms. We may do further lab testing, may consider other tests to rule out other conditions.
Can erectile dysfunction be prevented or avoided?
This depends on whether you know what it is causing your ED. There are some things you can do that may help prevent ED, including:
- Avoid drinking too much alcohol, smoking, or abusing drugs.
- Ask us if ED is a side effect of a new or current medicine you are taking. We may have an alternative medicine.
- Control your blood sugar and blood pressure.
- Try to relax and avoid stress.
Erectile dysfunction treatment
Treatment depends on what is causing it. If it is caused by uncontrolled blood sugar and high blood pressure, take your medicine, and follow instructions.
Once other causes are ruled out, we may prescribe Sildenafil (brand name: Viagra), tadalfil (brand name Cialis), and vardenafil (brand name Levitra). These medicines are taken by mouth to help you maintain an erection.
Not everyone can use these medicines. We might talk to you about alprostadil if oral medicines are not an option for you. Alprostadil is a synthetic version of prostaglandin E. It can be injected into the penis or inserted as a tiny suppository into the urethra (the hole at the end of the penis). We will help you decide which treatment is best for you.
Follow medical instructions when taking ED medicine. Usually, a man takes 1 tablet 30 minutes to 1 hour before he plans to have sex. Sildenafil works for 4-8 hours; vardenafil works for up to 8 hours; and tadalafil works for up to 36 hours.
You should not take more than 1 dose in 24 hours. Tadalfil and vardenafil come in tablets of 2.5 mg, 5 mg, 10 mg, and 20 mg. Sildenafil comes in tablets of 25 mg, 50 mg, and 100 mg.
Even if you take the medicine, you still need physical and mental stimulation and desire to have an erection. If your first dose does not help, please call us. We might need to change your tablet strength.
The side effects of ED medicine are mostly the same. Sildenafil and vardenafil can cause:
- Flushing (face and upper body turning red and warm).
- Stomach upset.
- Runny nose (sniffles).
- vision changes (things look blue).
Tadalfil has the same side effects, except for the flushing and possible changes in vision. It can also cause back pain and muscle aches. For each of the medicines, headache is the most common side effect. Vision changes are the least common. Let us know if you have any side effect that bothers you.
Call us immediately if you take one of these medications and have a prolonged erection that lasts 4 hours or longer. This condition may cause permanent impotence if not treated.
Can everyone use ED medications?
You should not use these medicines if you take nitroglycerin or any other nitrates for chest pain. If you have heart problems, let us know before taking any ED medicines. These medicines can have serious side effects in people who have heart problems.
If you use sildenafil, tadalafil, or vardenafil and get chest pains, be sure to tell the paramedics, nurses, or doctors at the hospital that you use it and when you used it last.
Living with erectile dysfunction
If the medicines are not right for you, you could try using a penile implant, vacuum pump devices, or have surgery. We might need to send you to a urologist to talk about these options.
Questions to ask
- How long will I have to take medicine for erectile dysfunction?
- What is the difference between tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra)?
- Are there any lifestyle changes I should make?
- How can I talk with my partner about my problem?
- Is there something I can do other than take medicine to help?
- What other medicines cause this problem?
National Institutes of Health, MedlinePlus: Erectile Dysfunction
Last Updated: April 24, 2020
This article was contributed by: familydoctor.org editorial staff