Overview
Erectile dysfunction is the repeated difficulty getting or keeping an erection firm enough for sexual activity. It's extremely common, increases with age, and is often an early warning sign of underlying heart or blood vessel disease rather than just a “sexual” problem.
ED affects roughly 30 million men in the United States (NIH). Most men over age 60 experience some degree of ED, and prevalence rises steadily with age.
Causes & risk factors
- Vascular disease — reduced blood flow from atherosclerosis is the most common physical cause
- Diabetes and high blood pressure, strongly linked to nerve/blood vessel damage
- Low testosterone or other hormonal imbalances
- Psychological factors — stress, anxiety, depression, relationship problems
- Certain medications (antidepressants, blood pressure drugs)
- Smoking, obesity, excess alcohol, and lack of exercise
Symptoms to watch for
- Trouble getting an erection
- Trouble keeping an erection long enough for sex
- Reduced sexual desire alongside erection problems
- Sudden ED in a younger man, especially with chest pain or on exertion, can flag urgent underlying heart disease — evaluate promptly
How it's diagnosed
- Detailed sexual and medical history plus symptom questionnaires
- Physical exam of the genitals, and often heart, pulses, and blood pressure
- Blood tests (testosterone, blood sugar, cholesterol) and urinalysis
- Specialised tests when needed: nocturnal erection monitoring, penile Doppler ultrasound
Treatment options
- Oral PDE5 inhibitors: (sildenafil, tadalafil, vardenafil) — first-line, effective, and similar in efficacy.
- Lifestyle changes: weight loss, exercise, quitting smoking, and reducing alcohol.
- Vacuum erection devices: a mechanical, non-drug option.
- Penile injection therapy or intraurethral alprostadil: for men who don’t respond to pills.
- Testosterone replacement: if a hormone deficiency is identified.
- Penile implant (prosthesis) surgery: for cases unresponsive to other treatments.
Outlook & prevention
ED is highly treatable — most men respond well to first-line oral medication. Because ED and heart disease share the same blood vessel risk factors, treating ED can be a useful trigger to screen for cardiovascular disease. Managing diabetes, blood pressure, weight, and quitting smoking meaningfully lowers risk.
When to see a doctor
- ED lasting more than a few weeks or worsening over time
- ED combined with chest pain, breathlessness, or exertional symptoms
- Erection problems affecting confidence, mood, or relationships