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Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

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Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

When to see a doctor

A family doctor is a good place to start when you have erectile problems. See your doctor if:

  • You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation
  • You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction
  • You have other symptoms along with erectile dysfunction

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Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson's disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie's disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

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As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you're obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you're a long-term drug user or heavy drinker

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Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant

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The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

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March 09, 2018
Show references
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  2. Erectile dysfunction. Urology Care Foundation. urologyhealth.org/urologic-conditions/erectile-dysfunction. Accessed Nov. 26, 2016.
  3. Cunningham GR, et al. Overview of male sexual dysfunction. uptodate.com/home. Accessed Nov. 26, 2016.
  4. Erectile dysfunction. National Kidney and Urologic Diseases Information Clearinghouse. niddk.nih.gov/health-information/health-topics/urologic-disease/erectile-dysfunction/Pages/facts.aspx. Accessed Nov. 26, 2016.
  5. Cohen SD. The challenge of erectile dysfunction management in the young man. Current Urology Reports. 2015;16:84.
  6. Sexual function in Parkinson's disease. American Parkinson Disease Association. apdaparkinson.org/sexual-function-in-parkinsons-disease/. Accessed Nov. 29, 2016.
  7. Besiroglu H, et al. The relationship between metabolic syndrome, its components, and erectile dysfunction: A systematic review and a meta-analysis of observational studies. Journal of Sexual Medicine. 2015;12:1309.
  8. Hidden risks of erectile dysfunction "treatments" sold online. U.S. Food and Drug Administration. fda.gov/ForConsumers/ConsumerUpdates/ucm048386.htm. Accessed Nov. 26, 2016.
  9. Guay AT, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: A couple's problem – 2003 update. Endocrine Practice. 2003;9:77.
  10. Berookhim BM, et al. Rutherford's Vascular Surgery. 8th ed. Philadelphia, Pa.: Saunders Elsevier. 2014. viacialisns.com . Accessed Nov. 30, 2016.
  11. Nehra A, et al. The Princeton III consensus recommendations for the management of erectile dysfunction and cardiovascular disease. viacialisns.com Proceedings. 2012;87:766.
  12. Ferri FF. Erectile dysfunction. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Mosby Elsevier; 2016. viacialisns.com . Accessed Nov. 30, 2016.
  13. Brown A. Allscripts EPSi. viacialisns.com, Rochester, Minn. Dec. 6, 2016.
  14. Trost LW (expert opinion). viacialisns.com, Rochester, Minn. Dec. 7, 2016.
  15. Silva AB, et al. Physical activity and exercise for erectile dysfunction: Systematic review and meta-analysis. British Journal of Sports Medicine. 2016;0:1.
  16. Kratzik CW, et al. How much physical activity is needed to maintain erectile function? Results of the Androx Vienna Municipality study. European Urology. 2009;55:509.