Erectile Dysfunction

Erectile Dysfunction

Causes, Symptoms and Treatments

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This content is intended for US audiences only

Stefano Mirabello NowPatientGreen tick
Created on 16 Jul 2024
Updated on 17 Jul 2024

Erectile dysfunction (ED) is a prevalent condition that affects many men worldwide. Here, we aim to provide you with a comprehensive overview of erectile dysfunction, including its definition, causes, risk factors, and available treatment options. By understanding the complexities of ED, men and their partners can seek appropriate help, find effective solutions, and enhance their intimate health and overall well-being.

What is the definition of erectile dysfunction?

Erectile dysfunction (ED) is clinically defined as the consistent or recurrent inability to attain and/or maintain an erection sufficient for satisfactory sexual performance. It involves a difficulty in achieving or sustaining an erection that is firm enough for sexual intercourse. This condition is considered significant when it persists for a period of at least three months or causes distress to the individual or their partner.

The clinical definition of ED takes into account both the physical and psychological aspects of the condition. It recognizes that various factors, including underlying medical conditions, lifestyle choices, and psychological factors, can contribute to the development of erectile difficulties. It is important to note that occasional episodes of erectile problems are common and may not necessarily indicate the presence of erectile dysfunction.

What are the causes of erectile dysfunction?

Erectile dysfunction (ED) can have various underlying causes, including physical, psychological, and lifestyle factors. Understanding these causes can help in identifying the appropriate treatment and management strategies. Here are some common causes of erectile dysfunction

Physical factors

  • Cardiovascular conditions: Conditions such as hypertension (high blood pressure), atherosclerosis (narrowing of arteries), and heart disease can impair blood flow to the penis, affecting erectile function
  • Diabetes: Uncontrolled diabetes can damage blood vessels and nerves, contributing to ED
  • Neurological disorders: Conditions such as multiple sclerosis, Parkinson’s disease, and spinal cord injuries can interfere with nerve signals involved in the erectile process
  • Hormonal imbalances: Low testosterone levels, a condition known as hypogonadism, can contribute to erectile difficulties
  • Obesity: Excess weight and obesity can increase the risk of ED by affecting hormone levels, blood flow, and overall vascular health
  • Medications: Certain medications, including those for high blood pressure, antidepressants, antihistamines, and chemotherapy drugs, can have side effects that impact erectile function
  • Smoking and substance abuse: Smoking and the use of recreational drugs, including alcohol and illicit substances, can negatively affect blood flow and nerve function, leading to ED
  • Surgical procedures: Surgeries involving the prostate, bladder, or pelvic region can sometimes damage nerves and blood vessels involved in erectile function
  • Prostate Cancer: A study by Prostate Cancer UK showed that 76% of men who are treated for prostate cancer experience erectile dysfunction (ED)
  • Peyronie’s disease: Peyronie’s disease is a non-cancerous condition caused by fibrous scar tissue that results in a painful, curved erection.  Peyronie’s disease can cause erectile dysfunction

Psychological Factors

  • Stress and anxiety: High levels of stress, anxiety, and performance-related pressure can interfere with sexual arousal and contribute to erectile difficulties
  • Depression: depression can affect sexual desire and interfere with the release of chemicals in the brain necessary for achieving and maintaining an erection
  • Relationship issues: Difficulties within a relationship, communication problems, or unresolved conflicts can impact sexual performance and contribute to ED

Lifestyle factors

  • Sedentary lifestyle: Lack of regular physical activity and a sedentary lifestyle can contribute to obesity, cardiovascular issues, and reduced blood flow, all of which can affect erectile function
  • Poor diet: Diets high in saturated fats, processed foods, and low in fruits, vegetables, and whole grains can contribute to underlying health conditions that affect erectile function
  • Substance abuse: Excessive alcohol consumption, smoking, and the use of recreational drugs can contribute to ED by affecting blood flow and nerve function

It is important to note that ED can result from a combination of factors, and the specific cause may vary from individual to individual. Consulting with a healthcare professional is crucial to determine the underlying cause of ED and develop an appropriate treatment plan based on individual circumstances.


What are the risk factors of erectile dysfunction?

Risk factors are conditions or factors that increase the likelihood of developing erectile dysfunction (ED)


The prevalence of ED tends to increase with age. It is more common in older men, although it can affect men of all ages

Chronic medical conditions

  • Cardiovascular disease: Conditions such as hypertension (high blood pressure), atherosclerosis (hardening of arteries), and heart disease can increase the risk of ED due to compromised blood flow to the penis
  • High cholesterol: The link between high cholesterol and heart disease is the reason why people with high cholesterol are likely to develop erectile dysfunction
  • Diabetes: Uncontrolled diabetes can damage blood vessels and nerves, leading to ED
  • Neurological disorders: Conditions like multiple sclerosis, Parkinson’s disease, and spinal cord injuries can interfere with nerve signals involved in achieving and maintaining an erection
  • Hormonal imbalances: Low testosterone levels, often associated with aging, can contribute to ED
  • Obesity: Excess weight and obesity can increase the risk of ED by affecting hormone levels, blood flow, and overall vascular health

Lifestyle choices

  • Smoking: Smoking damages blood vessels and reduces blood flow, increasing the risk of ED
  • Excessive alcohol Consumption: Heavy alcohol use can impair sexual function and contribute to ED
  • Substance abuse: Illicit drug use, such as cocaine or methamphetamines, can have a negative impact on erectile function

Psychological factors

  • Stress and anxiety: High levels of stress, anxiety, and performance-related pressure can contribute to ED
  • Depression: Depression can affect sexual desire and interfere with the release of chemicals in the brain necessary for achieving and maintaining an erection

What are the complications of erectile dysfunction?

Complications refer to the potential consequences that can arise from untreated or poorly managed ED.

  • Relationship issues: ED can strain relationships, leading to feelings of frustration, dissatisfaction, and decreased intimacy between partners
  • Emotional and psychological impact: ED can significantly impact a man’s self-esteem, causing feelings of inadequacy, embarrassment, and decreased sexual confidence. It may also lead to anxiety, depression, or other psychological issues
  • Reduced quality of life: ED can negatively affect overall well-being and quality of life due to the impact on sexual satisfaction and intimacy
  • Underlying health conditions: ED can sometimes be an early warning sign of underlying health conditions, such as cardiovascular disease or diabetes. Therefore, addressing ED may prompt early detection and management of these conditions
  • Treatment non-compliance: If left untreated, ED may lead to frustration, resignation, or avoidance of sexual activity, which can worsen the condition and reduce motivation to seek treatment
  • Premature ejaculation (PE): Premature ejaculation (PE) can often be a concern for individuals who also struggle with erectile dysfunction (ED).  ED can result in the inability to ejaculate

It’s important to remember that early intervention and appropriate treatment can often help manage ED and reduce the risk of complications. Consulting with a healthcare professional is crucial to determine the underlying causes, identify associated risk factors, and develop a tailored treatment plan for ED.

How is erectile dysfunction diagnosed?

The diagnosis of erectile dysfunction (ED) involves a comprehensive evaluation by a healthcare professional. The process typically includes a detailed medical history, a physical examination, and, if necessary, additional diagnostic tests. Here are the key components of diagnosing ED

Medical history

  • The healthcare professional will ask questions about the patient’s symptoms, the frequency and duration of erectile difficulties, any underlying medical conditions, medications being taken, and lifestyle factors
  • Discussing any psychological factors, relationship issues, or previous experiences that may contribute to ED

Physical examination

  • The healthcare professional may perform a physical examination to assess general health problems, including blood pressure measurements, examination of the genitals, and evaluation of secondary sexual characteristics
  • Special attention may be given to assessing nerve sensation and blood flow in the pelvic region

Laboratory tests

  • Blood tests: These may be conducted to assess hormone levels, such as testosterone, as low testosterone can contribute to ED. Blood tests may also evaluate blood sugar levels, lipid profile, and other factors related to erectile function
  • Urine tests: Urinalysis may be done to check for underlying health conditions, such as diabetes or kidney problems

Psychological assessment

  • The healthcare professional may inquire about psychological factors that could contribute to ED, such as stress, anxiety, depression, or relationship issues
  • In some cases, psychological assessments or questionnaires may be used to evaluate the impact of psychological factors on erectile function

Additional tests

  • Nocturnal penile tumescence (NPT) test: This test involves monitoring the frequency and quality of erections that occur during sleep. It helps determine if there are underlying physical causes for ED
  • Doppler ultrasound: This test uses ultrasound waves to evaluate blood flow and identify any vascular issues that may be causing ED
  • Injection test: A medication is injected into the penis to induce an erection and assess the response, helping determine if the cause of ED is primarily physical or psychological

The diagnostic process aims to identify any underlying medical conditions, psychological factors, or lifestyle factors that contribute to ED. It helps determine the most appropriate treatment options based on the individual’s specific needs and circumstances. Consulting with a healthcare professional is crucial for an accurate diagnosis and to develop a personalized treatment plan for ED

What are the treatment options for erectile dysfunction?

Erectile dysfunction treatments depend on the underlying cause, the severity of symptoms, the individual’s overall health, and personal preferences. Here are the common treatment approaches for ED

Lifestyle modifications

  • Healthy diet: Adopting a balanced diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats can improve overall cardiovascular health and potentially enhance erectile function
  • Regular exercise: Engaging in regular physical activity, such as aerobic exercises, strength training, and pelvic floor exercises (Kegels), can improve blood flow, cardiovascular health, and overall well-being, potentially improving erectile function
  • Smoking cessation: Quitting smoking can improve blood flow and enhance erectile function
  • Alcohol moderation: Reducing excessive alcohol consumption can help improve sexual function

Oral medications (Phosphodiesterase type 5 inhibitors)

FDA and MHRA approved Medications such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) are commonly prescribed. These medications enhance the effects of nitric oxide, a chemical that relaxes the smooth muscles in the penis, allowing increased blood flow for improved erections. They require sexual stimulation to be effective and should be taken under medical supervision

Vacuum erection devices (VED)

A vacuum device is a mechanical device that creates a vacuum around the penis, drawing blood into it to produce an erection. A constriction ring is then placed at the base of the penis to maintain the erection temporarily

Penile injections and urethral suppositories

Medications such as alprostadil can be injected directly into the base or side of the penis, or inserted into the urethra, to stimulate blood flow and produce an erection. These methods are typically used when oral medications are ineffective or contraindicated

Penile implants

For individuals who do not respond to other treatments or prefer a more permanent solution, penile implants may be considered. These surgical devices are implanted into the penis to provide an erection on demand. There are inflatable and malleable (bendable) implant options

Psychotherapy and counseling

If psychological factors, such as stress, anxiety, or relationship issues, contribute to ED, therapy or counseling may help. Techniques like cognitive-behavioral therapy (CBT), sex therapy, or couples therapy can address emotional barriers and improve sexual functioning

Testosterone replacement therapy (TRT)

If low testosterone levels contribute to ED, testosterone replacement therapy may be considered. It involves the use of testosterone medications, such as gels, patches, or injections, under medical supervision


Red ginseng, Vitamin D, L-arginine, Tribulus terrestris, L-carnitine

It’s important to consult with a healthcare professional to determine the most suitable treatment option based on individual needs, overall health, and preferences. They can provide personalized recommendations and guidance to help manage ED effectively.

What Erectile Dysfunction support organizations are available in the UK? 

In the United Kingdom, there are several organizations that offer support and resources for individuals with erectile dysfunction (ED). Here are a few:

  • British Society for Sexual Medicine (BSSM): This society encourages the highest standards of practice, education and research in the field of human sexual function and dysfunction
  • Sexual Advice Association (SAA): This charitable organization aims to help improve the sexual health and wellbeing of men and women and to raise awareness of the extent to which sexual conditions affect the general population
  • Men’s Health Forum (MHF): MHF is a charity that provides an independent and authoritative voice for male health in England and Wales and tackles the issues and inequalities affecting the health and well-being of men and boys
  • Relate: While not specifically for erectile dysfunction, Relate provides relationship support for individuals and couples, and this includes dealing with issues around sex, such as erectile dysfunction
  • Impotence Association (The Sexual Dysfunction Association): This is an organization that provides information and support for people with sexual dysfunctions, such as erectile dysfunction. Website: They used to have a website, but it appears to no longer be active as of my knowledge cutoff in September 2021. You may want to search online or ask a healthcare provider for the most current contact information
  • NHS: The NHS offers a wealth of information on erectile dysfunction, including symptoms, causes, diagnosis, treatment and prevention

What Erectile Dysfunction support organizations are available in the US?

Several organizations in the United States offer support and resources to people with erectile dysfunction (ED) and their families. Here are a few:

  • Sexual Medicine Society of North America (SMSNA): The SMSNA promotes, encourages and supports the highest standards of practice, research, education, and ethics in the study of human sexual function and dysfunction
  • American Sexual Health Association (ASHA): The ASHA promotes sexual health, offering resources on a variety of sexual health issues, including erectile dysfunction
  • American Urological Association (AUA): The AUA promotes the highest standards of urological clinical care through education, research and in the formulation of health care policy. They provide resources and guidelines on the diagnosis and treatment of ED
  • Men’s Health Network (MHN): MHN is a non-profit educational organization committed to improving the health and wellness of men. They provide a variety of resources on men’s health issues, including erectile dysfunction
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): The NIDDK provides comprehensive information about the causes, diagnosis, and treatment of erectile dysfunction
  • Urology Care Foundation: The official foundation of the American Urological Association, they provide educational material and resources on a range of urological conditions, including erectile dysfunction


Erectile dysfunction is a common and treatable condition that can significantly impact a man’s self-esteem, relationships, and overall well-being. By understanding the causes, risk factors, and available treatment options, men can seek appropriate help and regain their sexual confidence. It is important for individuals and healthcare providers to address the physical, psychological, and emotional aspects of ED, promoting comprehensive care and enhancing intimate health for men and their partners.

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The information provided here about medications is subject to change and is not meant to include all uses, precautions, warnings, directions, drug interactions, allergic reactions, or negative effects. The absence of warnings or other information for a particular medication does not imply that the medication or medication combination is appropriate for all patients or for all possible purposes.

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