Am Fam Physician. 2016;94(10):online
See related article on erectile dysfunction
What is erectile dysfunction?
Erectile dysfunction (ED) is when you cannot get or keep a good enough erection to have sex that is satisfying for you and your partner.
Are there other reasons to be concerned about ED?
It is normal to have ED once in awhile. But if it happens a lot, you may have a problem. Men with ED are at higher risk of heart problems. Men can have ED at any age, but it usually happens in middle-aged and older men.
What causes it?
The most common cause is not enough blood flow to the penis. When you get an erection, signals from the brain are sent to the nerves and blood vessels in the penis. This allows the penis to fill with blood. Some medical conditions block these signals, such as strokes, spine or pelvic injuries, Parkinson disease, and multiple sclerosis. Nerve damage from diabetes or prostate surgery can also cause ED.
Other things that increase the risk of ED include:
Being obese or overweight
Cigarette smoking or other tobacco use
Drug use (amphetamines, cocaine, heroin, or marijuana)
Hardening of the arteries
Having been sexually abused in the past
High blood pressure
Low testosterone or other hormone problems
Some medicines—especially medicines used to treat depression—can stop you from getting an erection. They can also lower your desire to have sex. Ask your doctor if any of the medicines you take might cause ED.
How is it treated?
It depends on what is causing it. You may need to stop smoking or using drugs, or drink less alcohol. You may need to lose weight or get regular exercise. If you have diabetes, high blood pressure, or high cholesterol, treating these conditions can help your ED.
There are medicines that can help you keep an erection longer. Counseling may help some men. If these don't work, talk to your doctor about other options.
Where can I get more information?
AAFP's Patient Information Resource
American Urological Association Foundation
National Institutes of Health