Erection Problems Explained

What I need to know about Erection Problems

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What I need to know about erection problems

Some people can talk with their doctors about sex. Others feel that sex is private. They do not want to share details with anyone. But if you have problems getting or keeping an erection, you have good reasons to talk to a doctor: your health and your quality of life.

Erection problems used to be called "impotence." Now the term "erectile dysfunction" is more common. Sometimes people just use the initials ED.

ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.

Drawing of Caucasian male patient on examining table with Caucasian male doctor
ED is a medical problem. Your doctor can help.

Another reason to see your doctor is to treat ED itself. Your doctor can offer several new treatments. For many men, the answer is as simple as taking a pill. Other men have to try two or three options before they find a treatment that works for them. Don't give up if the first treatment doesn't work. Finding the right treatment can take time.

Drawing of happy older Caucasian man and woman, cheek to cheek


What causes an erection?

Hormones, blood vessels, nerves, and muscles must all work together to make an erection. Your brain starts an erection by sending nerve signals to the penis when it senses sexual stimulation. Touching may cause this arousal. Another trigger may be something you see or hear. It may be a sexual thought or dream.

Diagram of nerve pathways from the brain to the penis
Your brain starts an erection by sending nerve signals to the penis.

The nerve signals cause the muscles within the penis to relax and let blood flow into the spongy tissue within the penis. Blood collects in this tissue like water filling a sponge. The penis becomes larger and firmer, like an inflated balloon. The veins then get shut off to keep blood from flowing out.

After climax, or after the sexual arousal has passed, the veins open back up and blood flows back into the body.

Anatomical drawing of blood vessels in the penis
Healthy blood vessels are needed for an erection.


What causes erectile dysfunction?

Many different conditions can lead to ED. Most of the causes of ED are health problems requiring treatment to help prevent more serious complications than ED:

  • High blood pressure and high cholesterol can injure the arteries that supply blood to the penis.

  • Diabetes injures blood vessels and the nerves that control erections.

  • Alcohol and drug abuse can cause ED by damaging blood vessels and deadening the nerves that control erections.

  • Some prescription drugs such as some antidepressants or some high blood pressure medicines can cause ED. Your doctor may be able to change your drug treatment. Never stop taking a prescribed drug without talking to your doctor.

  • Unhealthy habits like smoking, overeating, and avoiding exercise can also contribute to ED.

  • Anything that's bad for your heart is also bad for your sexual health.

  • An injury to the spinal cord can cause ED by interfering with nerve signals.

  • Treatments for prostate cancer, including radiation and prostate removal, can damage the nerves that control erections.

  • Diseases that affect the nerves, like multiple sclerosis, can also lead to erection problems.

  • A small number of ED cases result from a reduced level of the male hormone testosterone.

  • Doctors used to believe that most cases of ED resulted from mental or emotional problems. We now know that most ED has a physical cause. But depression and worry or anxiety can still cause ED. And ED from physical causes can lead to depression and worry, making physical ED worse.

  • A person should not assume that ED is part of the normal process of aging. There is quite likely an underlying cause.


What will happen in the doctor's office?

Talking about ED can be difficult. You might use a phrase like "I've been having problems in the bedroom" or "I've been having erection problems." Remember that a healthy sex life is part of a healthy life. Don't feel embarrassed about seeking help. ED is a medical problem, and your doctor treats medical problems every day.

If the interaction with your doctor doesn't put you at ease, ask for a referral to another doctor. Your doctor may send you to a urologist-a doctor who specializes in sexual and urologic problems.

Your partner may want to come with you to see the doctor. Many doctors say ED is easier to treat when both partners are involved.

To find the cause of your ED, your doctor will take a complete medical history and do a physical examination.

Medical History

Your doctor will ask general questions about your health, as well as specific questions about your erection problems and your relationship with your partner. Bring a list of all the medications you take, or bring them with you to show to your doctor. Tell your doctor about any surgery you have had.

Your doctor will ask about habits like alcohol use, smoking, and exercise.

Your doctor might ask you questions like

  • How do you rate your confidence that you can get and keep an erection?

  • When you have erections with sexual stimulation, how often are your erections hard enough for penetration?

  • During sexual intercourse, how often are you able to maintain your erection after you have penetrated (entered) your partner?

  • When you attempt sexual intercourse, how often is it satisfactory for you?

  • How would you rate your level of sexual desire?

  • How often are you able to reach climax and have an ejaculation?

  • Do you have an erection when you wake up in the morning?

The answers to these questions will help your doctor understand the problem.

Physical Exam

A physical exam can help your doctor find the cause of your ED. As part of the exam, the doctor will examine your testes and penis, take your blood pressure, and check your reflexes. A blood sample will be taken to test for diabetes, cholesterol level, and other conditions that may be associated with ED.


How is erectile dysfunction treated?

Your doctor can offer a number of treatments for ED. You may want to talk with your partner about which treatment fits you best as a couple. Most people want the simplest treatment possible. You may need to try a number of treatments before you find the one that works best for you.

Lifestyle Changes

For some men, the answer is to make a few lifestyle changes. Getting more exercise, quitting smoking, losing weight, and cutting back on alcohol solve some erection problems.


Even though most cases of ED have a physical cause, counseling can help couples deal with the emotional effects. Some couples find that counseling adds to the medical treatment by making their relationship stronger.

Oral Medication

Since 1998, doctors have been able to prescribe a pill to treat ED. Current brands include Viagra, Levitra, and Cialis. If your doctor finds that your health is generally good, you may be given a prescription for one of these drugs. You should not take any of these pills to treat ED if you take any of the heart medicines called nitrates. All of the ED pills work by increasing blood flow to the penis. They do not cause automatic erections. Talk with your doctor about when to take the pill. You may need to experiment to find out how soon the pill takes effect.

Even if taking a pill solves your erection problem, you should still take care of the other health issues that may have caused your ED.


Taking a pill doesn't work for everybody. Many men use medicines that go directly into the penis. Caverject and Edex are injected into the shaft of the penis with a needle. MUSE is a tiny pill inserted into the urethra at the tip of the penis. These medicines usually cause an erection within minutes. These medications can be very successful, even if other treatments fail.

Vacuum device

Another way to create an erection is to use a vacuum tube. The penis is inserted in the tube. As air is pumped out of the tube, the volume of the penis expands. Blood then flows into the penis and makes it larger. A specially designed rubber band is then placed at the base of the penis to keep the blood from flowing out.

Drawing of vacuum device used to make the penis erect
When air is pumped out of the tube, blood flows into the penis and makes an erection.

Penile Implant

If the other options fail, some men need surgery to treat ED. A surgeon can implant a device that inflates or unbends to create an erection. Implanted devices do not interfere with the way sex feels.

This operation cannot be reversed. Once a man has a penile implant, he must use a device to have an erection. Talk with your doctor about the advantages and possible drawbacks of having a penile implant.

Drawing of inflatable penile implant
A pump implanted under the skin fills two rods with fluid to make an erection.


Points to Remember

  • Erection problems may be a sign of health problems.
  • A doctor can help you overcome erection problems.
  • Smoking, being overweight, and avoiding exercise can contribute to erection problems.
  • Most cases of ED have a physical cause, but counseling can help couples build a stronger relationship.
  • Many men can take a pill to treat ED. These men should still treat the health conditions that caused ED.
  • Taking a pill doesn't work for everybody.
  • Men who take any of the medicines called nitrates should not take a pill to treat ED.

Drawing of happy, middle-aged African American man and woman