Erectile dysfunction, or ED, is when a man has problems getting or keeping an erection that’s firm enough for sex. ED is sometimes called impotence, though health care providers don’t use this term as often. About 30 million men in the U.S. are affected by ED. Studies have shown roughly one half of American men over the age of 40 have some degree of ED. While ED is more common in older men, age alone does not cause ED. In fact, many men still enjoy sexual activity as they age. 

Diabetes (high blood sugar), heart disease, and sometimes treatments for prostate cancer can raise your chance of having ED. The good news is there are many safe and useful treatments to help men improve their sexual function. 

ED can be caused by physical, medical or emotional factors. Years ago, ED was mostly thought to be an emotional problem. Today, ED is mostly thought to be a physical or medical problem with three basic causes. The first cause is that not enough blood flows into the penis. Smoking, heart disease and high blood sugar can affect blood flow and lead to ED. 

The second cause is that the penis can’t store blood during an erection, meaning that the man can’t keep an erection because blood doesn’t stay trapped in the penis long enough. This type of problem is called venous leak or cavernosal dysfunction, and can happen at any age. 

The third cause of ED is nerve signals from the brain or spinal cord don’t reach the penis. Certain illnesses, injuries or surgeries in the pelvic area can cause damage to the nerves in the penis. 

ED can also result as a side effect of taking certain medications such as blood pressure medications, antihistamines, antidepressants and ulcer medications. 

Even when there is a physical cause, psychological or emotional factors may make ED worse. For example, a physical problem that slows a man’s sexual arousal can create anxiety, which in turn can worsen ED. Depression and past sexual traumas can also lead to ED. If this is your situation, speaking with a mental health provider about these issues may help. 

A primary care physician is often the first person a man will talk to about ED. He or she will perform a physical exam and take your medical history. Based on your symptoms, more tests may be ordered. “Many primary care doctors are comfortable prescribing first-line treatment for ED, which is usually an oral medication,” says Arthur Burnett, MD, Professor of Urology at Johns Hopkins School of Medicine. 

If your ED is not getting better or you have other problems related to sexual function, you may be referred to a urologist. A urologist is a medical doctor who specializes in health problems of the male and female urinary tract, and the male reproductive organs.

For some men, changing certain habits like quitting smoking or stopping drug and alcohol use can help, or even eliminate, ED. Diet, physical activity, and weight are also vital factors. 

If your ED is caused by taking certain medications (e.g. blood pressure), your health care provider may be able to change your medications or cut the amount of medicine you are taking. You should not stop taking your medications without talking to a health care provider first. 

Counseling or “talk therapy” is one more way to manage ED. Psychiatrists, psychologists, social workers and marriage counselors can help you deal with problems at home or work that may be affecting your sex life. Some counselors specialize in sex therapy, which involves talking about your feelings related to ED, sex and intimacy. Counseling can be done on your own or together with your partner. 

About 7 in 10 men respond well to oral medications for ED. Oral medications work by relaxing the muscle cells in the penis and allowing for better blood flow. This increased blood flow helps create a firm erection. There are also injectable medications, sometimes called self-injection therapy. This is when a man injects medication into the base of his penis or tiny medicated pellets into the urethra before sex. 

Vacuum erection devices can be used by any man with ED. These devices help pull blood into the penis to create an erection. Once the erection occurs, an elastic ring is put around the base of the penis. These rings help keep blood in the penis. Rings should not be used for more than 30 minutes, as they can cause tissue damage. Vacuum erection devices are safe and effective, but some men find them hard to use. 

Surgery and penile implants may be appropriate for a select group of men with ED. Surgery can correct problems with blood vessels in the penis. Bendable implants allow a man to bend his penis upward and into an erect position, while inflatable implants allow a man to pump fluid into the implant to make the penis rigid. 

“One of the most important advances came from a 2005 paper published in the Journal of the American Medical Association, which showed that ED was a strong predictor of future heart disease,” says Joseph Alukal, M.D., Associate Professor of Urology at New York University School of Medicine. 

When Dr. Burnett started practicing urology in the 1980s, it was common for doctors to suggest an herbal supplement called yohimbe, and counseling for men with ED. At that time, ED was thought to be caused by psychological or emotional reasons. “We’ve recognized that ED is mainly a physical problem that can be effectively treated with medications, devices and surgery, when appropriate. Today, we have many more choices to help men with ED.”

Herbal medications and supplements are not regulated by the FDA, and there is limited scientific proof these products are useful for ED. Tell your doctor if you are taking any forms of alterative or complementary therapy. These ingredients can interact with other medications and be dangerous. 

Researchers are exploring new ways to treat ED. For example, there are studies testing the use of shock wave therapy and stem cells for treating ED. Other studies are looking at tissue engineering and rebuilding the genital structure. To learn more about ED research, visit ClinicalTrials.gov. 

Erection recovery is possible with proper treatment, but men also have some responsibility for improving their sexual function. Stay in shape, workout, eat well, don’t smoke, get checkups and manage your stress. This will help you and your providers create a realistic plan for dealing with ED. 

To find a urologist near you visit: UrologyHealth.org.