Erectile difficulties are common, often treatable, and can be an early sign of heart and blood vessel disease. See a licensed provider for new or persistent symptoms, and seek emergency care for an erection lasting more than 4 hours.
Erectile difficulties, known medically as erectile dysfunction (ED), mean trouble getting or keeping an erection firm enough for sex. They are common, they become more common with age, and they are often treatable once the cause is understood. ED can also sometimes be an early signal of heart and blood vessel disease, which is a good reason to bring it up with a licensed provider rather than simply living with it.
According to the NIDDK, research suggests that between 30 million and 50 million men in the United States have ED. About 40% of men are affected at age 40, and 70% report ED by age 70. Even so, the NIDDK is clear that ED is not a routine part of aging, and it can often be treated.
Symptoms can look different from person to person. The NIDDK describes three common patterns:
If a pattern persists, or there is a clear change from what is normal for you, it is worth discussing.
An erection depends on healthy blood vessels, nerves and hormones, plus a mind that is not overwhelmed by stress. The NIDDK groups the causes into four broad categories.
| Category | Examples from the NIDDK |
|---|---|
| Diseases and conditions | Diabetes; atherosclerosis, high blood pressure and stroke; chronic kidney disease, obesity and COPD; low testosterone and thyroid imbalance; nerve damage from multiple sclerosis, spinal cord injury or pelvic surgery; enlarged prostate or Peyronie's disease |
| Medicines | Antidepressants, blood pressure medicines and diuretics, antihistamines, some pain relievers, sedatives, chemotherapy and hormone medicines, and others |
| Mental and emotional health | Anxiety, depression or stress; feeling isolated; low self-esteem or negative body image |
| Lifestyle | Not enough physical activity, drinking too much alcohol, smoking, and recreational or illicit drug use |
Often more than one factor is involved. For example, a health condition can cause the first difficulty, and anxiety about it happening again can make the next experience harder. If you think a medication is playing a role, do not stop it on your own. The NIDDK advises talking with your health care professional first, and our article on medications that can affect sexual function explains what to ask.
ED and cardiovascular disease share many of the same risk factors, including age, diabetes, high blood pressure, high cholesterol and smoking. A 2005 study in JAMA followed 9,457 men aged 55 and older in the placebo group of the Prostate Cancer Prevention Trial. Among men without cardiovascular disease at the start, those who later developed ED had a 25% higher risk of subsequent cardiovascular events after adjusting for other risk factors (hazard ratio 1.25). For men with either new or existing ED, the hazard ratio was 1.45.
The authors noted that this increase was in the range of risk associated with current smoking or a family history of heart attack, and they concluded that ED should prompt investigation of cardiovascular risk factors. In practical terms, that can mean a provider evaluating ED checks blood pressure, blood sugar and cholesterol and ask about chest pain or shortness of breath with exertion. That is not a reason for alarm. It is an opportunity to catch and manage risk factors early.
The NIDDK explains that clinicians treat the underlying cause when possible and otherwise focus on improving sexual function. The American Urological Association (AUA) guideline, published in 2018, puts shared decision-making at the center: patients should be informed of all treatment options that are not contraindicated for them, and should understand the benefits, risks and burdens of each.
The NIDDK lists quitting smoking, limiting alcohol, increasing physical activity, maintaining a healthy weight, following a healthy eating plan and stopping recreational drug use as lifestyle changes that may help. Counseling can help when anxiety, stress or relationship factors are involved, and partners are often welcome. Our article on lifestyle and sexual health reviews the trial evidence.
PDE5 inhibitors, such as sildenafil and tadalafil, are FDA-approved oral medications that the NIDDK describes as improving blood flow to the penis. They are the most familiar prescription option, although NewDay Wellness does not offer them. Men with ED and low testosterone may be prescribed testosterone alongside a PDE5 inhibitor. Other FDA-approved options include injectable medicines and urethral suppositories, which a clinician teaches you to use.
PT-141 (bremelanotide) is sometimes discussed for men. No bremelanotide product is FDA-approved for men, so any use in men is off-label, and compounded PT-141 is not FDA-approved. Our PT-141 explainer covers its label warnings, including blood pressure effects.
Vacuum erection devices draw blood into the penis and use an elastic ring to maintain the erection. The NIDDK notes that most people with ED do not need surgery, but penile implants or, for some younger men, procedures to improve arterial blood flow are options when other approaches have not worked.
Make a routine appointment with a licensed provider if:
Seek emergency care right away for an erection that lasts more than 4 hours. This is called priapism. MedlinePlus describes an erection that does not go away as a medical emergency, and the NIDDK lists erections lasting longer than 4 hours as a side effect of ED medicines that needs immediate attention. The NIDDK also advises calling your health care professional right away about sudden vision or hearing loss after taking an oral ED medicine. For chest pain, trouble breathing or fainting, call 911.
It can be, in some men. The 2005 JAMA study found that new ED was associated with a higher risk of later cardiovascular events, and the authors recommended evaluating cardiovascular risk factors in men with ED. A licensed provider can decide which checks make sense for you.
No. The NIDDK lists anxiety, depression, stress, isolation and low self-esteem as factors that can cause ED or make it worse. Physical and emotional factors often overlap, which is why a full history matters.
The NIDDK advises talking with a health care professional before using dietary supplements or alternative products for ED, because they can interact with other medicines. The FDA has also found hidden prescription drug ingredients in many products sold for sexual enhancement; our article on unregulated enhancement products explains the risks.
Bring a list of every prescription, over-the-counter medicine and supplement you take, along with any history of diabetes, heart disease or pelvic surgery. Note when symptoms started and whether they happen in all situations or only some.
Erectile difficulties are a common health concern, and talking about them is the first step toward understanding the cause. A licensed provider can review your history, check for related conditions and walk you through options that fit your health and preferences. You can learn more on our sexual health page. This article is educational and does not determine eligibility for any treatment.
Written by the NewDay Wellness editorial team from the sources above and checked against them before publication, and medically reviewed by Dr. Sean Arora and Dr. Shannon Arora of Arora Health & Aesthetics; see our editorial standards. This article is educational and does not diagnose conditions, establish eligibility for any medication, or replace care from a licensed provider. Compounded medications are not FDA-approved.
The FDA warns that many sexual enhancement products sold as supplements, honeys, chocolates or "natural" pills contain hidden prescription drug ingredients that can cause dangerous drops in blood pressure and other harm.
Read articleMany common medications, including some antidepressants, blood pressure medicines, hormonal treatments and opioids, can affect desire, arousal, erections or orgasm. Never stop a medication on your own; talk with your prescriber about options.
Read articlePT-141 is bremelanotide, a melanocortin receptor agonist. One FDA-approved product (Vyleesi) treats acquired, generalized low desire in premenopausal women; use in men is off-label, and compounded PT-141 is not FDA-approved.
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