Symptoms of Erectile Dysfunction

At one point or another, most adult men will have trouble getting or keeping an erection long enough to have sex. This usually resolves on its own with little or no treatment. However, when it becomes an ongoing problem, it is called erectile dysfunction (ED).

ED can be caused by a physical problem, an emotional problem, or a combination of both. Many men are hesitant to see a doctor for their ED. However, when it happens regularly it can affect your personal life and overall health.

This article discusses the causes and symptoms of erectile dysfunction along with how it is diagnosed, how it is treated, and when you should see your doctor.

Erectile Dysfunction Symptoms

Erectile dysfunction is a common problem among men, affecting approximately 30 million men in the United States. ED typically develops over time, although it can happen suddenly for seemingly no reason at all.

It is not ED when it happens on occasion, for example, after a night of several drinks or even during a week when you are experiencing severe stress. However, it may be erectile dysfunction when it happens 25% of the time or more.

The primary symptoms of erectile dysfunction are:

• Difficulty getting an erection: The inability to get a firm enough erection to have sex when you desire it.
• Difficulty keeping an erection: The inability to keep an erection firm for long enough to complete sex or truly enjoy it.

Other physical symptoms of ED that you could experience include:

• Premature ejaculation
• Delayed ejaculation
• Inability to ejaculate
• Reduced libido or sex drive
• A dysfunction in the pelvic floor muscles
• Trauma to the pelvis, such as pelvic fractures
• Anorgasmia—failure to become aroused after sufficient stimulation
• Low testosterone levels
• Difficulty getting your partner pregnant

For many men, ED also causes emotional and psychological distress. ED can affect your relationships and your self-esteem, and may lead to feelings of guilt, embarrassment, shame, or other difficult emotions.

Causes

Sexual arousal is a complex bodily function influenced by a combination of age, hormones, stress, emotions, the nervous system, muscle tone, circulation, and more.

The most common cause of erectile dysfunction is arteriosclerosis—a condition in which the arteries harden. With ED, arteriosclerosis may begin in the penile arteries then progress until it affects the arteries that supply the heart with blood.

Other factors and conditions that could lead to erectile dysfunction include:

• Traumatic injury: Any trauma to the spine, pelvis, or perineum that damages penile blood vessels can cause ED.
• Vascular disease: ED can be an early sign of vascular diseases like atherosclerosis, in which the arteries harden due to plaque buildup, as well as coronary artery disease.
• Diabetes: Approximately 35% to 50% of men with diabetes have ED; diabetes may contribute to ED because of how it damages the nerves that control erections.
• Depression: Both depression and antidepressant medications are known to cause ED. Men with ED and depression should be screened for cardiovascular disease, as the three often occur together.
• Nerve problems: Numerous nerve problems stemming from diabetes, spinal cord injury, chronic alcoholism, multiple sclerosis, heavy metal poisoning, and others are all associated with ED.
• Medications: ED can be a side effect of drugs used to treat high blood pressure, anxiety and depression, glaucoma (eyedrops), kidney failure (dialysis), cancer (chemotherapy), and more.
• Hormones: Abnormal levels of thyroid hormone, testosterone, or a hormone called prolactin can lead to ED.

Risk Factors

Erectile dysfunction can be its own condition, but in many cases it is a symptom of another underlying condition.

Your risk of developing erectile dysfunction is higher if you have one of more of the following:

• Prostate cancer, prostate gland inflammation (prostatitis), and other prostate problems
• Type 2 diabetes
• Hypogonadism—the medical term for low sex drive
• High blood pressure
• High LDL cholesterol
• Chronic sleep disorders, such as insomnia or obstructive sleep apnea
• Peyronie's disease—a connective tissue disorder that causes the penis to curve when erect
• Penis inflammation
• Depression
• Chronic diseases, including heart disease, arterial disease, and kidney failure

Increasing age is a big risk factor for erectile dysfunction as well. An estimated 8% of men between the ages of 40 and 49, and 76% of men older than 75 have ED. Increasing age is also a risk factor for several conditions listed above, including prostate cancer, high blood pressure, and heart disease.

Diagnosis

The key to resolving ED is finding and treating the underlying cause as early as possible. Your doctor will likely utilize four types of procedures to find out why you are experiencing ED.

First, your doctor may begin by asking you about your medical and sexual history. They may ask about your sex drive, how long you have been having symptoms, and whether or not you are able to ejaculate or achieve orgasm.

From there, your doctor will move forward with a physical examination to check for problems with your hormones, nervous system, circulation, or other physical characteristics.

Next, your doctor may order a blood test, urine analysis, or other lab tests to measure your hormone levels and cholesterol. They will also check for elevated levels of liver enzymes, which can tell them if there is inflammation in your body.

Finally, your doctor may want to perform a psychosocial examination to evaluate your mental health and ensure that your ED isn't caused by emotional or psychological distress of some kind.

There is no need to feel any shame throughout this process. Rest assured that your physician has probably seen and heard it all before, so it's best to be honest. Your physician's sole focus is to diagnose you properly and get you well on your way.

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Treatment

Your doctor will determine your treatment based on several factors, including your age and overall health, your medical history, and your treatment preferences.

If a separate condition underlies your ED, resolving that condition will probably be your doctor's first concern.

For example, if your doctor finds that a hormone irregularity is causing your ED, they may recommend hormone replacement therapy. In particular, you may be given testosterone replacement therapy if your testosterone is low. This therapy may be injected, applied topically to the skin, or taken via a skin patch.

If treating the underlying condition doesn't resolve your ED, or if you don't have an underlying condition to start with, you may be prescribed one of the following ED medications:

• Viagra (sildenafil)
• Levitra (vardenafil)
• Cialis (tadalafil)
• Stendra (avanafil)

These medications do come with risk of side effects. To lower your risk, make sure you are clear with your doctor about any other prescription or over-the-counter drugs you are already taking.

Finally, if you and your doctor have exhausted all other treatment options yet you are still experiencing ED, your doctor may recommend a penile prosthesis, which can simulate an erection whenever you desire. There are two types:

An inflatable penile prosthesis is a pump with a saline-filled reservoir that is surgically implanted in your penis and scrotum. Opening the valve to the reservoir will create an erection; upon releasing the valve, your penis will become flaccid.

A semi-rigid penile prosthesis consists of two bendable rods that are implanted into your penis, which you will be able to manually straighten or bend as needed.

Both types of penile implant surgeries have a high patient satisfaction rate and are considered safe. Nonetheless, as is the case with any surgery, there is always a risk of complications, including uncontrolled bleeding and wound infection.

Summary

Erectile dysfunction is a very common condition, especially among older adult men. The condition may result from a physical injury or disease, emotional or psychological distress, or a combination of both.

Because ED is associated with numerous comorbid conditions, it's important to see your doctor if you have trouble getting or keeping an erection. Your doctor may use physical and psychological procedures and lab tests to find the cause of your ED.

A Word From Verywell

Despite how common erectile dysfunction is, many men feel deeply uncomfortable talking about it with their sexual partner(s). Being unable to communicate your needs will only place further stress on your relationship, slow your healing, and make it difficult for you to cope.

Be honest and open with your partner when discussing your ED. Listen to what they have to say. You might just find that there are other exciting ways to give and receive sexual pleasure, even when intercourse is not an option.