Erectile dysfunction (ED) is a common sexual health condition in which a person assigned male at birth cannot achieve or maintain an erection firm enough for sexual activity. Although it can happen at any age, the likelihood increases with age.

Research estimates that more than 12 million people in the United States are affected by ED. The condition can be temporary or long-lasting, and it often has multiple causes, including chronic illnesses, psychological stress, medication side effects, and lifestyle habits.

Symptoms of Erectile Dysfunction

ED symptoms can vary from mild to severe and may appear occasionally or consistently. A diagnosis is usually considered when problems persist for six months or more. You may have ED if:

  • You are completely unable to achieve an erection

  • You can get an erection but cannot maintain it long enough for sex

  • You sometimes fail to achieve an erection despite sexual arousal

  • Erections are weak or “soft” and do not allow full sexual activity

Beyond the physical challenges, ED often leads to emotional distress, performance anxiety, and strain on intimate relationships. It is also linked to conditions like depression and low self-esteem.

What Causes Erectile Dysfunction?

An erection occurs when blood fills spongy tissue in the penis, controlled by the nervous system and influenced by hormones. ED develops when this process is disrupted.

Because ED is a multifactorial condition, causes may include:

  • Cardiovascular issues such as atherosclerosis or heart disease

  • Nerve disorders, including multiple sclerosis or spinal injuries

  • Hormonal imbalances such as low testosterone

  • Side effects from medications (e.g., antidepressants, sedatives, blood pressure drugs)

  • Psychological issues such as anxiety, depression, or stress

  • Lifestyle factors including smoking, excessive alcohol, obesity, or lack of exercise

Risk Factors

Certain conditions and behaviors increase the likelihood of ED. Common risk factors include:

  • Type 2 diabetes

  • Cardiovascular disease and hypertension

  • Kidney disease

  • Depression and anxiety

  • Cancer treatments that affect pelvic nerves

  • Smoking and excessive alcohol use

  • Obesity and sedentary lifestyle

  • Advancing age

Diagnosing Erectile Dysfunction

Diagnosis begins with a detailed discussion of your health history, symptoms, and lifestyle. Questionnaires such as the International Index of Erectile Function (IIEF) may be used to assess severity.

Tests that may follow include:

  • Physical examination: Checking circulation, hormone balance, penile sensitivity, and signs of structural abnormalities

  • Mental health evaluation: Screening for depression, anxiety, or psychological causes

  • Laboratory tests: Blood or urine tests to detect diabetes, kidney disease, or hormone issues

  • Imaging (Doppler ultrasound): To measure blood flow to the penis

  • Nocturnal erection testing: Monitoring erections during sleep

  • Injection test: Using medication to trigger an erection and assess function

Treatment Options

ED treatment focuses on improving symptoms and addressing underlying causes.

Lifestyle modifications such as quitting smoking, reducing alcohol intake, exercising, and managing weight are often the first step.

Medications include oral PDE-5 inhibitors such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil). These drugs improve blood flow to support erections.

Injections such as alprostadil may be used when pills are not effective.

Vacuum erection devices (VEDs) create suction to draw blood into the penis and are often successful.

Preventing Erectile Dysfunction

Prevention is closely tied to healthy lifestyle habits and managing chronic conditions:

  • Stop smoking and limit alcohol

  • Maintain a healthy weight and active lifestyle

  • Control high blood pressure, cholesterol, and diabetes

  • Reduce stress and treat depression or anxiety early

  • Avoid illicit drugs

Comorbid Conditions

ED is often linked to other health issues, including:

  • Hypertension and cardiovascular disease

  • High cholesterol

  • Type 2 diabetes

  • Depression and anxiety

Because ED can be an early warning sign of serious health problems, seeking medical advice is essential.

Living With Erectile Dysfunction

ED can affect mental health, self-confidence, and relationships, but treatment options are highly effective. Talking openly with your partner and seeking professional support can make a big difference. Counseling, medical treatments, and lifestyle adjustments allow most people with ED to live fulfilling lives.