Erectile Dysfunction

Issue

Vol. 2 No. 2 (2025)

Date Log

Submitted
November 30, 2024
Accepted
April 6, 2025
Published
April 10, 2025

Erectile Dysfunction(ED) - Causes, Symptoms, Diagnosis, Treatment & Prevention

https://doi.org/10.69512/ajphi.v2i2.82
Dipendra Kandel, MD
Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal
https://orcid.org/0000-0001-7790-1278
Aakriti Karki, MD
Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh
https://orcid.org/0009-0007-4024-1617
Gauri Adhikari, MD
Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal

Corresponding Author(s) : Dipendra Kandel, MD

dipendrakandel5000@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 2 (2025)

Abstract


  1. Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

  2. While ED is more common in older men, it is not an inevitable part of aging. Younger men can experience ED, often due to psychological factors or lifestyle choices.

  3. ED can be caused by diabetes, high blood pressure, heart disease, and obesity, along with psychological conditions such as anxiety, stress, and depression.

  4. Lack of sexual attraction to your partner can be one of the causes of your erectile dysfunction.

  5. Exercise caution with advertised treatments for ED that are not FDA-approved.

Keywords

Erectile Dysfunction Older Men Sexual Attraction FDA Approved Treatment
Kandel, MD, D., Karki, MD, A., & Adhikari, MD, G. (2025). Erectile Dysfunction(ED) - Causes, Symptoms, Diagnosis, Treatment & Prevention. The American Journal of Patient Health Info, 2(2). https://doi.org/10.69512/ajphi.v2i2.82
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. Rew KT, Heidelbaugh JJ. Erectile Dysfunction. American Family Physician [Internet]. 2016 Nov 15;94(10):820–7. Available from: https://pubmed.ncbi.nlm.nih.gov/27929275/
  2. Lue TF. Erectile Dysfunction. Wood AJJ, editor. New England Journal of Medicine. 2000 Jun 15;342(24):1802–13.Available from: https://doi.org/10.1056/NEJM200006153422407.
  3. Mazzilli F. Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update. Journal of Clinical Medicine [Internet]. 2022 Jan 1;11(21):6429. Available from: https://www.mdpi.com/2077-0383/11/21/642
  4. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nature Reviews Disease Primers [Internet]. 2016 Feb 4;2(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/
  5. Sevim M, Alkis O, Kartal İG, Telli S, Aras B. A factor not to be ignored in post-COVID-19 erectile dysfunction; psychological effect, a prospective study. Andrologia [Internet]. 2022 Apr 21 [cited 2022 Apr 26]; Available from: https://pubmed.ncbi.nlm.nih.gov/35445425/
  6. McMahon CG. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia. 2019 May 17;210(10):469–76. Available from: https://doi.org/10.5694/MJA2.50167
  7. Pang K, Pan D, Xu H, Ma Y, Wang J, Xu P, et al. Advances in physical diagnosis and treatment of male erectile dysfunction. Frontiers in Physiology. 2023 Jan 9;13. Available from:https://doi.org/10.3389/FPHYS.2022.1096741
  8. Argiolas A, Argiolas F, Giacomo Argiolas, Maria Rosaria Melis. Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies. Brain Sciences [Internet]. 2023 May 15;13(5):802–2. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216368/
  9. L Michael Prisant. Phosphodiesterase-5 inhibitors and their hemodynamic effects. Current Hypertension Reports. 2006 Jul 1;8(4):345–51. Available from: https://doi.org/10.1007/S11906-006-0075-Y
  10. Nirupama Ancha, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, et al. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian Journal of Andrology [Internet]. 2024 Feb 20 [cited 2025 Apr 8];26(4):335–43. Available from: https://pubmed.ncbi.nlm.nih.gov/38376174
  11. Özkent MS, Hamarat MB, Taşkapu HH, Kılınç MT, Göger YE, Sönmez MG. Is erectile dysfunction related to self‐esteem and depression? A prospective case–control study. Andrologia. 2020 Nov 20;53(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33215726
  12. Yang Y, Song Y, Lu Y, Xu Y, Liu L, Liu X. Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross‐sectional study in a Chinese population. Andrologia. 2019 Aug 21; Available from: https://pubmed.ncbi.nlm.nih.gov/31434163
  13. Estruch R, Salas-Salvadó J. “Towards an even healthier mediterranean diet.” Nutrition, Metabolism and Cardiovascular Diseases. 2013 Dec;23(12):1163–6. Available from: https://doi.org/10.1016/j.numecd.2013.09.003
  14. Glina S, Sharlip ID, Hellstrom WJG. Modifying Risk Factors to Prevent and Treat Erectile Dysfunction. The Journal of Sexual Medicine. 2013 Jan;10(1):115–9. Available from: https://doi.org/10.1111/J.1743-6109.2012.02816.X
Read More
Author biographies is not available.
Download
PDF XML
Statistic
Read Counter : 1378 Download : 293

Dipendra Kandela, Aakriti Karkib, Gauri Adhikaric

a Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal

b Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh

c Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal

1st Submission: 15th December 2024

1st Revision: 27th December 2024

2nd Submission after Revision: 2nd January 2025

Acceptance: 5th January 2025

Article History

Background of Erectile Dysfunction

Erectile dysfunction (ED) is the inability of an individual to achieve or maintain a sufficient rigid penile erection for satisfactory sexual activity. [1] It has been estimated that in the United States alone, there are 20-30 million men who are affected by ED. [2] It's normal to have erection issues sometimes, but if you have persistence of this symptom for a long time, then it’s a good idea to schedule an appointment with your physician.

Causes and Risk Factors of Erectile Dysfunction

ED involves various mechanisms disrupting the normal process of achieving and maintaining an erection, including vascular, neurogenic, hormonal, and psychological factors.

Figure 1.

  • Vascular Cause: Even if you have sexual desire but couldn’t maintain a rigid penis it would be a problem. Vascular causes are those which disrupt the blood flow to the penis and make it flaccid during sexual activity. Common risk factors associated include hypertension (HTN), Diabetes Mellitus (DM), hyperlipidemia, and cigarette smoking. Acquired trauma in the pelvic area and degenerative changes in the blood vessels can also cause the problem. [3]
  • Neurogenic Cause: Sensory and psychological stimuli usually activate the brain signals sent through the spinal cord to the penile nerves. This enhances the release of Nitric Oxide (NO), which helps cause vasodilation and maintain an erection. Neurological disorders such as multiple sclerosis, spinal injuries, and pelvic surgeries can disrupt the nerve signals required for erection. [3]
  • Hormonal Cause: The male sex drive depends on testosterone and it controls the sexual arousal at spinal cord level and within the penis. It influences the synthesis of NO which helps to dilate the vessels within penis and allow more blood flow ultimately making penis rigid and erect; low testosterone due to hypogonadism and endocrine disorders like diabetes impair these functions. [4]
  • Psychological Cause: Even if you have a good erection, but you have no desire to have sexual activity, then this could be a problem. Various psychological factors like stress, anxiety, depression, and performance anxiety inhibit the brain's ability to initiate sexual activity and maintain erections. [4]
  • Other Causes: Medications like antihypertensives and antidepressants, along with substances such as tobacco, alcohol, and illicit drugs, can interfere with neurovascular mechanisms, leading to ED. [4]

Symptoms of Erectile Dysfunction

ED is not just about erection; it extends beyond the inability to achieve or sustain an erection, manifesting in a spectrum of associated symptoms. The most common symptoms of ED include: [5]

Figure 2.

  • Difficulty Achieving an Erection: The most common symptom of ED is difficulty in starting an erection when desired. This can happen occasionally or more frequently and vary in severity from person to person.
  • Difficulty Maintaining an Erection: This is another critical symptom where an individual can achieve an erection but has difficulty in maintaining it to complete the sexual intercourse. This can cause frustration, anxiety, and decreased sexual satisfaction.
  • Reduced Sexual Desire: Men with ED often experience a reduced interest in sexual activity. This decrease in libido can be a result of psychological factors, hormonal imbalances, or a response to recurring issues with erectile function.
  • Premature Ejaculation: Some men with ED may also experience premature ejaculation, where ejaculation occurs sooner than desired, either shortly after penetration or even before it.
  • Delayed Ejaculation: In contrast to premature ejaculation, some men might find it difficult to ejaculate despite having a sufficient erection. The ejaculation gets delayed, leaving the person tired and frustrated.
  • Emotional and Psychological Distress: The inability to perform sexually can lead to significant emotional distress, including anxiety, depression, low self-esteem, and relationship issues. These emotional responses can, in turn, exacerbate the symptoms of ED.

Diagnosis of Erectile Dysfunction

Figure 3.

  • Medical Examination: This includes an examination to check for the signs of systemic conditions like hypertension and peripheral arterial disease that might contribute to ED. Your doctor will do a focused exam of the genitals to identify any anatomical abnormalities, such as curvature of the penis, penile plaque, or testicular atrophy, which can cause ED. [5]
  • Blood Tests: Your doctor will perform specific blood tests to identify heart diseases, blood vessel problems, and the level of hormones in your body, like your blood glucose levels in diabetes mellitus, level for testosterone, and cholesterol levels. [6]
  • Psychological Assessment: In some cases, psychological factors may contribute to ED. Your doctor may inquire about your mental health, stress, and emotional well-being. [5]
  • Doppler Ultrasound: This imaging test assesses blood flow to the penis. It can identify vascular problems such as arterial insufficiency or venous leak. This test can also be used to inject some medications in the penis to increase the blood flow and simulate an artificial erection.
  • Nocturnal Penile Tumescence (NPT) Test: This is a special kind of test that measures erections during sleep. This test is based on the natural physiological phenomenon wherein men experience erections during certain stages of sleep. Your doctor will note penile circumference, axial and circumferential dilation rates, erection frequency, duration, and penile stiffness at night. This can give us an understanding of whether you have psychogenic ED or organic ED. [7]

Treatment of Erectile Dysfunction

Treatment for ED can range from lifestyle changes, oral or injectable medications, or implants, depending on the cause and severity of the condition.

Figure 4.

  • Oral Medications: Oral medications like sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), or avanafil (Stendra) are commonly used for ED. These medications can come in various forms: oral, intravenous, or as pellets that can be placed in the urethra. It relaxes the smooth muscle present in your penis and dilates blood vessels there, increasing the blood flow and improving erectile function. However, there is one significant side effect of these medications. These medications can cause the erection to last too long, causing you to have pain. This condition is known as priapism, and it needs immediate medical attention. A small percentage of people taking this medication may experience headaches or visual changes. [8] Another side effect is low blood pressure. Your blood pressure can drop drastically if you are taking nitrates along with these oral medications. [9] So, you should always consult your doctor if you are taking nitrates and one of these oral medications.
  • Injectable Medications: Alprostadil is a synthetic form of a naturally occurring prostaglandin E1 (PGE1) hormone. It has the same mechanism as other oral medications like Viagra. It can be injected directly into the base of the penis using a fine needle. This medication can produce an erection within 5 to 20 minutes, and the erection can last for up to an hour. It is an effective option for men who do not respond to oral medications. [8]
  • Vacuum Device: This is also known as a penis pump, and it draws blood into your penis. To use this device, first of all, you place a tube part of the device around your penis. The pump then creates a vacuum within the tub that pulls the blood into your penis. Once you get an erection, you slide an elastic ring to the base of the penis to hold the blood and keep it firm. The ring is removed after intercourse. [10]
  • Implanted Devices: Many men with ED might benefit from implanted prosthetics in getting an erection. A urologist places these implants surgically. There are two main types of implants: malleable and inflatable. The malleable implants are rods that let you manually modify the position of your penis, and inflatable implants use a pump in the scrotum to make your penis longer and broader. [10]

Complications of Erectile Dysfunction

Some of the potential complications of erectile dysfunction include:

Figure 5.

  • Emotional Impact: ED can lead to feelings of frustration, embarrassment, and lowered self-esteem. Anxiety, depression, and stress can also result from ED, creating a negative cycle that further exacerbates the condition.
  • Relationship Problems: Sexuality forms an integral part of an intimate relationship. ED can lead to reduced intimacy, emotional distance, and overall dissatisfaction.
  • Performance Anxiety: ED may lead to performance anxiety, where a person becomes overly concerned about their ability to perform sexually, making it even more challenging to achieve an erection.
  • Infertility: Infertility can be an issue when you have ED. It can prevent you from having sexual intercourse, indirectly impacting your ability to conceive.

Non-FDA-Approved Supplements and Treatments for Erectile Dysfunction

There are many non-FDA-approved supplements and treatments in the market for ED that often lack rigorous testing for safety and efficacy. For instance, many over-the-counter (OTC) male enhancement supplements have been found to contain undeclared ingredients, such as phosphodiesterase type 5 (PDE5) inhibitors like sildenafil, which can pose significant health risks. [1-2] These undeclared ingredients can lead to serious adverse events, including priapism. Counterfeit and adulterated products can contain inconsistent doses of active ingredients and harmful contaminants, posing direct and indirect health risks. Exercise caution with advertised treatments for ED that are not FDA-approved.

Tips to Prevent Erectile Dysfunction

Here are five tips for you to follow to prevent ED: [11,12]

Figure 6.

  • Healthy Diet: You should focus on eating a balanced diet rich in fruits and vegetables. Studies have also shown that the Mediterranean diet, which includes a plant-based diet with animal-based products, can help to improve cardiovascular health and prevent ED. [13]
  • Quit Smoking: Smoking is linked to various diseases of the heart and blood vessels, which can lead to ED. Hence, stopping smoking can help you to keep your sexual health on point. [13]
  • Exercise: Exercise is an integral part of sexual health. You can participate in physical activities such as brisk walking, running, swimming, or strength training. [14]
  • Manage Stress: Chronic stress and anxiety can lead to ED. You can reduce your stress with the help of techniques such as mindfulness, yoga, meditation, and deep breathing exercises. [14]
  • Healthy Sexual Relationship: You should maintain open communication with your partner about sexual preferences and concerns. This would help you to understand each other better and keep your sexual relationship healthy. [14]

When To See Your Doctor for ED?

If you are having a new onset ED, have them frequently, or it began after starting a new drug, it is advisable to seek medical advice from your doctor. In some cases, the ED can be a sign of underlying health conditions such as diabetes, cardiovascular disease, hypertension, or hormonal imbalances. You should talk to your doctor to determine the cause and get appropriate treatment.

Questions To Ask Your Doctor

  1. How can I communicate with my partner about my erectile dysfunction?
  2. How soon should I expect to see results from the treatment?
  3. What would be the complication if I did not treat my erectile dysfunction?
  4. Are there any dietary supplements or herbal remedies that could help erectile dysfunction?
  5. Can I engage in sexual activity while I am taking medications for erectile dysfunction?

Conflict of Interest

DK and AK are nonpaid research assistants at ehealthyinfo. GA is a paid research assistant at ehealthyinfo. There are no other conflicts of interest to declare.

Peer Reviewed By

Dr. Anamol Acharya, MD

Parkview Regional Medical Center, Fort Wayne, IN, USA

References

  1. Rew KT, Heidelbaugh JJ. Erectile Dysfunction. American Family Physician [Internet]. 2016 Nov 15;94(10):820–7. Available from: https://pubmed.ncbi.nlm.nih.gov/27929275/
  2. Lue TF. Erectile Dysfunction. Wood AJJ, editor. New England Journal of Medicine. 2000 Jun 15;342(24):1802–13.Available from: https://doi.org/10.1056/NEJM200006153422407.
  3. Mazzilli F. Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update. Journal of Clinical Medicine [Internet]. 2022 Jan 1;11(21):6429. Available from: https://www.mdpi.com/2077-0383/11/21/642
  4. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nature Reviews Disease Primers [Internet]. 2016 Feb 4;2(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/
  5. Sevim M, Alkis O, Kartal İG, Telli S, Aras B. A factor not to be ignored in post-COVID-19 erectile dysfunction; psychological effect, a prospective study. Andrologia [Internet]. 2022 Apr 21 [cited 2022 Apr 26]; Available from: https://pubmed.ncbi.nlm.nih.gov/35445425/
  6. McMahon CG. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia. 2019 May 17;210(10):469–76. Available from: https://doi.org/10.5694/MJA2.50167
  7. Pang K, Pan D, Xu H, Ma Y, Wang J, Xu P, et al. Advances in physical diagnosis and treatment of male erectile dysfunction. Frontiers in Physiology. 2023 Jan 9;13. Available from:https://doi.org/10.3389/FPHYS.2022.1096741
  8. Argiolas A, Argiolas F, Giacomo Argiolas, Maria Rosaria Melis. Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies. Brain Sciences [Internet]. 2023 May 15;13(5):802–2. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216368/
  9. L Michael Prisant. Phosphodiesterase-5 inhibitors and their hemodynamic effects. Current Hypertension Reports. 2006 Jul 1;8(4):345–51. Available from: https://doi.org/10.1007/S11906-006-0075-Y
  10. Nirupama Ancha, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, et al. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian Journal of Andrology [Internet]. 2024 Feb 20 [cited 2025 Apr 8];26(4):335–43. Available from: https://pubmed.ncbi.nlm.nih.gov/38376174
  11. Özkent MS, Hamarat MB, Taşkapu HH, Kılınç MT, Göger YE, Sönmez MG. Is erectile dysfunction related to self‐esteem and depression? A prospective case–control study. Andrologia. 2020 Nov 20;53(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33215726
  12. Yang Y, Song Y, Lu Y, Xu Y, Liu L, Liu X. Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross‐sectional study in a Chinese population. Andrologia. 2019 Aug 21; Available from: https://pubmed.ncbi.nlm.nih.gov/31434163
  13. Estruch R, Salas-Salvadó J. “Towards an even healthier mediterranean diet.” Nutrition, Metabolism and Cardiovascular Diseases. 2013 Dec;23(12):1163–6. Available from: https://doi.org/10.1016/j.numecd.2013.09.003
  14. Glina S, Sharlip ID, Hellstrom WJG. Modifying Risk Factors to Prevent and Treat Erectile Dysfunction. The Journal of Sexual Medicine. 2013 Jan;10(1):115–9. Available from: https://doi.org/10.1111/J.1743-6109.2012.02816.X

Most read articles by the same author(s)

1 2 3 > >> 

Similar Articles

1 2 3 4 5 > >> 

You may also start an advanced similarity search for this article.