Erectile Dysfunction

During a lifetime, men may experience various erectile health issues. One of these is erectile dysfunction, or ED.

ED is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.1

Other health issues include delayed ejaculation and premature ejaculation. A healthcare provider can assist men with these health-related concerns as well as address issues of infertility.


Living with ED means that you can’t regularly achieve or keep an erection long enough to satisfy your sexual needs or those of your partner. Whether men they admit it or not, most have had an occasional erection problem. But for as many as 30 million American men—10% of all men, up to 15-25% of men over 65, ED is an ongoing problem. It can start at any age in adult men and can develop slowly over time or suddenly. There are a lot of myths out there about ED. Some people insist that “it’s all in your head.” Others say that “it’s what happens when you get older.”

Causes of ED

While there are real physical and psychological reasons for ED, there’s no single cause. The chart below outlines the most common causes of ED.2

ed chart - causes

ED is not just a medical issue; it can also deeply affect relationships. It can limit intimacy, affect self-esteem, and impact the most important relationships.


About 70% of the time, ED is the result of a physical problem. It can almost always be treated successfully. Medical problems contributing to or causing ED include heart disease, high blood pressure, diabetes, smoking, alcoholism, back injuries, testosterone deficiency  (very rarely), prostate problems, surgery and over 200 different prescription drugs.

Insurance Coverage
Most insurers cover the diagnosis and medically necessary treatment of ED. Medicare has a national coverage policy for ED, which includes penile implants—however coverage may vary by geography and plan.

ED affects you AND your partner! Below are ways to start the ED talk with your partner.

  1. Always stay open and honest when discussing ED.
  2. Never shut out your partner and try to deal with ED alone. Talking to your partner can be difficult, but your ED affects her too.1 And she wants answers as much as you do.
  3. Not only is good communication essential to successful diagnosis and treatment, it can help your partner understand what you are going through. And help you understand her feelings too.

Sex, ED, and Relationship Conversation Starters

  1. I wonder if one of the medicines I’m taking causes the problems I experience when we try to have sex. Do you think I should see a doctor?
  2. I thought the problems I’ve been having would just go away, but they haven’t. Do you think I could have ED?
  3. I wonder if the surgical procedure I had caused ED. Do you think I should see a doctor?
  4. I read that ED might be a sign of other health problems. Do you think I should see a doctor?
  5. I miss being physically intimate with you. I want us to stay close. So what can we do while I look into treatments and try to solve this problem?


Physical and psychological factors including depression and performance anxiety are factors in the presence and severity of ED. Men who suffer from ED often feel inadequate and unsure of themselves. That can make them anxious, tense, angry or worried that they can’t satisfy their partner. Those feelings only make the ED worse. Even a “mild” case of ED due to physical or psychological factors will usually be made worse by performance anxiety.

If you’re experiencing ED, help yourself and your partner by scheduling a visit to your healthcare provider sooner rather than later. Chances are, they will be able to help your ED problem in just one or two visits. They will ask about your health habits, diet, prescription drugs and under what circumstances the ED happens. Your provider may also order tests of your blood, urine, heart function and hormone levels. Underlying medical problems are very common as men age and frequently they are a symptom of a much bigger issue like atherosclerosis.

ED may also be a sign of heart problems. The arteries in the penis are smaller than those in the rest of the body so blood flow issues appear sooner than in other areas. It is important to discuss sexual health with your healthcare provider as he can prescribe medications to improve your sexual function, and may be able to prevent a major heart problem or heart attack.

Prostate cancer itself does not cause ED but treatments for the disease can. The current methods of treating prostate cancer include surgery with radical prostatectomy (removal of the entire prostate gland), radiation therapy — whether by external beam or brachytherapy (seed implant) — and hormone therapy. All of these can cause ED


If you’re at risk of developing erectile dysfunction, here are some steps you can take to prevent ED:

  • If you smoke, stop smoking
  • Exercise regularly
  • Eat a healthy diet and maintain a healthy weight
  • Take prescribed medications as prescribed by your healthcare provider
  • Drink alcohol in moderation
  • If you have a chronic illness such as diabetes or kidney disease, follow your doctor’s instructions

Questions to Ask Your Health Care Provider

It may be difficult for you to talk to your healthcare provider about ED. But the more information you share about yourself, the easier it will be for your doctor to properly diagnose your condition. Here are some questions you can ask your doctor.

  1. What is the cause of my erectile dysfunction?
  2. What are the treatment options?
  3. Could any of my lifestyle habits be affecting my sexual function, such as smoking?
  4. What are the possible treatments for erectile dysfunction?
  5. What treatment is appropriate for me? Why?
  6. What risks and side effects should I expect?
  7. Will treatment affect my normal activities?
  8. Will I be able to father children after treatment?
  9. What is likely to happen without treatment?
  10. What medications are available to me and what are the benefits/side effects?
  11. Will these medications interact with other medications, over-the-counter products, or
  12. Should I change my diet? If so, what dietary changes should I make?
  13. What are my chances of returning to satisfying sexual function?


In many cases, taking steps to improve your overall health will help reduce or even eliminate ED. This means:

  • Eat a low-fat, low-sodium, low-cholesterol diet.
  • Quit smoking. Chemicals in cigarette smoke can narrow blood vessels, making it harder to maintain an erection.
  • Drink less alcohol. Alcohol slows your body’s reaction times.
  • Get more exercise. Exercise builds muscle, improves blood flow, and helps get the cholesterol out of your blood. It also improves your mood, which will make you feel better about yourself.
  • Cut back on coffee.
  • Use it or lost it. The more erections you get, the easier it is to get them.
  • Sexual activity, including masturbation, increases blood flow and oxygen to the penis.

If these lifestyle changes aren’t successful, your healthcare provider may prescribe one or more treatments for ED.

Treatment Options
There are multiple options to treat ED.

Oral Medications. There are a number of prescription medications available that may improve blood flow to the penis. Combined with sexual stimulation, this can produce an erection, when taken before sexual activity.

By allowing the blood vessels that supply blood to the penis to dilate better during sexual stimulation, these medications alleviate the symptoms of ED. These should only be taken under medical supervision because other health related issues need to be addressed to ensure the heart is healthy enough for additional medication and stress.

Injections. With injection therapy a needle is used to inject medication directly into the penis. The medication allows blood to flow into the penis, creating an erection.

Vacuum Erection Devices. A plastic cylinder is placed over the penis, and a pump (either manual or battery operated) creates a vacuum suction within the cylinder, drawing blood into the penis to create an erection. A stretchable tension band is placed at the base of the penis to help maintain the erection.

Urethral Suppositories. An applicator containing a small pellet (suppository) is inserted into the urethra and the pellet is released. The pellet dissolves and increases blood flow to the penis, creating an erection.

Penile Implants. A medical device that is implanted into the penis. Entirely contained within the body, a pump fills two cylinders and creates an erection. Penile implants require a surgical procedure by a physician, typically an Urologist who has been trained and is skilled in penile prosthetics.

There are three different types of penile implants: 3-piece inflatable implant, 2-piece inflatable implant, and a 1-piece bendable (malleable) implant. Because each type of implant offers unique features, the risks and benefits should be discussed with the physician to help choose the most appropriate option.


For more information on erectile dysfunction visit:

Medline Plus
Urology Care Foundation


  1. National Institutes of Health (NIH) Consensus Conference. NIH Consensus Development Panel on Impotence. Impotence. Journal of the American Medical Association.1993;270:83-90.
  2. Ridwan Shabsigh, MD, Tom F. Lue, MD. A Clinician’s Guide to ED Management. New York: Haymarket Media Inc.; 2006.
  3. Erectile dysfunction (ED). American Urological Association Web site. Downloaded January 21, 2013.

Last modified: December 4, 2014