Erectile dysfunction: What you need to know

Erectile dysfunction: What you need to know

A man is considered to have erectile dysfunction if he finds it difficult to get or maintain a firm enough erection to be able to have sex on a regular basis, or if it interferes with other sexual activities.

Occasionally, most men have experienced some difficulty getting their penis hard or staying firm. However, erectile dysfunction (ED) is only considered a concern if it has been impossible to achieve satisfactory sexual performance on several occasions over some time.

Since the discovery that sildenafil, or Viagra, has affected penile erections, most people have become aware that ED is a medicative condition that is treatable.

Men with a sexual performance problem may be reluctant to talk to their doctor, seeing it can be an embarrassing issue.

ED is now well known however, and various therapies are available.

This Nccmed Knowledge Center article provides helpful advice for patients experiencing this problem, or even those close to them.

Important facts about erectile dysfunction:

  • Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
  • Causes are usually medical but can also be psychological.
  • Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
  • Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.


Problems with any of the following systems can affect normal erectile function:

  • blood flow
  • nerve supply
  • hormones

Physical causes

Erectile dysfunction can cause embarrassment.
Erectile dysfunction can cause embarrassment.

Consulting a doctor about persistent erection problems is always useful, as it might be caused by a serious medical condition.

Whether the cause is simple or serious, a proper diagnosis can help address any underlying medical issues and help resolve sexual issues.

The list below sums up many of the most common physical or organic causes of ED:

Atherosclerosis is a common cause of problems regarding blood flow. Atherosclerosis causes the arteries in the penis to narrow or clog, preventing the necessary flow of blood into the penis to produce an erection.

Numerous prescription medications can also cause ED, including those below. Anyone taking medications should consult their doctor before stopping or changing their medications:

  • drugs to control high blood pressure
  • heart medications such as digoxin
  • some diuretics
  • drugs that act on the central nervous system, including some sleeping pills and amphetamines
  • anxiety treatments
  • antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
  • opioid painkillers
  • some cancer drugs, including chemotherapeutic agents
  • prostate treatment drugs
  • anticholinergics
  • hormone drugs
  • the peptic ulcer medication cimetidine

Physical causes account for 90 percent of ED cases, with much less common psychological causes.

Psychological causes

In rare cases, a man may have had ED at all times, and may have never had an erection. This is called primary ED, and if there is no obvious anatomical deformity or physiological issue the cause is almost always psychological. It may include such psychological factors as:

Most cases of ED are ‘secondary.’ This means that erectile function has been normal, but becomes problematic. Causes of a new and persistent problem are usually physical.

Less commonly, psychological factors cause or contribute to ED, with factors ranging from mental health that can be treated to everyday emotional conditions that most people experience at times.

It is important to note that the medical and psychosocial causes can overlap. For example, if a man is obese, changes in blood flow can affect his ability to maintain an erection which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause.

Does riding a bicycle cause ED?

Questions remain regarding the effects of riding a bicycle on men’s health.

Some research has raised concerns that, in addition to other men’s health issues such as infertility and prostate cancer, men who regularly cycle for long hours may have a higher risk of developing ED.

The recent research to investigate this found that there was no link between riding a bike and ED, but it did find a link between longer cycling hours and prostate cancer risk.

Prostate disease and ED

No ED is caused by prostate cancer.

Prostate surgery, however, will cause ED to remove the cancer and radiation therapy to treat prostate cancer.

The disorder can also be caused by treatment of non-cancerous, benign prostate disease.


The good news is there are many ED treatments and the majority of men will find a solution that works for them. Treatments include:

Drug treatments

Men can take PDE-5 (phosphodiesterase-5) inhibitors, a group of drugs.

Most of these pills are taken 30 to 60 minutes before sex-the best known is sildenafil (Viagra) blue-colored pill. Other options are:

  • vardenafil (Levitra)
  • tadalafil (taken as a once-daily pill called Cialis)
  • avanafil (Stendra)

PDE-5 inhibitors are available upon prescription only. A doctor can check for heart conditions before prescribing and ask about other medications.

Side-effects associated with PDE-5 inhibitors include:

Less commonly used drug options include prostaglandin E1, which is administered locally either by injecting it into the penis, or by inserting it into the urethra opening.

However, most people prefer a pill and these drugs acting locally tend to be reserved for people who are unable to undergo oral treatment.

Online pharmacies

ED treatment can be ordered over the internet. However, caution is recommended.

The Food and Drug Administration of the United States (FDA) has a consumer safety guide on this, including a recommendation to check that the pharmacy online:

  • is located in the U.S. and licensed
  • has a licensed pharmacist to answer questions.
  • requires a prescription.
  • offers direct contact with a person who can discuss any problems.

Using this List of Verified Internet Pharmacy Practice Sites (VIPPS) to check if the pharmacy is licensed.

The FDA also gives advice about how to spot the risks of an unsafe website, including the following clues:

  • There is no way to contact the website by phone.
  • Prices are dramatically lower than those offered by legal online pharmacies.
  • Prescription drugs are offered without requiring a prescription – which is illegal.
  • Personal information is not protected.

The FDA adds that these unauthorized sites are capable of shipping products of unknown quality and origin, including sending the wrong drug or harmful product.

Vacuum devices

Vacuum erection devices are a mechanical way for people who don’t want or can’t use drug therapies to create an erection, or find that they don’t work.

The penis is made rigid using a sealed vacuum pump that draws blood up around it. The use of an accompanying band prevents this from then leaving the penis.

The lack of spontaneity in the use of vacuum devices means that many people find additional treatments preferable for ED.

Surgical treatments

There are several surgical treatment options:

  • Penile implants: These are a final option reserved for men who have not had any success with drug treatments and other non-invasive options.
  • Vascular surgery: Another surgical option for some men is vascular surgery, which attempts to correct some blood vessel causes of ED.

Surgery is a last resort, which should be used only in the most serious situations. The recovery time varies but there are high success rates.

Do dietary supplements and alternative treatments work?

The short answer is “no.”

The use of dietary supplements such as herbal pills does not endorse any recommendations followed by doctors, nor any established sources of evidence.

Besides there is no evidence in support of non-prescription options for ED, the FDA has warned of the secret dangers of online “treatments” sold.


Men can not always reach an erection successfully, and if this occurs rarely, it’s not considered a medical problem.

But ED is not just referring to a total inability to achieve an erect penis. Symptoms may also include struggling to maintain an erection long enough to complete the intercourse or an inability to ejaculate.

Emotional symptoms, such as embarrassment, shame , anxiety, and a diminished interest in sexual intercourse are also common.

When those symptoms occur frequently, a man is known to have ED.


There are exercises that a man can do to lessen the effects of ED.

The easiest way to treat erectile dysfunction without any medicine is by using Kegel exercises to strengthen the pelvic floor muscles. These are often associated with women seeking to reinforce their pelvic area during pregnancy but may be effective for men seeking to regain full penis function.

Firstly, consider muscles in the pelvic floor. This can be done by stopping mid-stream the next time you urinate, two or three times. The pelvic floor muscles are the muscles you can feel working during this process, and they will be the focus of Kegel exercises.

One Kegel exercise is to tighten and hold the muscles for 5 seconds, and then release them. Try doing 10 to 20 repetitions a day. This will not be possible if you do the exercises first. Over time, though, they should become simpler.

You should be able to find an difference after 6 weeks.

Make sure that in this process you relax naturally, and avoid pushing down as though you are forcing urination. Instead, muscles are pulled together in a squeezing motion.

Aerobic exercise, like a jog or even a brisk walk, can also enable better circulation of the blood, and can also improve ED in people with circulation problems.


The many potential causes of ED usually mean a doctor must ask a lot of questions and arrange for blood tests to be performed. These tests will check, among other things, for heart problems, diabetes and low testosterone. The doctor should also conduct a physical exam including genitals.

A doctor should search for signs that have lasted for at least 3 months, before accepting a condition that needs medication.

If a medical background is identified a doctor may carry out further investigations. One simple test, known as the ‘postage stamp test,’ can be helpful in determining if the cause is physical rather than psychological.

Men usually have 3 to 5 erections a night. This test checks for the presence of overnight erections by seeing if post stamps applied around the penis before sleep have snapped off overnight. Other tests of nocturnal erection include the Poten test and Snap-Gauge test.

Such methods provide limited information, but can help guide the choice of further tests by a doctor.