Erectile Dysfunction Symptoms

There are instances when you feel changes in erection quality, which often points to a certain problem. Erectile dysfunction (ED) is a sexually related problem. It lowers self-confidence and strains relationships, whilst overall affecting the quality of life. Repeated problems with the erection are part of male sexual dysfunction and need immediate attention, or long-term damage can happen. Symptoms of erectile dysfunction can indicate that there is a problem in your body and that the body will require intervention. You can seek a medical professional for the treatment of dysfunction, and you can learn the causes of dysfunction. All of these steps can help you get care, improve long-term health and keep a happy sex life.

What is erectile dysfunction?

Definition and overview

Erectile dysfunction is the persistent inability to achieve or maintain an erection firm enough to fulfil the requirements for satisfactory sexual intercourse. When the condition develops slowly or unexpectedly, according to the cause, patients can struggle with sex. An erection involves the coordinated participation of parts of the brain, hormones, nerves, blood vessels, and erectile tissue.

Disruption to any aspect of this process — including decreased blood supply, impaired nerve signalling in the nervous system, or imbalanced hormones — can also result in erectile dysfunction. It is frequently cited that ED is medically identified as impotence in men, yet modern medical literature favours erectile dysfunction for the clinical role it plays in a more accurate description of the disease.

How common is ED?

Erectile dysfunction is common and becomes more common with age. Large population studies indicate that over 50% of men aged 40-70 develop some degree of erectile dysfunction. But the impact of such erectile dysfunction doesn’t apply only to older men. [1]

ED among younger men may arise with mental health, lifestyle, medication or medical issues. Crucially, having difficulties with erectile function does not mean that it is simply a normal or inevitable part of ageing.

Types of erectile dysfunction

Erectile dysfunction can be classified into several types based on its underlying cause.:

• Organic (physical) erectile dysfunctionassociated with vascular disease, hormonal imbalances or neurological disorders.
• Psychogenic (psychological) erectile dysfunction common among those who suffer from anxiety, depression, stress or another mental illness.
• Mixed erectile dysfunctioncomprising factors both physical and psychological.
• Iatrogenic ED caused by medications or medical treatments, such as certain antidepressants, blood pressure medications, prostate surgery, or radiation therapy.

Common symptoms of erectile dysfunction

Erectile dysfunction is characterised by persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual activity.

It's important to note that occasional difficulty with erections is normal and doesn't necessarily indicate ED—the condition is typically diagnosed when symptoms persist for three months or longer and cause significant distress or relationship problems. Men experiencing these symptoms should consult a healthcare provider, as ED can be an early warning sign of underlying health conditions such as cardiovascular disease [3] or diabetes.

Difficulty getting an erection

Difficulty getting an erection with sufficient sexual stimulation is known to be one of the most common symptoms of ED. Erections may take longer to develop or not occur at all.

Difficulty maintaining an erection

Many men have complained that they get a weaker erection at some point or have difficulty sustaining it, especially during penetrative sex. Erections could become weaker during intercourse or lead to a complete loss of erection, making sexual effort a bit more difficult to maintain.

Reduced sexual desire or libido

Impairment in sexual desire or interest often accompanies ED, though this can also be a separate issue. That can be related to hormonal changes, emotional stress or underlying illnesses.

Inconsistent erections

Some men notice inconsistent erections, where they can achieve erections sometimes but not consistently, or can get erections during masturbation or upon waking but not with a partner.

Ejaculation disorders

Delayed or absent ejaculation may occur alongside erectile difficulties in some cases.

How to tell if you have erectile dysfunction

ED questionnaires are simple tools that help assess how severe your erectile problems are. The most common is the IIEF-5 (International Index of Erectile Function), which asks five straightforward questions about your ability to get and keep erections, your confidence during sex, and your overall satisfaction over recent months.

You can find these questionnaires online as self-tests, and they typically categorise ED as mild, moderate, or severe based on your answers. While these tests give you a useful starting point and can help you recognise there's a problem, they're not a diagnosis—you'll still need to see your GP for a proper evaluation to diagnose erectile dysfunction.

Causes of erectile dysfunction

That requires an understanding of when it is erectile dysfunction to be properly treated and managed.

Physical causes of ED problems

Physical causes of erectile dysfunction may include states and medical conditions that disrupt blood flow, nerve function or hormone levels. These may include:

• Cardiovascular disease is one of the most common causes, as conditions like atherosclerosis (hardening of the arteries), high blood pressure, and high cholesterol restrict blood flow to the penis. [2]
• Diabetes mellitus damages blood vessels and nerves over time, significantly increasing ED risk—up to 50% of diabetic men experience some degree of erectile problems [4].
• Metabolic syndrome and obesity contribute to ED through hormonal imbalances, reduced testosterone, and impaired circulation.
• Hormonal imbalances, particularly low testosterone (hypogonadism), thyroid disorders, or elevated prolactin levels, affect sexual function.
• Neurological disorders such as multiple sclerosis, Parkinson's disease, spinal cord injuries, or stroke can disrupt nerve signals between the brain and penis.
• Prostate conditions and treatments, including benign prostatic hyperplasia (BPH), prostate cancer, surgery, or radiation therapy, may contribute to erectile dysfunction.

Moreover, Peyronie's disease (penile curvature from scar tissue), chronic kidney or liver disease, sleep disorders like sleep apnea, and substance abuse (alcohol, tobacco, recreational drugs) also contribute to the symptoms of erectile dysfunction.

As erections are closely dependent upon adequate circulation, erectile dysfunction can be an early warning of cardiovascular disease.

Medications that may cause erectile dysfunction

Some prescription medications and prescription drugs are going to interfere with erectile function. These include:

• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, and citalopram, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine, commonly cause sexual side effects, including reduced libido and erectile difficulties. Tricyclic antidepressants and MAO inhibitors can also affect erectile function.
• Antipsychotic medications used to treat schizophrenia and bipolar disorder, such as haloperidol, risperidone, and olanzapine, can cause ED by affecting dopamine levels and increasing prolactin.
• Medical drugs to treat high blood pressure (antihypertensives)are frequent culprits, including thiazide diuretics (such as hydrochlorothiazide), beta-blockers (like propranolol, metoprolol, and atenolol), and some calcium channel blockers. These medications can reduce blood flow to the penis or interfere with the nerve impulses needed for erections.
• Corticosteroids used long-term for inflammatory conditions can lower testosterone levels.
• Medications for prostate conditions, including 5-alpha reductase inhibitors (finasteride and dutasteride) used for benign prostatic hyperplasia (BPH) and male pattern baldness, are known to cause erectile problems and reduced libido in some men.
• Antihistamines, particularly older first-generation types like diphenhydramine and chlorpheniramine, may interfere with sexual function.
• Opioid pain medications such as morphine, oxycodone, and codeine can suppress testosterone production and directly trigger ED symptoms.<
• Chemotherapy drugsand medications for seizures (anticonvulsants) may also impact erectile function.

If erectile dysfunction develops after beginning a new medication, a health care professional can evaluate options. If you suspect your medication is causing ED symptoms, never stop taking it without consulting your doctor. Alternative medications or dosage adjustments may be available that don't affect sexual function, or ED treatments like PDE5 inhibitors can often be safely used alongside these medications to manage the side effect.

Lifestyle factors and substance use

Lifestyle habits can make all the difference for an erection. Here are the factors that lead to erectile dysfunction:

• Tobacco and smoking are one of the most damaging habits, as nicotine constricts blood vessels and damages the lining of arteries, reducing blood flow to the penis. Smokers are nearly twice as likely to develop the signs of ED compared to non-smokers, and the risk increases with the number of cigarettes smoked daily.
• Too much alcohol useimpairs the central nervous system, reduces testosterone production, and interferes with the signals needed for erections.
• Recreational drug use, some of which are over-the-counter drugs: Cannabis (marijuana) can reduce testosterone levels and impair sexual performance. Cocaine and amphetamines constrict blood vessels and can cause long-term vascular damage. Opioids (heroin, prescription painkillers) suppress testosterone production and directly interfere with sexual arousal.
• Lack of physical activity contributes to ED through multiple mechanisms: poor cardiovascular health, obesity, reduced testosterone, and impaired blood flow.
• A poor diet high in processed foods, saturated fats, and sugar contributes to ED by promoting cardiovascular disease, diabetes, and obesity.
• Chronic sleep deprivation and sleep disorders like sleep apnea reduce testosterone production and increase stress hormones, negatively affecting sexual function.
• Chronic stressand poor work-life balance elevate cortisol levels, which can suppress testosterone and reduce libido.
• Excessive pornography use has been linked with erectile difficulties in some individuals, potentially due to desensitisation or unrealistic expectations.

Psychological and emotional causes

Psychological factors and mental health problems are an important contributor to ED, particularly among young men. These have to do with:

• Performance anxiety
• Depression and anxiety disorders
• Low self-esteem
• Relationship difficulties with a sexual partner
• Additional mental health issues or psychological disorders

Psychogenic ED often has distinctive characteristics: erections may occur spontaneously (morning erections) or during masturbation but not with a partner, symptoms may appear suddenly rather than gradually, and the problem may be situational (occurring with one partner but not another, or in certain circumstances).

When to see a doctor

If you are persistently asking yourself, "Do I have erectile dysfunction?" You might want to see someone.

From the clinical perspective, you should see a doctor if you experience persistent erectile difficulties that last for three months or longer, as this indicates a pattern rather than occasional, normal fluctuations in sexual performance.

A healthcare provider can analyse the symptoms, go over your medical information and sexual history, and suggest ED treatment for you. It’s especially critical to get an early evaluation if erectile dysfunction develops suddenly, worsens over time, or is accompanied by other symptoms, such as decreased sexual desire or changes in general health.

Seek medical attention if ED is accompanied by other symptoms such as chest pain, shortness of breath, dizziness, irregular heartbeat, pain during urination, blood in urine or semen, or unusual penile curvature or pain. These may indicate conditions requiring immediate medical attention. If you notice a sudden loss of erection following a new medication, injury, or medical procedure, contact your doctor to discuss potential adjustments or alternative treatments.

Risk factors for erectile dysfunction

Several risk factors increase the chances of experiencing erectile dysfunction. Knowing these potential causes helps direct prevention and early intervention.

Age and general health

Although risk increases with age, erectile dysfunction tends to be associated with declining cardiovascular health and age-related hypogonadism (low testosterone) more than age alone. Men with multiple chronic conditions have an increased risk.

Lifestyle and habits

Smoking, heavy alcohol consumption, obesity, physical inactivity and poor fitness impair circulation and nerve function, adding to the risk of erectile dysfunction.

Medical history

A history of diabetes, heart disease, hormonal disorders, pelvic surgery, neurological or mental health conditions greatly raises the risk of erectile dysfunction.

Treatment options for erectile dysfunction

Erectile dysfunction can be effectively treated through various approaches, with treatment choice depending on the underlying cause, severity, overall health, and personal preferences. The ED meds can help if not to fix erectile dysfunction entirely, but to manage its symptoms.

Oral drugs(PDE5 inhibitors) are the first line of treatment, including Sildenafil and Tadalafil, which increase blood circulation to the penis during sexual stimulation.

Brand-name alternatives such as Viagra and Cialis are commonly prescribed and may be suggested depending on the length of dosing and a person's response to each.

Lifestyle modifications are crucial and can significantly improve or reverse ED, particularly when caused by obesity, poor diet, or sedentary habits.

Psychological counselling and sex therapy are highly effective for psychogenic ED or when psychological factors contribute to physical causes. Cognitive behavioural therapy (CBT) addresses performance anxiety and negative thought patterns, while couples counselling can resolve relationship issues affecting intimacy. Working on and addressing other related sexual health issues, such as Premature Ejaculation, may also increase general confidence and improve erectile dysfunction.

Hormone replacement therapy (namely, testosterone replacement therapy) may be recommended for men with clinically low testosterone levels (hypogonadism).

Vacuum erection devices (VEDs)> are non-invasive mechanical aids that create a vacuum around the penis, drawing blood into it to produce an erection.

Intracavernous injections involve self-injecting medication (alprostadil, papaverine, or phentolamine) directly into the side of the penis 5-20 minutes before sex. This produces an erection lasting 30-60 minutes independent of sexual stimulation.

Intraurethral suppositories (MUSE) deliver alprostadil medication via a small pellet inserted into the urethral opening using an applicator.

Penile implants (prostheses) are surgical options for men who haven't responded to other treatments.

A licensed clinician can offer you a highly tailored treatment plan that includes physical and psychological strategies to treat erectile dysfunction.

FAQ

The following questions address common concerns about erectile dysfunction and ways to manage it.

Can erectile dysfunction be reversed by nature?

Sometimes, without any medications, lifestyle solutions, including regular physical exercise, weight loss, decreased alcohol consumption, and stress reduction, help improve erectile function. But for many men, medical care may still be necessary.

Can ED go away on its own?

Temporary erectile dysfunction caused by stress, illness, or fatigue may resolve naturally. Continued or increased ED most often requires medical testing and focused treatment.

Could erectile dysfunction be a sign that I have a heart condition?

Yes. Erectile dysfunction is closely linked to cardiovascular disease and may develop several years prior to heart disease symptoms being clear.

What’s the new treatment for erectile dysfunction?

Several innovative treatments for erectile dysfunction have emerged in recent years, offering new hope for men who haven't responded to traditional therapies. Those include low-intensity shockwave therapy (LI-SWT), platelet-rich plasma (PRP) therapy ( "P-Shot"), stem cell therapy, gene therapy, topical gels, and novel oral medications and new dosage forms (e.g. melting strips with sildenafil). Researchers are exploring medications that work through alternative pathways to enhance erectile function or address specific patient populations who don't respond to current treatments, although many of these therapies are still under clinical investigation and not yet widely recommended in standard guidelines.

How to help a boyfriend with erectile dysfunction?

Supporting a boyfriend with erectile dysfunction starts with open, non-judgmental communication. Reassurance, patience and reducing pressure around sex can help, as well as encouraging him to speak to a GP or healthcare professional if the problem persists.

Does erectile dysfunction impact fertility?

Erectile dysfunction does not suppress sperm production but can make conception more difficult via reduced sexual intercourse. Treating ED can restore sexual function and increase the chances of conception.

Sources

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54–61. doi:10.1016/S0022-5347(17)34871-1. https://pubmed.ncbi.nlm.nih.gov/8254833/

2. Montorsi P, Ravagnani PM, Galli S, et al. Association between erectile dysfunction and coronary artery disease. Eur Heart J. 2006;27(22):2632–2639. doi:10.1093/eurheartj/ehl142. https://pubmed.ncbi.nlm.nih.gov/17082208/

3. Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction as a cardiovascular risk marker. Circulation. 2013;128(25):e371–e375. doi:10.1161/CIRCULATIONAHA.113.001034. https://pubmed.ncbi.nlm.nih.gov/24344156/

4. Kitaw TA, Abate BB, Tilahun BD, et al. The global burden of erectile dysfunction and its associated risk factors in diabetic patients: an umbrella reviews. BMC Public Health. 2024;24(1):2816. Published 2024 Oct 14. doi:10.1186/s12889-024-20300-7. https://link.springer.com/article/10.1186/s12889-024-20300-7