An erection is a blood-flow event. When you're aroused, nerve signals relax the smooth muscle inside the penis, blood rushes into its spongy chambers and the outflow is squeezed shut. Erectile dysfunction is what happens when that system stops working reliably, whether the problem is getting hard, staying hard, or both. A single off night after a few drinks, a long day or a new partner isn't ED; the term describes a pattern that keeps happening and bothers you.
It is far from rare. In the Massachusetts Male Aging Study, 52% of men aged 40 to 70 reported some degree of erection difficulty, and complete ED tripled from 5% at age 40 to 15% at age 70.1 Age was the factor most strongly linked with it, but heart disease, high blood pressure, diabetes, related medicines, and measures of anger and depression were all associated too.
Most ED has a physical root, a psychological one, or a mix of the two, and each tends to feed the other. That's why a good assessment looks at your blood vessels, hormones, medicines and state of mind, rather than jumping straight to a tablet.
What causes erectile dysfunction?
Anything that affects blood flow, nerves, hormones or your state of mind can cause ED. Age, heart disease, high blood pressure, diabetes, some medicines and low mood are among the factors most consistently linked with it.
Because erections depend on small arteries opening wide, the same things that damage blood vessels elsewhere in the body tend to affect the penis as well. In the Massachusetts study, smoking was linked with a greater chance of complete ED in men who already had heart disease or high blood pressure.1
Psychological causes are just as real. Worry about performing, relationship strain and low mood can block arousal even when the physical machinery is fine. Our guide to how stress affects erections and libido goes deeper, and the performance anxiety entry explains the loop that keeps it going.
- Blood vessels: narrowed arteries, high blood pressure, smoking
- Metabolic and hormonal: diabetes, carrying extra weight, low testosterone
- Nerves: damage from surgery, injury or long-term illness
- Medicines: several common prescriptions list ED as a possible side effect
- Mind and relationships: anxiety, depression, conflict
Is erectile dysfunction a sign of heart disease?
It can be. ED and heart disease share risk factors, and in one large study men with ED had a higher risk of later heart and circulation problems, so new erection trouble is a good reason to get checked.
In a study that followed 9,457 men aged 55 and over, those with ED had a 45% higher risk of a later cardiovascular event, a risk in the same range as current smoking or a family history of heart attack.2 The researchers concluded that ED should prompt a look at cardiovascular risk factors such as blood pressure, cholesterol and blood sugar.
None of this means an erection problem equals a heart problem. It means ED is worth treating as a health signal rather than only a bedroom issue, especially if it has come on gradually and you have other risk factors.
What helps erectile dysfunction?
The right treatment depends on the cause, but lifestyle change, prescription medicines, pelvic floor training and talking therapies all have a place. Most men have several reasonable options.
Lifestyle changes genuinely move the needle. A meta-analysis of randomised trials found that lifestyle and cardiovascular risk-factor interventions improved erectile function scores by an average of about 2.4 to 2.7 points on the five-item IIEF questionnaire.3 More movement, weight loss and stopping smoking are the usual targets; see does cardio really improve erections?
The American Urological Association guideline says men should be told about every treatment that isn't unsafe for them, from tablets to more invasive options, as potential first choices, and decide together with their clinician.4 Prescription PDE5 inhibitors are the most familiar option, and training the pelvic floor has trial evidence of its own.
When should I see a doctor about erection problems?
See a GP if erection problems last more than a few weeks, keep coming back, or are affecting your relationship or confidence. Seek urgent help for a painful erection that won't go down.
A GP will usually ask about your health, medicines, mood and relationship, check your blood pressure, and may test blood sugar, cholesterol and testosterone. It's a routine conversation for them, even if it isn't for you.
One useful thing to note beforehand is whether you still get morning erections or can get hard on your own. That detail helps a clinician weigh up physical and psychological causes, and the morning wood entry explains why.
Common questions
Can young men get erectile dysfunction?
Yes. ED becomes more likely with age, but it can happen at any adult age. Whatever your age, it's worth a check-up rather than guessing at the cause, because the fix depends on what's behind it.
Is erectile dysfunction permanent?
Often not. ED linked to lifestyle, stress or a medicine can improve when that cause is addressed, and trials show lifestyle and risk-factor changes improve erectile function scores.3 Even when an underlying condition remains, effective treatments exist.
Do I need a blood test for erectile dysfunction?
Often, yes. Because ED shares risk factors with heart disease, checks of blood sugar, cholesterol and sometimes testosterone are common.2 Your GP will decide what's needed based on your history.
Read more on this
Does cardio really improve erections? What the research says
How stress affects erections and libido
The pelvic floor guide nobody gave you
Sources
- Feldman HA, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. PubMed
- Thompson IM, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. PubMed
- Gupta BP, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011;171(20):1797-803. PubMed
- Burnett AL, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633-641. PubMed
Not medical advice. Written by Eric Stephens from the research cited above; not reviewed by a doctor. If something worries you, see a GP.