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Erectile Dysfunction (ED)


The Manual's Editorial Staff

Reviewed/Revised Jul 2023
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What is erectile dysfunction?

The Penis and Urethra

Erectile dysfunction (ED) is when a man often has problems getting or keeping an erection (getting hard). Your penis may not get erect at all or only once in a while. Or you may get erections, but they don't last long enough.

  • It’s normal for men to have problems getting an erection once in a while—doctors don’t consider it ED unless it happens often

  • ED can be caused by injuries, psychological problems, nervous system and blood vessel diseases, certain medicines, and surgery

  • ED is common in men older than 40

  • ED is usually treatable

Sometimes ED is a sign of more serious health problems.

See a doctor right away if you have ED and:

  • Feel numbness in the area between your legs (your crotch)

Numbness plus ED could be a sign of a problem with your spinal cord.

Ask your doctor's office how soon you should be seen if you:

  • Don’t ever get erections in the night or when you wake up in the morning

  • Get cramping in your leg muscles after exercise that goes away when you rest

What causes erectile dysfunction?

Most of the time, ED is caused by problems with blood flow to your penis or problems with the nerves to your penis.

Common causes of ED are:

ED can also be caused by:

What will happen at my doctor visit?

How do doctors treat erectile dysfunction?

First, doctors:

  • Treat any health problems you have that might be causing ED

  • Consider changing any medicine you're taking that’s causing ED

Your doctor may also advise you to:

  • Lose weight

  • Stop smoking

  • Drink less alcohol

However, the main treatment for ED is medicine. Usually, doctors prescribe:

  • Pills, such as sildenafil (Viagra)

Pills like sildenafil are called phosphodiesterase inhibitors. You take them about an hour before you want to have sex. You shouldn't take these pills if you also take a certain type of heart medicine called nitrates. Nitrates such as nitroglycerin are medicines for chest pain.

If you can't take phosphodiesterase inhibitors, your doctor may:

  • Prescribe medicine that you inject into your penis before sex

  • Prescribe medicine that you put into the opening of your penis before sex

  • Have you use a vacuum device

A vacuum device is a round plastic tube that you place over your penis. It has a hand pump you use to pull out the air. This gives you an erection. After the erection, you'll place a ring or band around the base of your penis to maintain your erection when you take the pump off.

If you have severe ED and none of these treatments work, doctors may:

  • Do surgery to put a device in your penis

The device may be a solid silicone rod that keeps your penis stiff all the time. Or it may be an inflatable device that you pump up to give yourself an erection.

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