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Treatment of Impotence

Speak With Your Doctor


The ability to get and keep an erection is more than a sexual issue. It is part of your overall health. It can affect how you feel about yourself.
More than 30 million men in the U.S.—and 152 million men worldwide—have some kind of recurring erection difficulty. Over half of all men over 40 are thought to have such changes. But even some younger men say they have trouble getting or keeping an erection.

If you experience a consistent inability to achieve a quality erection, you're not alone.

What Is Erectile Dysfunction?

Erectile dysfunction (ED) is the term doctors use to describe difficulty getting and/or maintaining an erection that is sufficient for sexual intercourse.

Signs and symptoms

Many, if not most, men notice a change in their erections once in a while. They may have one or more of these problems:

  • Trouble getting erections.

  • Trouble keeping erections.

  • Erections not firm enough for having sex.

  • Erections are hard enough for sex but weaker than they used to be.

  • Less confidence about getting and/or keeping an erection.

Usually, it's nothing to worry about. These difficulties may be caused by feeling tired, stressed, or have had a bit too much alcohol to drink.

But if it keeps happening, even if it doesn't happen every time you want to have sex, you should talk to your doctor. Erection difficulties could be a sign of another health problem.

Different degrees

There are different degrees of erection difficulties. Not every man has the same symptoms. But you don't have to settle for a sex life that's less than satisfying—for you or your partner. No matter the degree of your symptoms, there's something you can do about it.

You can talk to your doctor, your best source for health information.

What Affects Erectile Function?

Some men assume the quality of their erections will naturally decline with age. For some men, that may be true. But age alone does NOT cause erection difficulties.

Instead, the cause may be something that interferes with blood flow, such as other health conditions, medicines, and/or your lifestyle.

Health conditions

Health conditions that interfere with blood flow are a common cause of erection difficulties. These conditions include diabetes, heart disease, and high blood pressure. They restrict blood flow by damaging blood vessels, nerves, or tissues involved in getting and keeping an erection.


Diabetes can affect the blood vessels and nerves involved in erections. Many men with diabetes have erection difficulties. They also tend to get these problems at a younger age than other men.

High blood pressure

High blood pressure can cause blood vessels to stiffen or narrow. This can restrict the flow of blood to the penis. Medicines used to treat high blood pressure can also contribute to erection difficulties.

Heart disease and high cholesterol

Heart disease and high cholesterol can affect blood flow to the penis. Men treated for heart disease are four times as likely as others to get severe erection difficulties.


Depression, along with stress, anxiety, and fear of failure, can contribute to erection difficulties. At the same time, men who have changes in erection quality because of a physical cause may feel depressed, stressed, or anxious.

Prostate cancer treatment

Prostate cancer treatment, including radiation and surgery, can injure nerves and arteries near the penis.

Other conditions that may cause erection difficulties or make them worse include:

  • Kidney disease

  • Alcoholism

  • Multiple sclerosis

  • Hardening of the arteries

Learn more at
Visit to learn more about a number of the conditions that can contribute to erection difficulties, including high blood pressure, type 2 diabetes, and depression.

Medication Side Effects

Sometimes, the medicines prescribed to treat a health condition, rather than the condition itself, can cause erection difficulties.

About 25% of men with erection difficulties can trace them to medicines they take for other health problems. These may include medicines used to treat:

  • High blood pressure

  • Depression

  • Heart disease

  • Anxiety

Be sure to follow your doctor's advice and take your medicines as directed.

Talk with your doctor about medications that can affect your sex life. He or she may be able to prescribe a different drug that may reduce or stop the problem.

Pharmacists are also good sources of information. They can tell you how medicines work together, and which drugs may affect the quality of your erections.


Some lifestyle factors can cause or worsen erection difficulties. They include:


Smoking damages blood vessels. It can cause the kind of blood-flow problems that can keep you from getting and keeping an erection. If you smoke you should talk to your healthcare provider about ways to quit.

Too much alcohol

Drinking too much, whether at one sitting or over time, can affect the quality of your erections.

Illegal drugs

Drugs like marijuana and cocaine take a toll on your ability to get and keep erections. So can the anabolic steroids used by some athletes.

Eating habits

A high-fat diet can lead to clogged arteries and poor blood flow—a major cause of erection difficulties. High cholesterol levels can increase your risk for erection difficulties. But not all cholesterol is bad. Increasing your levels of "good" (HDL) cholesterol and decreasing "bad" (LDL) cholesterol can reduce your chances of having erection difficulties. Here are some ways to do that:

  • Eat foods high in fiber.

  • For cooking, use liquid vegetable oils high in unsaturated fats, like olive oil.

  • Get regular exercise.

  • Quit smoking.

Your healthcare provider is your best source of information about your health. See your doctor if you have any questions about health, symptoms, or medicines for you or your partner.

Making the Diagnosis

If you have erection difficulties, you're not alone. And doctors are professionals who treat all kinds of health problems every day. They also follow strict privacy rules.

Your family doctor or internist may be able to pinpoint and treat the cause. Or you may need to see a specialist. The important thing is to find a doctor who makes you feel comfortable.

Several types of doctors treat men who are concerned with changes in erection quality. Here are some who can help:

  • Primary care physicians. For many men, this will be the first professional they see. If the doctor feels you need more specialized treatment, he or she may send you to a specialist.

  • Urologists treat diseases of the urinary tract and urogenital system. Your primary care doctor can recommend one. You can also ask a hospital or health center in your area. Some urologists require referrals.

  • Other specialists who treat sexual health issues include cardiologists (heart specialists), endocrinologists (hormone and diabetes specialists), and psychiatrists.

Types of tests

Doctors have several ways to find the cause of erection difficulties. Your doctor may use simple interviews and questionnaires. Or he or she may prefer more informal chats about lifestyle, stress, and relationship problems.

Your doctor may then do a physical exam. Depending on those results, your doctor may order tests, including:

  • Blood tests to diagnose conditions like diabetes, anemia, cholesterol, or liver and kidney problems.

  • Ultrasound, which uses sound waves to produce images of blood flow in the penis and the blood vessels that supply it.

  • Nerve tests check the health of nerves that send stimulation signals to the penis.

  • Injections into the blood vessels of drugs cause them to enlarge. This allows blood to enter the penis more easily.

  • Measurements of how fluid moves in the penis and blood vessels. This is done with dyes that can be traced on x-rays.

Doctors have several ways to find the cause of erection problems.

Improving Erectile Function

Having trouble getting and keeping an erection can be very frustrating. And no matter what your age or how mild or severe your symptoms are, there is something you can do about it. You can talk to your doctor.


Having erection difficulties doesn't mean you have to give up on your sex life. Several prescription medications are available to treat erection difficulties. See your doctor to find out if one might be right for you.

Oral medications

Oral medicines include pills that can help you get an erection. Oral medicines do not cause an erection directly. Instead, they work by allowing blood to flow more easily into the penis once you are sexually stimulated.

After you are finished having sex, the erection should go away.

Oral medicines are discreet, easy to use, and convenient.

But they are not for everyone.

If you have tried these in the past without success, talk to your healthcare provider about new medicines available. Your doctor can let you know if you're a good candidate for one of these medicines.

Medicines may be used by men who have erection difficulties once in a while, and also by those who have them more often. Common side effects can include:

  • Headache

  • Flushing

  • Stuffy nose

Side effects may vary with different medicines. Talk to your healthcare provider about finding one that you tolerate well.


Seek care at once if you use any medicine to treat erection problems and you have an erection that lasts more than four hours. Call your doctor if erection difficulties occur when there is:

  • Any type of injury to the back, legs, buttocks, groin, penis, or testicles.

  • A loss of pubic or armpit hair, and growth of the breasts.

Other Therapies & Devices

Oral medicines are not the only way to treat erection difficulties. Other methods include:

  • Hormone therapy: Low testosterone levels can cause erection difficulties. Hormone therapy raises testosterone back to its normal level. It may be given through the skin by a patch, by injection, or by mouth. The most common method is by a patch. Side effects for the patch can include skin rashes. Also, hormone therapy may raise the risk of prostate cancer.

  • Vacuum devices: A vacuum device includes a tube that you place over the penis. You pump air out of the tube to create an erection by suction. A ring you put around the base of the penis helps keep the erection. The vacuum draws blood into the penis and the ring "traps" the blood inside. These devices are generally safe and effective. But they should not be used for more than 30 minutes at a time.
    When you take off the ring, the erection goes down. Disadvantages may include a lack of spontaneity and coldness of the penis. Some men also report difficulty and discomfort with ejaculation. Side effects may include numbness of the penis and/or bruising on the skin of the penis.

  • Surgery: Penile implants are silicone cylinders that are implanted by a surgeon. The cylinders, which are either semi-rigid or inflatable, produce an erection. The implants can be a good choice for some men with erection difficulties. Many men report satisfaction with this type of treatment. So do many of their partners. As with any surgery, there may be discomfort as you recover. There is a slight risk of infection.
    This method can't be reversed.

  • Psychotherapy: This involves talking to a psychiatrist, psychologist, sex therapist, or another counselor about concerns—sexual or otherwise—that can affect your ability to get or keep an erection.

Lifestyle Changes

No matter what treatment your doctor prescribes for you, a healthy lifestyle will help reduce your risk of erection difficulties.

Quit smoking

Experts think smoking plays a role in the loss of erection function. Quitting can help some men maintain their erectile function.

Control diabetes

Diabetes can affect arteries or nerve endings in the penis. Men with diabetes are two to five times more likely to have changes in erection quality. By age 70, more than 50% of men with diabetes have some erection difficulties. Taking steps to control your blood sugar can help prevent these problems.

Reduce cholesterol

You need healthy circulation for an erection. If your cholesterol is high, your doctor may want you to reduce it through diet, exercise, and, perhaps, medicine.

Avoid substance abuse

Abuse of alcohol or tobacco can contribute a lot to erection difficulties. So does the use of marijuana, cocaine, and other illegal drugs.

Lose weight

Overweight men are more likely to have erection difficulties. Losing weight can protect your health and your ability to get and keep erections.


A recent, large-scale study showed that regular exercise can reduce your risk of developing erection difficulties.

Reduce stress and anxiety

Stress and anxiety often trigger changes in erection function.

No matter what treatment your doctor prescribes for you, a healthy lifestyle will help reduce your risk of erection difficulties.

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