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Erectile Dysfunction: Impotence (ED) Causes, Symptoms And Treatment

What are impotence causes, ED symptoms, treatment, and diseases conditions for erection problems?

Last updated Fact Checked: Feb 17, 2022

What men’s sexual health and medical urology clinic services are available for diagnosis? Read this online information for medical education but always seek proper medical advice from a healthcare provider.

Ever since doctors discovered that taking Viagra could be used to treat erectile dysfunction disorders, more people came to know about such issues. Originally, Viagra was a treatment for treating heart diseases,1 but as a side-effect, the users discovered that it worked wonders for their erection.

Men, being the nature that they are, find it difficult to convey difficult issues to their doctor. And probably the most embarrassing one of those issues to talk about would be sexual function. The advancement of medicine and its discoveries have brought to light explanations and reasons as to why male sexual dysfunction occurs.

It is nothing to worry about or be ashamed about, seeing as medical professionals commonly address various embarrassing problems that people face daily. With that being the case, it is a problem that is better understood than it ever has been. There are many more ways of treating it now too.2

So for anybody suffering from sexual dysfunction, you will find this article packed with useful information.

What Is Erectile Dysfunction?

If you have experienced a difficult time either gaining or maintaining an erection, which is hard, firm, and sufficient enough to carry out penetration during sex, then you are considered to be suffering from ED. Not only that but if this problem is interfering with other forms of sexual activity, including foreplay, then you still fall under the category.3

Every man experiences some difficulty with their erection throughout their lifetime at some point, but this doesn’t necessarily equate to requiring a diagnosis.4 It only becomes a concern if it is a problem that consistently arises or should we say doesn’t arise at all. Excuse the pun!

To put it briefly, sexual dysfunction can be categorized into two forms – medical or psychological.5

Facts About Erectile Dysfunction

This is just a quick summary of the most important points. The rest of the article will explain them in further detail.

Which ED Medicine Should You Choose?

Studies show that 30%- 65% of men suffer from this condition.14 If you are one of them, you are probably wondering what causes it and what are the best prescriptions out there. Below are the top three Prescription Erectile function pills and their differences.

ED can be caused by vascular disease, diabetes, drugs, hormone imbalances, smoking, and psychological conditions such as stress and anxiety.15

Over the last ten years, newer prescription medicines work by enhancing the natural reaction to sexual stimulation, opening up the blood flow needed for erections. Now on to the 3 different types of ED medicines: Viagra, Cialis, and Levitra.

Viagra (Sildenafil)

Viagra comes in 25 mg, 50 mg, and 100 mg tablets. It takes 40 minutes to start working and it works for 4 hours.

Cautions and Interactions16

Common Side Effects17

Cialis (Tadalafil)

Cialis comes in 2.5 mg, 10 mg, and 20 mg tablets. It takes 30 minutes to work and works for 36 hours.

Cautions and Interactions18

Common Side Effects19

Levitra (Vardenafil)

Levitra comes in 5 mg, 10 mg, and 20 mg tablets. It takes 20 minutes to work and works for 12 hours.

Cautions and Interactions20

Common Side Effects21

When taking ED medication, it is always best to start with a lower strength tablet and build up as needed. Sometimes one drug may work better for one person than it does another. So it is best to try everyone to see which works best for you.

What Are The Causes Of ED?

To explain this, we should first explain how a natural erection occurs so you can see where the problem lies.

The muscles within the penis start to relax, granting permission so to speak to the blood and so it enters into the cylindrical tissue chambers of the penis which increases tissue pressure and causes an erection.22

Blood remains in the penis due to valves that block the blood from leaving through the veins. The firmness of the penis is kept until stimulation comes to an end and ejaculation occurs.

Nerves and hormones are the ones that control the blood flow when the brain sends chemical signals as a response to stimuli such as touch and arousal.23 Anxiety can suppress brain signals. Any psychological problems that caused the change in flow, nervous supply, and hormones can also inhibit an erection from occurring.24

Vascular and neurological causes are the most common forms of medical problems that cause erectile function because they are a result of atherosclerosis and diabetes.25

Atherosclerosis is when the blood vessels are restricted due to them being narrowed by the buildup of harmful substances in the blood. This is the single most common reason as to why ED occurs and the culprit for this; usually smoking and diabetes.26

Not only that, but diabetes can cause nerve problems, called neuropathy. Nerves are often damaged after pelvic surgery, and this is more common than other neurological causes such as stroke and multiple sclerosis.27

Diabetes risk factors should be reduced by stopping smoking, increasing physical exercise, and eating healthier.28

Diabetes is Implicated in ED

The biggest culprit is blood sugar levels. This is a major factor in diabetes.29 One out of two men who have diabetes also suffers from erectile function.30 Other conditions that affect ED include kidney disease, atherosclerosis (hardening of the arteries). cardiovascular disease and multiple sclerosis.31 Each of these conditions can impair the blood flow throughout the body.

ED Caused By Atherosclerosis

Blockage and the thickening of blood vessels cause them to become thickened, and therefore the internal walls become narrow and restrict the flow of blood.

The smallest vessels of the penis are affected, to begin with. Because they are so small to start with, even the slightest amount of narrowly of these vessels plays a tremendous impact on circulation.

The loss of elasticity caused by the arteries of the penis due to atherosclerosis prevents them from dilating, and so it becomes harder for them to fill with blood and for an erection to occur.

An early indication of this discovery can be beneficial in counteracting arterial disease, as this is one of the first warning signs.32

ED Caused By Hypertension

Hypertension is increased blood pressure. The added force exerted on the walls of arteries as blood travels through them causes damage. The penis region is not all that is affected but it affects the whole of the cardiovascular system.33

Medical Conditions that Cause ED

It is estimated that between 15 and 30 million men have ED according to the National Kidney and Urologic Disease Information Clearinghouse.
Ed differs from impotence in that it isn’t caused by a lack of desire, and doesn’t result in ejaculation problems.34

Men can help themselves by staying healthy because certain medical conditions cause erectile dysfunction. Avoiding the medical problem, or correcting it, can lead to improvement.

Some of these conditions are out of the control of the patient. Others, such as diabetes, obesity, high blood pressure, and atherosclerosis are things people can avoid if they take proper care of themselves. Follow a healthy diet and exercise routine to keep weight under control and maintain good cardiovascular health. Stopping smoking and not drinking excessively will help also.

If diagnosed with one of these conditions, take medication as directed and do whatever it takes to regain good health. The rewards are certainly worth the effort.

Physical Causes Of ED

If you find yourself unable to achieve an erection consistently, you are firmly advised that you consult your doctor as it could be that there is a more severe underlying condition associated with you not being able to get erect.

Don’t brush it under the carpet thinking that it is only a small issue. The earlier you can get a proper diagnosis, the quicker the right treatment can be made available to you.

Here is a list that includes some of the natural and physical complications that can lead to erectile dysfunction;41

Not only recreational drugs but it is also known that some prescription drugs can also cause issues. It is important to note that any changes in medication should be per your doctor’s advice.


A physical problem is grounds for about 90% of cases with the remaining percentage resulting from psychological factors.42

Psychological Causes Of ED

Primary ED is a case when somebody has never been able to achieve an erection. This is never usually caused by any physical factors; rather it is almost entirely psychological. Some of the psychological reasons for this could be guilt, fear of intimacy, depression, or anxiety.43

Now we move on to secondary erectile dysfunction. This is when at some point in time ED was never an issue. However, it has developed later on and become a problem.

Psychogenic ED can also cause temporary erectile problems. We would not go to the full extent as to class it as erectile dysfunction. Other psychological factors may be specifically related to a particular partner, time, or environment.44

Facing the Embarrassment of ED?

ED does not have to be embarrassing and you shouldn’t feel bad or embarrassed by it happening to you.
Erectile dysfunction can happen to nearly any man, especially after one’s sexual peak years have passed. But there is hope for those who have ED.

There is a distinction between those men who have occasional trouble achieving an erection and those who are diagnosed with ED.

If you’ve had a few times where you weren’t able to get it up enough for sexual activity, you aren’t alone. Many things can affect the ability to get an erection including drinking, stress, fatigue, certain foods, mood, temperature, and more.49

If it happens to you in the heat of the moment you might panic and want to run out of the room. But many guys find that humor can soften then the embarrassment of occasional erection issues. Sometimes just getting a few minutes to regroup can be enough to get back in the mood.

Partners should be understanding and realize that occasional issues with achieving an erection can happen to any guy. The lack of an erection does not mean the person isn’t attracted to you or not interested in sex.50 Sometimes the equipment doesn’t work when the operator wants it to right away.

If you’ve had trouble achieving an erection or one that can be sustained for intercourse the majority of the time you try to engage in sexual activity you may have ED and not just an occasional problem due to outside influences.

If you feel you might have ED don’t be embarrassed. Make an appointment with your health care provider or doctor and tell them your concerns. Many doctors will diagnose problems with achieving an erection as being ED and this is a diagnosis many men hear every day.

You aren’t alone and thankfully science has allowed the pharmaceutical industry to create prescription medication that can solve the problem of getting it up for most healthy men. ED drugs like Viagra and Cialis have been on the market for years and have given hope to men worldwide.

These drugs have helped millions of men get their sexual confidence back and bring back the spark to the bedroom. Partners of men suffering from erection issues are also benefiting as now their partner is better equipped to please them and get into the action.

Remember, if you have trouble achieving an erection once in a while this is most likely not a sign of ED. If you have trouble doing so often then you’ll want to speak to your doctor and ask about oral medication such as Viagra or Cialis. Don’t be ashamed as you are far from alone and realize that it is a treatable condition.

What Can You Do About ED?

When we talk about ED the main concern of men and women is related to sex. It is just natural – the most obvious. But much more important than the issue of sex is what ED may indicate: circulatory problems, hypertension, clogged arteries, high cholesterol, diabetes, etc.51

Ironically, the problem of sex is the smallest of all in that perspective and easiest to solve. It’s simple, it need not be for only a doctor to understand: the penis works with blood, correct? If blood circulation is normal, it will work. Otherwise not, or not as well as we desire.

The five simple recommendations below are part of a program created by Dr. Steven Lamm from the University of New York Medical Center. Lamm is known for starring in a television show on ABC (America). In 2005, he launched the book ‘The Hardness Factor”. Books like that sell more if you address them to the sexually related problem – the bad side effect becomes the star.

7 steps to improve your heart health/sexual performance:52

In the summary ahead, from the book ‘The Hardness Factor’, I’ve tried to get all the crucial information about Dr. Steven Lamm’s health program.53 Have in mind that by doing what the Doctor suggests what we are taking good care of is actually of great importance: our heart and the whole circulatory system. All the rest are positive side effects (and possible good sex included!).


Good sex is something relative – if everything is fine with us, good sex on our human perspective is something to be learned.


Egg yolk, butter, and fatty red meats should be reduced. According to Dr. Lamm, the fats damage the blood vessels, preventing them from responding appropriately to sexual stimuli transmitted from the brain to the penis. More: the penile nerves lose their sensitivity to the accumulation of cholesterol.

Try to eat 10% less than you used to eat at meals. That’s important because the total calories in your gut affect the amount of testosterone available to you. The more calories, less testosterone, says Lamm. Later he adds: make the right decisions at the dinner. The right choices will not burden the digestive system, and the blood will go to where you need it. Avoid cocktails before going to the table and move away from foods with excess salt. Consume olive oil or vinegar instead of salad dressings and remove all visible fat from meat.

According to Dr. Lamm, exercise is the best way to improve the resistance of the penis/heart. Exercise awakens sexual desire and strengthens self-esteem, positively affecting the brain waves that make you feel energized. The practice also releases substances that prevent fatigue during sex and increases levels of testosterone; libido empowering.

Green tea is something not to be taken for granted. Green tea has been said to help in everything from weight loss to cancer prevention. It is a strong source of antioxidants and raises our metabolism. Today we have green tea pills, but those are not as good as the real tea itself, reportedly. Green tea is not like an energy drink. This must become a habit and a cup every day will do the job.

Finally, make your heart pump blood better, try to increase by 5000 steps your daily walk – a pedometer, a device that records that, can help in keeping track. The ideal, according to Dr. Lamm, is 10,000 steps a day to improve fitness and reduce weight. And as the pointer of the balance goes down, the erections will, literally, go up and remain aloft for much longer.

Dr. Lamm also highly endorses and encourages the taking of VigRX Plus Supplements. You can see for yourself on their official website where he discusses their benefits in a short video here.


Body Freedom exclusively utilizes the best quality sources, including peer-reviewed studies, to support the facts in our content. Read our editorial process to learn more regarding our fact-checking to maintain the accuracy, reliability, and trustworthiness of our content.

  1. Marko V. (2020) Viagra. In: From Aspirin to Viagra. Springer Praxis Books. Springer, Cham.
  2. Campbell, Jeffrey D., et al. “Technological Advancements for Treating Erectile Dysfunction and Peyronie’s Disease.Urologic Clinics 49.1 (2022): 175-184.
  3. Andersson KE. Mechanisms of penile erection and basis for pharmacological treatment of erectile dysfunction. Pharmacol Rev. 2011;63(4):811-859. doi:10.1124/pr.111.004515
  4. Brotto, Lori A. “The DSM diagnostic criteria for hypoactive sexual desire disorder in men.The journal of sexual medicine 7.6 (2010): 2015-2030.
  5. Rosen, Raymond C. “Psychogenic erectile dysfunction: classification and management.Urologic Clinics of North America 28.2 (2001): 269-278.
  6. Hatzimouratidis, Konstantinos, et al. “Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation.European urology 57.5 (2010): 804-814.
  7. Andersson, Karl-Erik. “Erectile physiological and pathophysiological pathways involved in erectile dysfunction.The Journal of urology 170.2 (2003): S6-S14.
  8. Muneer A, Kalsi J, Nazareth I, Arya M. Erectile dysfunction. BMJ. 2014;348:g129. Published 2014 Jan 27. doi:10.1136/bmj.g129
  9. Glina, Sidney, David J. Cohen, and Marcelo Vieira. “Diagnosis of erectile dysfunction.Current opinion in psychiatry 27.6 (2014): 394-399.
  10. Corona, Giovanni, et al. “Phosphodiesterase type 5 (PDE5) inhibitors in erectile dysfunction: the proper drug for the proper patient.The Journal of Sexual Medicine 8.12 (2011): 3418-3432.
  11. Yarnell, Eric. “Herbs for erectile dysfunction.Alternative and Complementary Therapies 21.6 (2015): 276-283.
  12. Brison, Daniel, Allen Seftel, and Hossein Sadeghi‐Nejad. “The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction.The journal of sexual medicine 10.4 (2013): 1124-1135.
  13. Kucuk, Eyup Veli, et al. “Erectile dysfunction patients are more satisfied with penile prosthesis implantation compared with tadalafil and intracavernosal injection treatments.Andrology 4.5 (2016): 952-956.
  14. Campbell, Jeffrey D., et al. “Technological Advancements for Treating Erectile Dysfunction and Peyronie’s Disease.Urologic Clinics 49.1 (2022): 175-184.
  15. Chen, Lei, et al. “Male sexual dysfunction: a review of literature on its pathological mechanisms, potential risk factors, and herbal drug intervention.Biomedicine & Pharmacotherapy 112 (2019): 108585.
  16. Arora S, Surakiatchanukul T, Arora T, Cagini C, Lupidi M, Chhablani J. Sildenafil in ophthalmology: An update. Surv Ophthalmol. 2022;67(2):463-487. doi:10.1016/j.survophthal.2021.06.004
  17. Ausó, Eva, Violeta Gómez-Vicente, and Gema Esquiva. “Visual side effects linked to sildenafil consumption: an update.Biomedicines 9.3 (2021): 291.
  18. Martin, Keith R., and Richard J. Bloomer. “14 Nitrate and Human.” Nitrate Handbook: Environmental, Agricultural, and Health Effects (2021): 303.
  19. Tiwari, Shashank. “A comparative review on avanafil vs tadalafil vs sildenafil tablet.Journal of Pharmaceutical Sciences and Research 12.5 (2020): 598-601.
  20. Agarwal, Shubham, and Sanjeev Kumar Agarwal. “Lopinavir-ritonavir in SARS-CoV-2 infection and drug-drug interactions with cardioactive medications.Cardiovascular Drugs and Therapy 35.3 (2021): 427-440.
  21. Maia, Nathalia de Paula Doyle, Karen de Carvalho Lopes, and Fernando Freitas Ganança. “Otorhinolaryngological adverse effects of urological drugs.International braz j urol 47 (2021): 747-752.
  22. Chen, Jian-Guo, and Rui Jiang. “Contraction mechanism of smooth muscle cells and its relationship with penile erection.Zhonghua nan ke xue= National Journal of Andrology 24.2 (2018): 172-175.
  23. Calabrò, Rocco S., et al. “Neuroanatomy and function of human sexual behavior: A neglected or unknown issue?.Brain and Behavior 9.12 (2019): e01389.
  24. Meston, Cindy M., and Amelia M. Stanton. “Understanding sexual arousal and subjective–genital arousal desynchrony in women.Nature Reviews Urology 16.2 (2019): 107-120.
  25. Diaconu, Camelia Cristina, et al. “The erectile dysfunction as a marker of cardiovascular disease: a review.Acta Cardiologica 75.4 (2020): 286-292.
  26. Chowdhury, Sumon Rahman, et al. “Association between erectile dysfunction and cardiovascular disease: A systematic review.Chattagram Maa-O-Shishu Hospital Medical College Journal 18.2 (2019): 59-66.
  27. Giovannini S, Coraci D, Brau F, et al. Neuropathic Pain in the Elderly. Diagnostics (Basel). 2021;11(4):613. Published 2021 Mar 30. doi:10.3390/diagnostics11040613
  28. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98. doi:10.1038/nrendo.2017.151
  29. Kumar, Sachin, et al. “Implicating the effect of ketogenic diet as a preventive measure to obesity and diabetes mellitus.Life sciences 264 (2021): 118661.
  30. Ziaei-Rad, Marzieh, Mariam Vahdaninia, and Ali Montazeri. “Sexual dysfunctions in patients with diabetes: a study from Iran.Reproductive Biology and Endocrinology 8.1 (2010): 1-8.
  31. Wang, Connie J., Daniel Cukor, and Kirsten L. Johansen. “Sexual Dysfunction Among Patients With Chronic Kidney Disease.Seminars in nephrology. Vol. 41. No. 6. WB Saunders, 2021.
  32. Salvio, Gianmaria, et al. “Hyperhomocysteinemia: Focus on endothelial damage as a cause of erectile dysfunction.International Journal of Molecular Sciences 22.1 (2021): 418.
  33. Koroglu, Gokhan, et al. “Management of erectile dysfunction: an under-recognition of hypertension.Current Pharmaceutical Design 24.30 (2018): 3506-3519.
  34. Wincze, John P., and Risa B. Weisberg. Sexual dysfunction: A guide for assessment and treatment. Guilford Publications, 2015.
  35. Hernández-Cerda, Jorge, et al. “Understanding erectile dysfunction in hypertensive patients: the need for good patient management.Vascular Health and Risk Management 16 (2020): 231.
  36. Moon, Ki Hak, So Young Park, and Yong Woon Kim. “Obesity and erectile dysfunction: from bench to clinical implication.The world journal of men’s health 37.2 (2019): 138-147.
  37. Flanagan, Eoin P. “Neuromyelitis optica spectrum disorder and other non–multiple sclerosis central nervous system inflammatory diseases.CONTINUUM: Lifelong Learning in Neurology 25.3 (2019): 815-844.
  38. Mitidieri E, Cirino G, d’Emmanuele di Villa Bianca R, Sorrentino R. Pharmacology and perspectives in erectile dysfunction in man. Pharmacol Ther. 2020;208:107493. doi:10.1016/j.pharmthera.2020.107493
  39. Jankovic, Joseph, and Anthony E. Lang. “Diagnosis and assessment of Parkinson disease and other movement disorders.” Bradley’s Neurology in Clinical Practice E-Book (2021): 310.
  40. Wojciechowska-Zdrojowy, Marta, et al. “Analysis of sexual problems in men with psoriasis.Journal of Sex & Marital Therapy 44.8 (2018): 737-745.
  41. Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. Published 2016 Feb 4. doi:10.1038/nrdp.2016.3
  42. Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005;32(4):379-v. doi:10.1016/j.ucl.2005.08.007
  43. Bennett, Sarah E., et al. “Understanding the psychosocial impact of joint hypermobility syndrome and Ehlers–Danlos syndrome hypermobility type: a qualitative interview study.Disability and Rehabilitation 43.6 (2021): 795-804.
  44. Retzler, Kathryn. “Erectile dysfunction: A review of comprehensive treatment options for optimal outcome.Journal of Restorative Medicine 8.1 (2019).
  45. Liu, Qian, et al. “Erectile dysfunction and depression: a systematic review and meta-analysis.The Journal of Sexual Medicine 15.8 (2018): 1073-1082.
  46. Kalaitzidou, I., Venetikou, M. S., Konstadinidis, K., Artemiadis, A. K., Chrousos, G., & Darviri, C. (2014). Stress management and erectile dysfunction: a pilot comparative study. Andrologia, 46(6), 698-702.
  47. Pyke RE. Sexual Performance Anxiety. Sex Med Rev. 2020;8(2):183-190. doi:10.1016/j.sxmr.2019.07.001
  48. Suijker CA, van Mazijk C, Keijzer FA, Meijer B. Phenomenological and existential contributions to the study of erectile dysfunction. Med Health Care Philos. 2021;24(4):597-608. doi:10.1007/s11019-021-10029-0
  49. Swartz, J. M., and Y. L. Wright. Maximize Your Testosterone At Any Age!: Improve Erections, Muscular Size and Strength, Energy Level, Mood, Heart Health, Longevity, Prostate Health, Bone Health, and Much More!. Lulu. com, 2019.
  50. East, Leah, et al. “Patient perspectives and experiences of sexual health conversations and cardiovascular disease: A qualitative study.Journal of clinical nursing 30.21-22 (2021): 3194-3204.
  51. ThetSuSu, Shabeeh H. (2022) Cardiovascular Health in Men. In: Goonewardene S.S., Brunckhorst O., Albala D., Ahmed K. (eds) Men’s Health and Wellbeing. Springer, Cham.
  52. Khan, Laura Kettel, et al. “Recommended community strategies and measurements to prevent obesity in the United States.Morbidity and Mortality Weekly Report: Recommendations and Reports 58.7 (2009): 1-29.
  53. Lamm, Steven, and Gerald Secor Couzens. The Hardness Factor: How to Achieve Your Best Health and Sexual Fitness at Any Age. Harper Collins, 2005.

Shahrokh Shariat, MD

Prof. Shariat has published over 1400 scientific papers in peer-reviewed journals. In 2014 he received the Matula Award from the European Society of Urology (EAU), in 2017 the Gold Cystoscope Award from the American Society of Urology, probably the most important urologist award worldwide.

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