"Erectile dysfunction can be a very serious issue because it's a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night's sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.
"Smoking is a short- and long-term cause of erectile dysfunction," warns Feloney. "In the short-term nicotine constricts the blood vessels that you need to get an erection, and in the long-term nicotine contributes to hardening of the arteries that can cause erectile dysfunction." Some approaches for quitting include making a clean break, avoiding the triggers of smoking, trying a nicotine patch or gum, and joining a smoke cessation program.
If not properly controlled, both type 1 and type 2 diabetes can cause complications due to high blood sugar levels. Over time, these high levels can cause irreversible nerve damage and narrow your blood vessels. While nerve damage may affect the sensitivity of your penis, blood vessel damage can affect the blood flow to your penis and make it more difficult for you to get an erection.
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin [an antibiotic], ketoconazole [Nizoral, a medication for fungal/yeast infections], and protease inhibitors [medications used to treat AIDS]). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over 65 years of age with liver disease, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example,

Most men may not openly talk about their erection problems, but erectile dysfunction — when a man cannot achieve or maintain an erection well enough or long enough to have satisfying sex — is very common. According to the National Institutes of Health, 5 percent of 40-year-olds and 15 to 25 percent of 65-years old have ED. But while ED is more likely to occur as a man gets older, it doesn’t come automatically with age.
Diabetes occurs when you have too much sugar circulating in your bloodstream. There are two main types of diabetes: type 1 diabetes, which affects less than 10 percent of those who have diabetes, and type 2 diabetes, which accounts for over 90 percent of diabetes cases. Type 2 diabetes often develops as a result of being overweight or inactive. Approximately 30 million Americans have diabetes, and about half of them are men.
Erections also require neural input to redirect blood flow into the corpora cavernosae. Psychogenic erections secondary to sexual images or auditory stimuli relay sensual input to the spinal cord at T-11 to L-2. Neural impulses flow to the pelvic vascular bed, redirecting blood flow into the corpora cavernosae. Reflex erections secondary to tactile stimulus to the penis or genital area activate a reflex arc with sacral roots at S2 to S4. Nocturnal erections occur during rapid-eye-movement (REM) sleep and occur 3–4 times nightly. Depressed men rarely experience REM sleep and therefore do not have nocturnal or early-morning erections.
*all photos are models and not actual patients.If you are interested in a prescription product, Hims will assist in setting up a visit for you with an independent physician who will evaluate whether or not you are an appropriate candidate for the prescription product and if appropriate, may write you a prescription for the product which you can fill at the pharmacy of your choice.
“With the success of Viagra-type drugs, there has been a tendency to start all patients with ED on one of these drugs and not look much further for a medical cause. But we now know that ED may be an early warning for heart and blood vessel disease, so it is important to look for common risk factors. These include high blood pressure, diabetes, medications, smoking, drinking, and drugs,” said Dr. Wang.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
Cultivating and maintaining a healthy relationship is not easy. It takes time to truly get to know someone and to trust them. If you and your partner are experiencing trouble with your relationship, it could very well bleed over into your sex life. It could also be the case that your erectile dysfunction is creating problems in the relationship – it is another example of the cycle of ED that can affect many different aspects of your life. Communication is the first step in resolving this particular cause for psychological ED but it is also one of the most difficult steps to take.
Regular exercise for about 20 to 30 minutes a day may act as a libido enhancer and certainly will improve your overall health. "Exercising improves blood flow to all areas of your body and that includes the pelvic region where the blood vessels needed for sexual functioning are located," says Feloney. Some other ways that regular exercise can improve your sexual performance include building up your stamina, lowering your blood pressure, relieving stress, and helping you look and feel better.

Because blood vessel problems are the leading cause of erectile dysfunction, erections have been described as a useful barometer for a man’s overall health. The American Heart Association urges that physicians screen for cardiovascular risks in patients who have erectile dysfunction, even if no other risk factors are present; the onset of ED can precede cardiac events by two to five years.


Other medical therapies under evaluation include ROCK inhibitors and soluble guanyl cyclase activators. Melanocortin receptor agonists are a new set of medications being developed in the field of erectile dysfunction. Their action is on the nervous system rather than the vascular system. PT-141 is a nasal preparation that appears to be effective alone or in combination with PDE5 inhibitors. The main side effects include flushing and nausea. These drugs are currently not approved for commercial use.

Studies show that high cholesterol and obesity are linked to erectile dysfunction, and both can be improved through diet. "A heart-healthy diet that prevents cardiovascular disease and maintains a healthy weight is also good for erectile functioning," says Feloney. An ideal diet plan involves eating foods low in saturated fat and cholesterol and having frequent servings of fruits, vegetables, and plenty of whole grains.


Obesity.  Obesity and erectile dysfunction in men has unfortunately become an epidemic in this country, affecting children, teenagers, young adults and up.  This disease tends to follow men and women through adulthood, if not addressed.  Obesity leads to heart disease, diabetes and high blood pressure.  This trifecta results in the three main medical causes of erectile dysfunction.
Erectile dysfunction can be embarrassing and difficult to talk about for some men. Many men may feel like they need to hide their diagnosis from their partner. "Failure to communicate openly about erectile dysfunction can result in both partners drawing away from the relationship," warns Feloney. Remember that your partner is also affected by your problem; being open and honest is the best way to decrease fear and anxiety. Discuss options for achieving sexual satisfaction together, and be positive — most erectile dysfunction problems can be treated.
Erectile dysfunction (ED) is defined as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction. This definition, which has been recently endorsed by the Fourth International Consultation on Sexual Medicine (ICSM) (1), is based on a clinical principle which leaves room to the judgement of patients, being widely affected by their self-perception of normality. Furthermore, rather than focusing on possible causes of the dysfunction, it hinges on the sexual distress which it causes. This is consistent with the philosophy of Sexual Medicine, according to which, only symptoms creating despair are worthy of medical care. On the other hand, it carries the risk of over- or under-estimating a medical condition that does not have objective medical parameters of definition. This is particularly the case for young and apparently healthy men whose complaint of ED can be perceived by medical practitioners as excessive or overrated thus, minimized without even performing an adequate screening of possible associated or causing conditions. This review is aimed at summarizing the available evidence on the organic and non-organic disorders that can be associated with ED in young men, underlining the importance of recognition and assessment of a symptom, which can lead to a unique opportunity for performing a high quality preventive medicine intervention.
Sildenafil should be taken 1–2 h before intercourse. It is important to tell patients that the drug’s effectiveness requires sexual stimulation. One patient in our clinic recently complained that he had no effect from taking sildenafil. It was later discovered that he took the pill and then sat on his couch and read a book about how to grow tomatoes!
You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra,  Staxyn, and Stendra. All work by improving blood flow to the penis during arousal. They're generally taken 30-60 minutes before sexual activity and should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.
The truth is medication or psychosexual counselling are the first treatments a doctor will suggest because they’ve been proven to work. If a doctor has approved a medication for you then it’s safe. If you would still like to see if herbal supplements work for you, then there is a list below of supplements thought to work for erectile dysfunction. Just before you invest your money in them, remember they aren’t proven to work:
Additionally, speaking to more than just the sexual issues related to erectile dysfunction, the research addresses implications related to the overall understanding of penile health. According to Arthur Burnett, M.D., a professor of urology and head of the research team, "eNOS plays roles in both immediate erectile response and the overall health and function of the penile tissue." 

Before a man concludes that oral drugs don’t work for him, he should have his testosterone levels checked to rule out hormone deficiency as the cause of (or as a contributor to) his sexual dysfunction. Other symptoms of low testosterone include a low sex drive and infertility. Checking testosterone levels requires a blood test. If a man’s levels of testosterone are decreased or at the lower end of normal, his doctor may prescribe supplemental testosterone therapy, either as testosterone injections or testosterone gel, which is applied daily to the skin. In some cases, testosterone therapy alone can resolve sexual dysfunction, or it can be combined with the use of oral erectile dysfunction drugs.
Erectile dysfunction is your body’s “check engine light” because ED can be an early sign of serious health problems like high blood pressure, diabetes, high cholesterol or low testosterone. The blood vessels in the penis are smaller than other parts of the body. So ED symptoms often occur long before more serious problems like a heart attack or stroke. When an otherwise healthy man in his 20’s experiences ED, it’s cause for concern.
In the popular media, it’s easy to find claims of a rising “epidemic” of erectile dysfunction in young men. For example, this article argues that the rate of ED in young men has increased 1000% in the last decade alone—though, problematically, no research is cited to back it up, which makes this a very questionable claim. So what does the science say on this subject? Are erectile difficulties really rising at a dramatic rate in young guys? Let’s take a look.
Although ED can become a permanent condition, this typically isn’t the case for men who experience occasional erectile difficulties. If you have diabetes, you may still be able to overcome ED through a lifestyle that includes sufficient sleep, no smoking, and stress reduction. ED medications are usually well-tolerated, and can be used for many years to help overcome any ED problems.
Injury to the nerves and arteries near the penis can lead to erectile dysfunction. According to the National Institutes of Diabetes and Digestive and Kidney Diseases, surgeries for prostate and bladder cancer can injure penile nerves and arteries, although it doesn’t always happen. Spinal cord injuries can affect the ability to achieve and maintain an erection, as can injuries to the penis, prostate, bladder and pelvis.

Penile prosthesis is a viable option for men who cannot use sildenafil and who find the injections or vacuum erection therapy distasteful. A non-adjustable semi-rigid prosthesis is easy to insert and has no postoperative mechanical problems. The inflatable prosthesis has a pump that is put in the testicular sac for on-demand inflation and deflation. Future versions will have a remote control device similar to a garage-door opener.

After a full history and physical examination, the urologist likely has a perception of the etiology of the problem. Additional laboratory evaluations may be necessary to evaluate for specific types of organic disease. These tests might include serum chemistry, complete blood count, lipid profile, thyroid stimulation hormone/free thyroxine, and early morning serum testosterone to assess for metabolic abnormalities, such as diabetes mellitus, hyperlipidemia, renal dysfunction, thyroid disease, and hypogonadism (16). These are not mandatory components of the assessment in a patient with hypertonic cavernous smooth muscle as the source of ED.
If not properly controlled, both type 1 and type 2 diabetes can cause complications due to high blood sugar levels. Over time, these high levels can cause irreversible nerve damage and narrow your blood vessels. While nerve damage may affect the sensitivity of your penis, blood vessel damage can affect the blood flow to your penis and make it more difficult for you to get an erection.
Psychological causes are less common than we thought but more often the cause in younger men. Performance anxiety triggers the release of adrenaline. Adrenaline causes blood to flow TO the vital organs, such as the heart, lungs and brain, and AWAY from less vital structures like the fingers, toes and the penis. Our bodies do this to cope with the physical stress of a physical attack or physical challenge, but sexual anxiety also triggers this reflex.
It's not easy to get in the mood when you're overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

In the popular media, it’s easy to find claims of a rising “epidemic” of erectile dysfunction in young men. For example, this article argues that the rate of ED in young men has increased 1000% in the last decade alone—though, problematically, no research is cited to back it up, which makes this a very questionable claim. So what does the science say on this subject? Are erectile difficulties really rising at a dramatic rate in young guys? Let’s take a look.


Accurate statistics are lacking on how many men are affected by the condition because it is often underreported, but it is estimated that about half of men over 40 in Canada have frequent problems achieving or maintaining an erection. The number of men suffering from erectile dysfunction increases with age, but it is not considered a normal part of aging. The majority of cases can be successfully treated.
Circulatory problems: An erection occurs when the penis fills with blood and a valve at the base of the penis traps it. Diabetes, high blood pressure, cholesterol, clots, and atherosclerosis (hardening of the arteries) can all interfere with this process. Such circulatory problems are the number one cause of erectile dysfunction. Frequently, erectile dysfunction is the first noticeable symptom of cardiovascular disease.
The association between psychiatric conditions and sexual dysfunctions, including ED, is well known. Data from population-based studies demonstrate a cross-sectional association between depressive symptoms and ED (65-68) and, among men seeking medical care for ED, depression is significantly associated with a greater severity of the impairment in erectile function (69,70). A meta-analysis of the available prospective studies has shown the role of depression as a significant risk factor for development of ED (71). However, the relationship seems to be bidirectional, as also ED has been associated with the occurrence of depression (72). In addition, treatment with PDE5i is related with an improvement in depressive symptoms (72). Most of this evidence comes from studies not specifically designed for the assessment of this relationship in younger men. However, few studies available in younger populations seem to confirm these results. In an internet-based survey, involving more than 800 North American medical students with a mean age of 25.7 years, ED was reported by 13% of them and it showed a significant association with depressive symptoms, whose frequency got higher as a function of ED severity (73). In a population of more than 2,500 very young Swiss men, aged 18–25 years, participating to a survey on sexual function while attending the medical screening for the evaluation of military capability, ED had a prevalence of 30%. Among the possible correlated conditions, mental health showed an independent association, besides the use of medications without medical prescription, a shorter sexual lifespan and impaired physical health (74). The results from this Swiss study were then prospectively extended on a sample of 3,700 men evaluated at baseline and 15.5 months later (75). Among a number of different possible predictors, including life-style, drug abuse, perceived physical fitness and BMI, only perceived impairment in mental health and depression, either newly occurred or continuously present, were associated with both persistence and development of ED (75). In a retrospective population-based study from Finland, involving almost 3,500 men aged 18–48 years, the role of depression as a significant predictor for ED was confirmed, but this study also showed that anxiety plays a significant role and that ED is significantly less frequent in men with a longer lasting sexual life, thus underlining the positive role of sexual experience and self-confidence (76). Anxiety is often involved in the pathogenesis of ED at the beginning of sexual life. In fact, anxiety can lead to an excessive focus on quality of erection, thus providing a cognitive distraction that negatively affects the arousal and consequently the erection itself (77-79). On the other hand, anxiety can result from one or more sexual failures, with loss of sexual confidence, increasing fears and avoidance for sexual experiences that, in the end, lead to an increased probability of new failures, thus creating a vicious circle (77). Cognitive distraction could be also provided by excessive worry for physical, and in particular genital, self-image. In fact, it has been proposed that when most mental energy is focused on monitoring body, psychological resources are distracted from sex, resulting in an impaired functioning (80,81). In line with this cognitive explanation, a recent study conducted on 367 military personnel younger than 40 years showed that a deteriorated genital self-image is associated with sexual anxiety which, in turn, is associated with a higher probability of sexual dysfunction (82).
The National Institutes of Health estimates that erectile dysfunction strikes as many as 30 million men in the United States. Its prevalence does increase with age — 4 percent of men in their 50s are affected by ED, 17 percent in their 60s, and 47 percent of those over 75. But research has also found that 5 percent of those affected were between 20 and 39.

The link between chronic disease and ED is most striking for diabetes. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Yet evidence shows that good blood sugar control can minimize this risk. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.

Penile implants - are generally used if physical damage (like an accident) makes the anatomical parts needed for an erection not work. These are inserted by surgery and can provide a permanent treatment choice if others fail to work. The implants can be semi-rigid or inflatable. They can be pretty expensive and are not usually available on the NHS.
The reasons young men develop erectile dysfunction differ from those of their older peers. The typical aging male with erectile dysfunction develops the condition because some underlying disease (such as heart disease or diabetes) is preventing blood from flowing into his penis. For a younger man, the problem is more likely to be some form of trauma, such as an accident that damaged nerves needed to produce an erection. Regardless of the cause, a young man with erectile dysfunction should talk about the problem with a physician.
Phosphodiesterase inhibitors: This class of medications includes sildenafil, tadalafil, and vardenafil. They work by inhibiting an enzyme called phosphodiesterase type 5 (PDE-5), allowing more blood to enter the penis and helping to produce an erection. These medications are often taken before sex and will cause an erection only when the man is sexually stimulated.
Few simple laboratory tests can help identify obvious causes of organic ED. Initial labs should include HbA1c, free testosterone, thyroid function tests, and prolactin levels. However, patients who do not respond to pharmacological therapy or who may be candidates for surgical treatment may require more in-depth testing, including nocturnal penile tumescence testing, duplex Doppler imaging, somatosensory evoked potentials, or pudendal artery angiography.
Pharmacological treatment of T deficiency in the young essentially relies on the site of origin of the dysfunction: the testis (primary hypogonadism) or the hypothalamic-pituitary region (secondary hypogonadism). In the case of primary hypogonadism, the only available treatment is T replacement therapy (TRT). In secondary hypogonadism, patient needs dictate the therapy. If fertility is requested, gonadotropin is the only option, with the caveat of anti-estrogens in selected cases. If fertility is not an issue, TRT is again the primary choice (63).
The key to treating erectile dysfunction is to identify the underlying cause. In many cases, it takes a fair bit of trial and error. Because the majority of ED cases are caused by physiological issues, your first step should be to talk to your doctor about your concerns. After completing a physical examination and reviewing your medical history, your doctor will ask you some questions and run some tests to rule out medical causes for your ED.

Performance jitters. For some young men, the desire to perform well in bed can be so overwhelming that, in turn, it causes them to not perform at all. “When a younger man experiences ED, it often is associated with significant performance anxiety, which in turn increases the problem, sometimes turning a temporary situation (i.e., too much to drink that night) into a permanent problem,” says Jerome Hoeksema, MD, assistant professor of urology at the Rush University Medical Center in Chicago. “The more they worry about it, the worse it gets. Young men need to recognize this cycle and try to reduce the ‘stress’ surrounding sex.”
Although ED and diabetes are two separate conditions, they tend to go hand in hand. Half of men with diabetes will experience ED within 10 years of their diagnosis.8 For some men, ED may be the first symptom of diabetes even if they have not yet been diagnosed, particularly in men younger than 45.6 Left untreated, ED can damage self-confidence and relationships.
Performance anxiety can be another cause of impotence. If a person wasn’t able to achieve an erection in the past, he may fear he won’t be able to achieve an erection in the future. A person may also find he can’t achieve an erection with a certain partner. Someone with ED related to performance anxiety may be able to have full erections when masturbating or when sleeping, yet he isn’t able to maintain an erection during intercourse.

This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection. All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B.
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