What is erectile dysfunction? A Mayo Clinic expert explains

Learn more from Matthew Ziegelmann, M.D.

I'm Dr. Matthew Ziegelmann, a urologist at Mayo Clinic. In this video, we'll cover the basics of erectile dysfunction. What is it? Who gets it? The symptoms, diagnosis, and the treatments. Whether you're looking for answers for yourself or for someone you love, we're here to give you the best information available. Erectile dysfunction, also known as impotence, is defined by difficulty getting and keeping an erection. It can be an embarrassing thing to talk about. It's been reported that more than half of men between the ages of 40 and 70 experience some form of ED. So take comfort in knowing that you are not alone. Experiencing difficulty with erections from time to time is usually no cause for concern. But ongoing issues can cause stress, it can affect self-confidence, and it can contribute to relationship problems. Sometimes it may indicate an underlying condition. The bottom line is that if you experience ED, you should talk about it with your doctor, even if you're embarrassed, because we have a number of ways that we can effectively treat erectile dysfunction. ED can be caused by physical or psychological issues. Sexual arousal is a complicated process. It involves your brain, your hormones, your nerves, your muscles, and your blood vessels. A hiccup in any of these can cause a problem.

The fact is that erectile dysfunction affects men of all ages. However, as you get older, your risk can increase. This is not only because erections take longer to develop, but also that other contributing factors may come into play. Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction. On the other hand, depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual feelings. And this can cause or worsen your erectile problems. Often, it's a bit of both. So it's important to understand one's physical and psychological state to know the underlying cause of one's erectile dysfunction.

Unlike a lot of medical conditions, the symptoms of erectile dysfunction are rather straightforward. If you have persistent trouble getting or keeping an erection, you might have erectile dysfunction. If you're dealing with any of these symptoms, a family doctor or an internist is usually a good place to start.

Usually, the hardest part of diagnosing erectile dysfunction is overcoming that embarrassment that comes with talking about your ED. But once you talk to your doctor, you'll find that it's common, and a diagnosis can happen quickly. For many people, a physical exam and answering some basic questions about your medical history is all that is needed. If you have chronic health conditions or your doctor suspects an underlying condition might be involved, you could need further tests or a consultation with a specialist such as me.

Millions of men are able to successfully treat their erectile dysfunction. Oral prescription medications are one popular route. Taking medications does not automatically produce an erection. These tablets amplify the effects of nitric oxide. This is a chemical that your body produces that relaxes muscles in the penis. Sexual stimulation releases this chemical and these medications enhance its effect, allowing for an erection. Other less common, but effective, medications for ED include self-injections or urethral suppositories. If medications aren't effective, your doctor may recommend a vacuum penis pump. This device uses a hollow tube to create a vacuum that pulls blood into your penis. Penile implants are another option and involve surgically placing a device that allows the penis to achieve an erection. If your ED is impacting your mental health or your relationship, your doctor may also recommend that you and your partner visit a psychologist or a sexual therapist. What your treatment ultimately looks like depends on the cause and severity of your erectile dysfunction, as well as any underlying health condition that may be present. Your doctor will be able to work with you to find the right solution.

Erectile dysfunction can be an uncomfortable topic to discuss with your doctor, with your partner and with your friends. But don't assume that you're alone. Involve your partner, and communicate openly and honestly about your condition. Try to remember that it's very common. And more importantly, it's very treatable. If you'd like to learn more about erectile dysfunction, here are some other related videos. Or you can visit mayoclinic.org. We wish you well.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

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Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

When to see a doctor

A family doctor is a good place to start when you have erectile problems. See your doctor if:

  • You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation
  • You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction
  • You have other symptoms along with erectile dysfunction
Erectile dysfunction care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started.

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Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson's disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie's disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you're obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you're a long-term drug user or heavy drinker


Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant


The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.
Erectile dysfunction care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started.

Get the process started

March 29, 2022
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