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Understanding Erectile Dysfunction: Common Symptoms, Causes and Treatments

Understanding Erectile Dysfunction: Common Symptoms, Causes and Treatments
Dr. Constance Odom, MD Picture of Dr. Constance Odom, MD

Medically reviewed by

Written by our editorial team.

Last Edited 4 min read

Erectile dysfunction is the inability to achieve an erection and sustain it during sexual intercourse. While complete ED only affects approximately 5 percent of men over the age of 40, according to the University of Wisconsin School of Medicine, nearly 50 percent of men in their 50s experience mild or moderate ED. 

While causes and symptoms vary wildly, it is important to understand that this condition can stem from a variety of factors, not all of which are medical. True, the most common cause is problems with blood flow or penile nerves, but psychological factors, like stress and anxiety, can also replicate the physical condition. That is why, before jumping to any conclusions, it is beneficial to gain a thorough understanding of the symptoms, causes and treatments of erectile dysfunction.

Physical Symptoms 

A few of the most common physical symptoms of ED are reduction in sexual urges, difficulty keeping and forming an erection, and ejaculation and climax issues. While these symptoms can be alarming, it is vital to take note of any physical difficulties because it can indicate a deeper, more pressing physical condition, likely pertaining to the cardiovascular system. 

The symptoms of ED may produce feelings of inadequacy and embarrassment, and while natural, it is necessary to understand that physical symptoms are nothing to be ashamed of. Do not hide information from your physician. Any information you share is confidential and may be potentially life-saving.

Psychological Symptoms

While the physical symptoms of erectile dysfunction may point to an underlying physical condition, the inability to perform sexually can produce unfortunate psychological symptoms. As masculinity is often tied to one’s sexual prowess and desirability, men experiencing ED may begin to demonstrate feelings of anxiety, low self-esteem and even depression. While shame is often associated with men experiencing ED, there is no cause for it. ED is an unfortunate condition that has a plethora of causes, and each one of those causes can be treated, leading to prolonged health and improved quality of life.

Physical Causes

While erectile dysfunction can be the result of any number of factors, the most common physical causes are:

  • Lack of blood flow to the penis
  • Penis’ inability to trap blood
  • Faulty nerve signals from the brain or spinal cord
  • Small vessel disease or nerve damage

Each of these physical conditions can be the result of age, diabetes, high cholesterol, drug use, sedentary lifestyle, or any other number of treatable factors. 

Low Testosterone

There is a common misconception that low testosterone is the one and only cause of erectile dysfunction, but as previously stated, most of the common physical causes are associated with issues in the blood or penis itself. Granted, a low libido is associated with ED, and that specific symptom does have a direct correlation to testosterone, but a reduced sex drive is not the only symptom of ED. While testosterone also aids in maintaining the nitric oxide levels in the penis, it is likely not the sole cause of ED despite the common belief.

Psychological Causes

While erectile dysfunction can be the cause of some concern over your physical health, its root cause is not always physical. In fact, nearly 10 to 20 percent of all ED cases are caused by underlying psychological issues. The leading psychological causes are guilt, stress, anxiety, indifference, low self-esteem and depression. In addition to these psychological factors, ED may be caused by certain medications that are being used to treat a psychological disorder, mainly depression. 

Potential Health Risks

While there are many causes and symptoms that may be troubling, erectile dysfunction may also be an indicator of other more threatening illnesses. For instance, ED can be a symptom of heart disease, Peyronie’s disease, multiple sclerosis, Parkinson’s disease, Metabolic syndrome and several other pressing illnesses. Because of the many potential causes and possible underlying issues, it is imperative that you seek medical assistance when you experience sexual problems, like premature or delayed ejaculation, or you are experiencing other physical symptoms of ED.

Scheduling a Doctor’s Appointment

Scheduling a doctor’s visit can be stress-inducing for many people, especially when you have a legitimate health concern. While erectile dysfunction may be uncomfortable to talk about, it is a genuine health issue, and the best way to get comfortable with the conversation is to schedule an appointment and be prepared to answer several questions regarding your condition. These questions will be personal, but they all have a purpose. For example, a doctor may ask you if your erections are different with different sexual positions and exercises, or if your erections are painful. They may ask you about firmness and if you have difficulty with penetration. There may be additional questions about arousal and sex drive. 

Your visit will also include questions about medications, stress, nutrition and emotional well-being. During this interview portion of the appointment, your doctor is trying to establish a medical history and assess any apparent connections between behavior, health, and history and your condition. All of these questions will help the doctor hypothesize whether your condition is more likely physical or psychological. After gathering the necessary information, your doctor will likely order a physical exam and several tests to determine the root cause of your erectile dysfunction. 

Physical Exam and Other Tests

In the process of officially diagnosing erectile dysfunction, you will likely undergo a physical exam and several other tests. The physical exam is used to assess overall health, with a particular focus on the genital examination. In addition to the physical exam, your physician may focus on your cardiovascular system by checking your heart, blood pressure and peripheral pulses. Beyond the basic checkup, your doctor may order a rectal exam, blood work, pelvic x-rays, nocturnal penial tumescence and an ultrasonography. While all of these tests may sound intimidating, they are not painful, and not every patient will require all tests. 

Diagnosis and Treatment

Once erectile dysfunction is diagnosed, there are several options for treatment. More often than not, medical professionals prefer noninvasive options to prevent surgical risk and uncomfortable recoveries. However, there are circumstances that require surgical intervention. Before either of these options, your doctor is likely to recommend lifestyle changes. Dietary changes along with exercise may be the first things prescribed by your physician, as these changes have proven beneficial for heart and vascular health. Additionally, therapy and counseling may be suggested to help combat certain emotional issues, like stress, anxiety and self-esteem problems. 

Noninvasive Treatment

Once lifestyle changes have been addressed, your health care professional may prescribe other noninvasive treatments, like medications, testosterone therapy, vacuum devices or intracavernosal (ICI) and urethra therapies (UI). Medication is the most common treatment of ED, and there are currently only four oral treatments in the U.S. that are approved by the Food and Drug Administration: Cialis (tadalafil), Stendra (avanafil), Levitra (vardenafil HCI), and Viagra (sildenafil citrate). 

Surgical Options

While not recommended for aging men, who are better served with ICI and IU therapy, there are surgical options for those who need further intervention. Surgical treatments for erectile dysfunction often involve the insertion of a penile implant. The two most common penile implants used are: 

  • Inflatable Implants: This type of implant consists of the placement of a pump and fluid-filled cylinders in the genitals. The pump is placed in the scrotum, and the cylinders are placed in the penial shaft. When the pump is engaged, the user experiences an erection.
  • Semi-rigid Implants: This type of implant involves the placement of two flexible, silicone rods that allow the user to position the penis downward for urination and upward for sex. The implants are rigid enough to provide the necessary firmness for penetration, but not inhibit normal day to day routines.

Clinical Trials

While treatment for erectile dysfunction is currently limited to medications, injections and surgical interventions, there are several therapies currently being tested in clinical trials. Extracorporeal shock wave therapy is a restorative treatment that aims to fix erectile tissues to restore natural erections. Intracavernosal injection autologous platelet rich plasma is a treatment that may bolster the regrowth of cavernous tissue. Additionally, intracavernosal injection of stem cells is also being tested to regrow cavernous tissue. All of these treatments are only clinical trials, and as such, are not approved by the FDA, meaning that they are likely not covered by insurance at this time, but for the right, qualified patient, these trials may provide ED relief.

Nutrition and Dietary Supplements

Erectile dysfunction may be treated by making better nutritional decisions, but those decisions should be made at the behest of your medical provider. Granted, certain foods, like fruits, vegetables and seafood, may provide certain nutrients that have been proven effective in the treatment of ED, but only a medical professional can assure you that these changes are affecting the underlying cause of your condition. Additionally, some over-the-counter supplements have been tested to have ‘bootlegged’ ingredients that may be dangerous or ineffective, forcing the FDA to issue consumer warnings and alerts. Trying a natural approach to treating ED is fine but do so with the supervision of your doctor.

Erectile dysfunction can be a serious condition if not diagnosed and treated. While it may create discomfort or displeasure in your sexual life, ED can be a symptom of a greater issue. Though it is understandable that men may feel emasculated due to the condition, resulting in feelings of inadequacy and even shame, take comfort in the fact the treatments and therapies exist. If you are experiencing any of the symptoms associated with ED, then seek medical intervention. Here at Nu Image Medical, we offer patient support seven days a week. If you have any questions or concerns about erectile dysfunction, then don’t hesitate and contact us today.


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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.