Overview

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

Occasional erection problems are not necessarily a cause for concern. However, when erectile dysfunction is an ongoing problem, it can cause stress, affect your self-confidence, and contribute to relationship problems. Problems getting or maintaining an erection can also be a sign of an underlying 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 the underlying condition is enough to resolve erectile dysfunction. In other cases, medications or other direct treatments may be needed.
Symptoms

Symptoms of erectile dysfunction may include:

    Difficulty getting an erection
    Difficulty keeping an erection
    Decreased sexual desire

When to see a doctor

A primary care doctor is a good place to start if you are having erection problems. See your doctor if:

    You are worried about your erection or have other sexual problems such as premature or delayed ejaculation
    You have diabetes, heart disease, or another known health problem that may be related to erectile dysfunction
    You have other symptoms along with erectile dysfunction

Causes

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

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

Many times, erectile dysfunction is due to something physical. Common causes include:

    Heart disease
    Clogged blood vessels (atherosclerosis)
    High cholesterol
    High blood pressure
    Diabetes
    Obesity
    Metabolic syndrome - a condition with elevated blood pressure, high insulin levels, body fat around the waist, and high cholesterol levels
    Parkinson's disease
    Multiple sclerosis
    Certain prescription medications
    Nicotine use
    Peyronie's disease - development of scar tissue inside the penis
    Alcoholism and other forms of drug abuse
    Sleep disorders
    Treatments for prostate cancer or an enlarged prostate gland
    Surgery or injury affecting the pelvic area or spine
    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 arousal. A number of things can affect sexual feelings and cause or worsen erectile dysfunction. These include:

    Depression, anxiety, or other mental illness.
    Stress
    Relationship problems due to stress, poor communication, or other issues

Risk factors

As you get older, it may take longer to develop an erection, and it may not be as firm. You may need more direct touches of your penis to get and keep an erection.

Several risk factors can contribute to erectile dysfunction, including:

    Medical conditions, especially diabetes or heart disease
    Tobacco use, which restricts blood flow in the veins and arteries, can - over time - cause chronic health conditions that lead to erectile dysfunction
    Being overweight, especially if you are obese
    Certain medical treatments, such as prostate surgery or radiation treatment for cancer
    Injuries, especially if they damage the nerves or arteries that control erections
    Medications, including antidepressants, antihistamines, and drugs used to treat high blood pressure, pain, or prostate problems
    Mental conditions, such as stress, anxiety, or depression
    Drug and alcohol use, especially if you are a long-term drug user or drink heavily

Complications

Complications that result from erectile dysfunction can include:

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

Prevention

The best way to prevent erectile dysfunction is to maintain a healthy lifestyle and manage pre-existing health problems. For example:

    Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
    See your doctor regularly for checkups and medical screening tests.
    Stop smoking, drink little or no alcohol, and don't use illegal drugs.
    Exercise regularly.
    Take steps to reduce stress.
    Get help for anxiety, depression or other mental health problems.