What is erectile dysfunction, and what treatments are available?

By (gynecologist), (embryologist) and (biochemist).
Last Update: 08/17/2022

Sexual impotence, also called erectile dysfunction, is the inability of a man to maintain an erect penis long enough to achieve complete and satisfying sexual intercourse.

One should bear in mind that in order for it to be considered a case of impotence, the problem must persist for more than minimum of three months.

Normally, the most common cause of erectile dysfunction is damage to arteries, nerves, muscles, and fibrous tissues. However, psychological factors also play an important role in this male pathology.

How does an erection occur?

An erection is a complex process involving several mechanisms. It is the hardening of the penis upon filling with blood.

Generally speaking, erection of the penis begins with mental stimulation (fantasies, memories, etc.), stimulation of the senses through sight or touch, and combination of these. The central nervous system sends nerve impulses that cause blood flow to the penis to increase. This blood is trapped by the corpus cavernosum, causing the penis to expand and stiffen. In addition, the veins that would drain blood from the penis contract, causing an erection.

The corpora cavernosa are two cylindrical chambers that fill with blood during an erection. These structures are located at the top of the penis.

When the muscles of the penis contract, blood flow into the penis is interrupted and blood flow through the veins is opened. This mechanism causes the erection to be reversed and the penis to become flaccid.

What is erectile disfunction?

Erectile dysfunction (ED) or sexual impotence is considered a benign disease characterized by the inability to achieve or maintain an erection of the penis long enough to achieve full sexual intercourse.

Erection problems in men can occur at any time in their lifes. Whats more, the frequency of a man suffering from erectile dysfunction increases with age and affects 14% of men aged 40-49, 25% of men aged 50-59 and 49% of men aged 60-69.

On the other hand, men who suffer from diabetes, hypertension or smoking have a greater tendency to suffer from erectile dysfunction.

Causes of erectile dysfunction

As we have already mentioned, male erection is a rather complex neurological and vascular process that requires a sequence of events. Therefore, erectile dysfunction can occur when any of these processes are interrupted.

Usually, sexual impotence is due to physical causes by hormonal and vascular factors, among other things. However, this pathology may also be due to psychological factors such as anxiety or stress.

In the following sections we are going to detail the different factors that cause erectile dysfunction.

Organic Causes

Organic or physical sexual impotence is the most common in men. This is a type of erectile dysfunction caused by disorders in the penis or by certain medications.

The types of organic sexual impotence are described below:

when too little blood reaches the penis or is not properly retained inside the corpora cavernosa. As a result, blood leaks out and makes it impossible for the penis to become erect. Diabetes, hypertension and cardiovascular disease are among the most common causes of vascular sexual impotence.
caused by problems in the nerve signals to the penis from the brain and spinal cord. This type of sexual impotence is caused by diabetes, diseases of the spinal cord, surgery for cancer of the prostate, bladder and rectum, etc.
due to a testosterone deficit. This male hormone increases sexual desire libido.
many of the drugs used to treat diseases of the nervous system affect the erection of the penis.

Psychological Causes

When a man is not emotionally stable, he is more likely to suffer from erectile dysfunction. The brain is a key point for the activation of the processes that initiate the erection in men

There are psychological causes for which a man can begin to have this type of problem. The most frequent ones are the following:

  • Anxiety.
  • Fear of pregnancy, that is, the man is worried about getting his partner pregnant. This can obviously affect a man's concentration and sexual performance.
  • Stress and tension.
  • Depression.
  • Marital conflicts. When a relationship is not satisfactory, it’s normal for a man to have erectile dysfunction.


Male sexual impotence is often a symptom of other health problems. Therefore, it is essential that man with this condition consult a specialist to establish a diagnosis.

The first step in evaluating erectile dysfunction is to obtain detailed information about the medical and psychological history of patients and their partners. It is important to create a relaxed atmosphere in the practice between the specialist and the patient to make it easer for the patient to ask questions about erectile function and other sexual aspects.

Step two is to perform a physical examination focusing on the genitourinary, endocrine, vascular and neurological systems. This type of test may give clues about systemic problems.

In the third step, the specialist will request a series of analytical tests adapted to the patient's symptoms and risk factors. All patients should be tested for blood glucose, lipids and total testosterone. When testosterone levels are low, the levels of prolactin, FSH or LH will be measured.

Finally, one of the tools for diagnosing erectile dysfunction would be to observe and monitor nocturnal erections in order to rule out certain psychological causes. However, this control is not always completely reliable.

Treatment of erectile dysfunction

Most doctors prefer that treatments for erectile dysfunction be carried out following an ascending pattern.

In any case, erectile dysfunction has different treatments that allow you to enjoy full sexual relations. To achieve this, it is vitally important to identify the causes and choose the most appropriate treatment for each case.

Psychological therapy

When a physical cause of erectile dysfunction has been ruled out, it is best to see a psychologist. In these cases, treatment of erectile dysfunction consists of re-education of sexual behaviors and attitudes, sensory focusing, and management of anxiety associated with sexual performance.

Generally speaking, any psychological treatment for erectile dysfunction is combined with relaxation techniques to control anxiety. This will make it easier to regain sexual activity and erections.


After making a diagnosis of erectile dysfunction, the specialist will prescribe some medication to take orally in order to achieve and maintain an erection. The most common ones are vardenafil, tadalafil or sildenafil. They all act by increasing blood flow to the penis and therefore help maintain an erection.

Some commercial brands of these drugs are Levitra, Cialis and Viagra and their effectiveness is similar, so the choice will depend on cost, ease of use and / or side effects.

On the other hand, these types of drugs are not recommended if the patient is being medicated with nitrates to treat a heart condition because it could cause a sudden drop in blood pressure, fainting and dizziness.

Penile pump, surgery and implants

When none of the above treatments solves the problem of erectile dysfunction, the doctor will indicate other options. Here are some of them:

can be arterial or venous in the penis. The goal of arterial surgery is to increase the flow and pressure of blood within the penis. Venous surgery involves tying or removing some veins from the penis so that blood does not leak out.
Vacuum pump
also known as penis pump. This is a hollow plastic tube with a hand pump or batteries that is placed over the penis. The air inside the tube is then sucked out to generate a vacuum. This causes bloodflow into the penis.
Penile Implants
which are placed on both sides of the penis to keep it firm but flexible. With these devices it is possible to control the time and duration of an erection.

Natural Remedies

Although many of these popular remedies have been challenged by doctors, many men rely on their effectiveness. For example, according to traditional Chinese medicine, ginseng is widely used to increase the erection of the penis.

Sprouted wheat, oats and sesame also help overcome erectile dysfunction. Apart from that, it is advisable to take cinnamon and nutmeg for their aphrodisiac properties or some vegetables such as tomato.


As far as possible, the prevention of erectile dysfunction is aimed at avoiding the risk factors that contribute to its onset. Therefore, it is recommended to:

  • Monitor existing diseases and have regular check-ups.
  • Quit smoking.
  • Exercise regularly.
  • Reduce stress.

Erectile dysfunction can be prevented by adopting a healthy lifestyle from a young age or by modifying bad habits.

FAQs from users

How can I get pregnant if my husband suffers from erectile dysfunction?

By Marita Espejo Catena M.D., M.Sc., Ph.D. (gynecologist).

The inability to deposit sperm in the vagina during sexual intercourse has traditionally been one of the absolute causes of infertility.

Until the introduction of the most complex assisted reproduction techniques, the only option that could be contemplated was the use of a donor sperm sample.

With the development of in vitro fertilization (IVF) techniques, and especially with oocyte insemination by means of sperm microinjection (ICSI), the possibility of conceiving with a scarce number of spermatozoa is feasible.

In patients suffering from impotence that is not due to andrological medical treatment, nor psychological, an epididymal aspiration or testicular biopsy may be performed.

Epididymal aspiration consists of extracting the sperm stored in the epididymis using local anesthesia, where they acquire the ability to move after being generated in the seminal ducts.

Biopsy is reserved in cases of epididymal aspiration with negative results and requires access to mature sperm directly from the testicular tissue. Although it can be performed under local anesthesia, it can also be performed under anesthetic sedation, which allows the procedure to be performed at different points or on both testicles.

Does diabetes cause erectile dysfunction?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Erectile dysfunction can be a symptom of many pathologies, including diabetes. Therefore, it is very important to consult a doctor about any erection problem so that the possible cause can be diagnosed.

Does erectile dysfunction cause loss of sex drive?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

No, although they are closely related. Erectile dysfunction can lead to a loss of sexual interest due to the inability to maintain or achieve an erection of the penis.

How does tobacco affect ED?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

The main substance in tobacco, nicotine, negatively affects all blood vessels in the body. If the blood vessels in the penis are affected, the blood flow here will not be adequate and consequently problems will arise in initiating or maintaining an erection.

In addition, the possibility of erection problems associated with smoking increases with age and the number of cigarettes smoked.

Can a vasectomy cause sexual impotence?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

No, vasectomy is a simple surgical intervention that consists in the section of the vas deferens. It does not affect the mechanism of the erection in any way?

Erectile dysfunction is a cause of male sterility due to post-testicular factors. You can read more about this in the following article: Post-Testicular Factors of Male Infertility - Causes & Treatment.

We also recommend having a look at the following article to read about the treatments availble for male infertility: Treatmens for Male Infertility.

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FAQs from users: 'How can I get pregnant if my husband suffers from erectile dysfunction?', 'Does diabetes cause erectile dysfunction?', 'Does erectile dysfunction cause loss of sex drive?', 'How does tobacco affect ED?' and 'Can a vasectomy cause sexual impotence?'.

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Authors and contributors

 Marita Espejo Catena
Marita Espejo Catena
M.D., M.Sc., Ph.D.
Graduated in Medicine and Surgery from the University of Valencia in 1992. Specialist in Gynaecology and Obstetrics. Doctor in Medicine from the University of Valencia in 2000. Master in Assisted Human Reproduction by the Rey Juan Carlos University and IVI in 2008. Currently, she is the director of Instituto FIVIR. More information about Marita Espejo Catena
License: 464616497
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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