Erectile dysfunction; Impotence; Sexual dysfunction - male
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at all. Or, you may lose the erection during intercourse before you are ready. Erection problems do not usually affect your sex drive.
Erection problems are common. Almost all adult men have trouble getting or keeping an erection at one time or another. Often the problem goes away with little or no treatment. But for some men, it can be an ongoing problem. This is called erectile dysfunction (ED).
If you have trouble getting or keeping an erection more than 25% of the time, you should see your health care provider.
To get an erection, your brain, nerves, hormones, and blood vessels all need to work together. If something gets in the way of these normal functions, it can lead to erection problems.
An erection problem is usually not "all in your head." In fact, most erection problems have a physical cause. Below are some common physical causes.
Other physical causes:
In some cases, your emotions or relationship problems can lead to ED, such as:
Erection problems can affect men at any age, but are more common as you get older. Physical causes are more common in older men. Emotional causes are more common in younger men.
If you have erections in the morning or at night while you sleep, it is likely not a physical cause. Most men have 3 to 5 erections at night that last about 30 minutes. Talk with your provider about how to find out if you have normal nighttime erections.
Symptoms may include any of the following:
Your provider will perform a physical exam, which may include:
Your provider will also ask questions to help find the cause, such as:
Your provider will also ask about your lifestyle:
You may have a number of different tests to help find the cause, such as:
The treatment may depend on what is causing the problem and how healthy you are. Your provider can talk with you about the best treatment for you.
For many men, lifestyle changes can help. These include:
If you and your partner have trouble talking about your relationship, it may cause problems with sex. Counseling can help both you and your partner.
Lifestyle changes alone may not be enough. There are many treatment options.
ED pills you take by mouth (Viagra, Levitra, or Cialis) can have side effects. These can range from muscle pain and flushing to heart attack. DO NOT use these drugs with nitroglycerin. The combination can cause your blood pressure to drop.
You may not be able to use these drugs if you have any of the following conditions:
Other treatments also have possible side effects and complications. Ask your provider to explain the risks and benefits of each treatment.
You may see many herbs and supplements that claim to help sexual performance or desire. However, none have been proven to successfully treat ED. Plus, they may not always be safe. DO NOT take anything without talking with your provider first.
Many men overcome erection problems with lifestyle changes, medical treatment, or both. For more severe cases, you and your partner may have to adjust to how ED affects your sex life. Even with treatment, counseling can help you and your partner overcome the stress ED may put on your relationship.
An erection problem that does not go away can make you feel bad about yourself. It can also harm your relationship with your partner. ED may be a sign of health problems such as diabetes or heart disease. So if you have an erection problem, do not wait to seek help.
Call your provider if:
If you think any medicine you are taking may be causing erection problems, talk with your provider. You may need to lower the dose or change to another drug. DO NOT change or stop taking any medicine without first talking to your provider.
Talk to your provider if your erection problems have to do with a fear of heart problems. Sexual intercourse is usually safe for men with heart problems.
Call your provider right away or go to an emergency room if you are taking ED medicine and it gives you an erection that lasts for more than 4 hours.
To help prevent erection problems:
American Urological Association. Management of erectile dysfunction. Available at:
Burnett A. Evaluation and management of erectile dysfunction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 27.
Qaseem A, Snow V, Denberg TD, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009;151:639-49. PMID 19884625
Swerdloff RS, Wang C. The testis and male hypogonadism, infertility, and sexual dysfunction. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 234.
Last reviewed on: 11/1/2015
Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.