10 common questions about erectile dysfunction, answered

Romy Arroyo Fernandez/NurPhoto via Getty ImagesErectile dysfunction is more common than you might think.
  • Erectile dysfunction (ED) is the inability to get or keep an erection.
  • There are varying degrees of ED and it’s possible to experience mild or moderate symptoms.
  • ED can be caused by many things, including diabetes, anti-depressant medications, heart disease, and stress.
  • ED can be treated with medication, vacuum devices, and penile implants. Diet and lifestyle changes may also improve symptoms of ED.

Despite being the mostcommonly treated sexual disorder, many people find talking about erectile dysfunction (ED) to be difficult. Some people also might think it only affects older people and its treatment is as simple as popping a pill.

In an effort to dispel some of the myths around ED, INSIDER consulted with doctors to answer some of the most common questions about the condition and what a person can do about it.

What exactly is erectile dysfunction?

Erectile dysfunction, or ED, is the inability to get or keep an erection. Not being able to sustain an erection can interfere with sexual intercourse or make sex less satisfying. It can also lead to self-confidence problems and may even impact romantic relationships.

“An erection is simply a physiological process resulting in increased arterial blood flow to the penis. Erectile dysfunction may arise when that blood flow is compromised, making it difficult to achieve or maintain an erection for sex,” Nesochi Okeke-Igbokwe, internal medicine physician and health expert, told INSIDER.

There is a difference between occasional performance problems and erectile dysfunction. Generally, you need to be experiencing erectile dysfunction the majority of the time to be diagnosed with ED.

“The clinical term ‘erectile dysfunction’ is reserved for men who have a problem getting or keeping an erection more often than not. And while it can certainly put a damper on sexual intimacy, ED can also serve as a warning sign of other serious health issues,” S. Adam Ramin, urologist and medical director of Urology Cancer Specialists in Los Angeles, told INSIDER.

Is it possible to have ‘a little’ ED?

It is possible to have varying degrees of erectile dysfunction and not all individuals present with the same symptoms.

“Though some men experience severe ED and are unable to obtain erections that are adequate for intercourse, many men experience mild to moderate symptoms of ED. Some men may have intermittent difficulty obtaining erections, and others men might have slightly decreased erection hardness or difficulty maintaining erections as long as they are used to,” Dr. Alex Shteynshlyuger, board-certified urologist and director of urology at New York Urology Specialists, told INSIDER.

How do you know if you have ED?

Man doctor's office blood pressureJoe Raedle/Getty ImagesIt’s best to talk to your healthcare provider if you believe you have ED.

Though many people are able to recognise erectile problems based on knowledge of their normal sexual performance, doctors can also use something called a Sexual Health Inventory for Men (SHIM) score to quantify ED. A SHIM score of fewer than seven means a patient has severe ED, while a score between 17 and 21 suggests mild ED.

“ED is one of the few diagnoses that is self-diagnosed by a patient. If a man feels that his erections are not as good as they used to be, or not as good as he wishes them to be, he may self-diagnose ED,” explained Dr. Shteynshlyuger.

It’s worth talking to your healthcare provider to determine if you could benefit from possible treatments of ED.

What are the most common causes of ED?

When aroused, the brain sends signals to nerve receptors in the body that increase blood flow to the penis. This results in the pressure necessary to make it firm, or erect. The penis will remain hard until either ejaculation occurs or arousal stops. In many cases, circulation or blood flow problems are at fault for erectile problems.

“Even though by the name alone it sounds like it should help, not hurt an erection, high blood pressure prevents the arteries that carry blood to the penis from expanding the way that they’re intended to. This causes a lack of blood flow to the penis and stops it from becoming erect,” said Dr. Ramin.

Erectile problems can also be a sign of heart disease, as a narrowing of the arteries can make it difficult for the penis to receive enough blood flow to become erect.

Diabetes is another potential culprit, as it can lead to damage to the nerves and blood vessels that facilitate erections.

“One of the signs that diabetes may be to blame for a man’s ED experience is the age of onset. ED tends to occur earlier in men with diabetes than in those who do not have the disease. In fact, sometimes a visit to the doctor for ED can lead to a diagnosis of diabetes the man previously didn’t know he had,” Dr. Ramin told INSIDER.

Sometimes, medications taken to treat conditions other than ED can cause erectile problems.

“Certain classes of antidepressant medications such as SSRIs may sometimes induce the side effect of erectile dysfunction in patients,” Dr. Okeke-Igbokwe added.

Can stress or nerves cause ED?

Stressed outDan Kitwood/GettyExtreme stress could affect sexual performance.

People with no circulatory problems or chronic medical conditions can still experience erectile dysfunction. Sometimes, difficulty achieving an erection can actually be linked to stress, fatigue, or nervousness about sexual performance.

“In younger men, situational erectile dysfunction caused by stress and anxiety related to sexual activity as well as work stress is the most common cause of ED,” said Dr. Shteynshlyuger.

Unfortunately, worrying about not being able to get an erection can actually prevent you from achieving one. If you’re finding that sexual performance fears are turning into a self-fulfilling prophecy, it could be smart to talk to a therapist or your healthcare provider about possible treatment options.

Is ED common?

“Erectile dysfunction is very common,” said Dr. Shteynshlyuger.

According to The Massachusetts Male Ageing Study, ED is increasingly prevalent with age. Approximately 40% of men are affected at age 40 and nearly 70% of men are affected at age 70.

These numbers vary, however, depending on the definition of ED and the varying degrees of the condition.

Doctors know that most people with penises will experience some sort of erectile problem at some point in their life. Though erectile dysfunction can be frustrating at any age, it’s a condition that urologists and healthcare providers are well-equipped to diagnose and treat.

Is ED permanent or can it be cured?

It is possible to treat this condition in almost everyone.

“Fortunately, ED can be effectively treated in almost all men. In many men, healthy lifestyle and diet can help prevent and sometimes reverse ED,” Dr. Shteynshlyuger said.

In some cases, treating ED might involve working to heal the underlying medical conditions contributing to erectile problems. In other cases, working with a mental health professional can help to alleviate situational erectile dysfunction caused by stress and anxiety.


Read more:
10 science-backed ways to help with erectile dysfunction

Do herbal supplements or over-the-counter pills work for ED?

VitaminsSarah Schmalbruch/INSIDERSupplements advertising themselves as treatments for ED are best avoided.


Some herbal supplement manufacturers claim to have products that can help people achieve firmer or longer-lasting erections. The marketing of these supplements marketing isn’t always backed up by science.

“Studies show that [some] herbal supplements have minimal to no benefit in the treatment of ED. Many ED supplements have undeclared medications such as Viagra (sildenafil) and Cialis (tadalafil) and that accounts for the reasons that some supplements seem to work,” said Dr. Shteynshlyuger.

The United States Food and Drug Administration (FDA) has issued multiple warnings against the use of nearly 30 brand names of commonly marketed herbal pills. That’s because taking an herbal supplement that contains undeclared (or hidden) sildenafil or tadalafil could inadvertently jeopardize your health. These medicines should only be used under a physician’s supervision as they have the potential to interact dangerously with other prescription medications and shouldn’t be combined with alcohol.

“The dangers with taking herbal sexual-enhancement pills can also begin with the psychology of how they are perceived. If a person taking it thinks it isn’t as ‘strong’ as a prescription drug, he may double or triple the dose in an attempt to achieve the desired effect. The result can be disastrous,” added Dr. Ramin.

There are, however, some studies that have shown that Panax ginseng (red ginseng) may improve blood flow and, in turn, help treat ED.

Are there any non-drug options for treating ED?

Medications such as Viagra (sildenafil) and Cialis (tadalafil) can help most people achieve erections strong enough for sexual activity. But these medications aren’t medically appropriate or desirable for everyone.

“For men with ED caused by an underlying vascular problem (such as men with diabetes, high blood pressure, and high cholesterol) shockwave therapy for ED is an effective medication-free treatment option. Shockwave therapy for ED is a new treatment and has been shown in studies to be as effective as medications such as Viagra and Cialis for many men,” said Dr. Shteynshlyuger.

Vacuum devices that increase blood flow to the penis and penile prosthesis surgery are also options for people who don’t want to take medication. The most important thing for anyone dealing with sexual health problems is to talk to a qualified healthcare provider about treatment options.

Can diet or exercise help ED?

Burger chipsJonathan Knowles / GettyFoods that are high in sodium and high in fat might increase your chances of developing ED.

The good news is that making a few lifestyle tweaks might help ward off erectile dysfunction and even reverse some types of ED. Adherence to a healthy diet and the adoption of an appropriate exercise routine can help sexual performance.

“Don’t underestimate the extent to which lifestyle modifications can help improve ED symptoms. Studies have linked aerobic exercise to improved erectile functioning. Additionally, nutritional choices have been shown to either exacerbate or ameliorate one’s ED symptoms. High-sodium, high-cholesterol, and high-fat foods make the list of what should be eliminated from the diet to lessen ED symptoms,” advised Dr. Okeke-Igbokwe.

Keeping physically fit is a great idea even if you’re not dealing with erectile dysfunction. Keeping an eye on your diet and making sure you’re staying active is a good way to help keep your sex life satisfying at all stages of life.

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