Blog/Sexual Health

Erectile Dysfunction Symptoms: What You Need To Know

Erectile dysfunction symptoms like inability to achieve/maintain erections for sex can stem from varied physical and psychological underpinnings

Erectile dysfunction (ED), sometimes called impotence, affects over 30 million men in the United States according to the Cleveland Clinic. ED makes it difficult to get and maintain an erection firm enough for satisfactory sexual intercourse. Understanding the common symptoms and underlying causes of erectile dysfunction is key to getting effective treatment.

What Are the Symptoms and Signs of ED?

The primary symptom of erectile dysfunction is being unable to achieve or sustain an erection of sufficient rigidity for sex. But there can be other clues that you may have ED:

  • Trouble getting an erection when you want to be sexually intimate
  • Erections do not last long enough for pleasurable intercourse
  • Erections are not as firm as they used to be
  • Need to constantly stimulate the penis to keep erections
  • Taking a long time to achieve full erection
  • Losing erections during sexual activity
  • Difficulty maintaining an erection until orgasm

According to the Cleveland Clinic, if you experience occasional difficulty getting an erection but are still able to have sex most of the time, it likely isn’t ED. But if problems occur more than 50% of the time, it may indicate ED requiring treatment. Talk to your doctor if erectile troubles are an ongoing issue.

What Causes Erectile Dysfunction?

ED can stem from both physiological and psychological factors. Common medical causes include:

  • Diabetes – Diabetic nerve damage and blood vessel restrictions are major risk factors for ED. Over 50% of diabetic men experience some degree of ED.
  • Heart disease – Atherosclerosis and related vascular issues limit blood flow. ED occurs in up to 75% of heart disease patients.
  • Obesity – Excess abdominal fat leads to hormonal changes that contribute to ED. Obese men have up to a 30% higher risk of ED.
  • Metabolic syndrome – The combination of obesity, high blood pressure, and abnormal cholesterol levels associated with metabolic syndrome increases ED risk.
  • Parkinson’s disease – Men with Parkinson’s have 4 times higher odds of experiencing ED due to neurological deficits.
  • Multiple sclerosis – MS damages nerves involved in erections leading to ED in up to 80% of male patients.
  • Low testosterone – Insufficient testosterone production reduces sexual desire and functioning.

Psychological and social factors that can contribute to ED include:

  • Performance anxiety and stress
  • Depression
  • Poor body image or low self-esteem
  • Marital or relationship problems
  • The social stigma associated with aging
  • Prior problems with erections create a cycle of anxiety

In many cases of ED, both physiological and psychological components are involved. The good news is there are many effective treatment options available.

Diagnosing the Cause of ED

Pinpointing the underlying reason for erectile dysfunction requires a trip to the doctor. Be prepared to answer questions about your medical history including:

  • Ongoing health issues
  • Prescription medications
  • Supplements and herbs you take
  • History of injuries, surgeries, or cancer treatment
  • Family history of ED
  • Alcohol, tobacco and substance use

Your doctor will also ask about the patterns of your erectile difficulties:

  • When issues began
  • Frequency of problems getting/sustaining erections
  • If issues occur with self-stimulation or only with a partner
  • Quality of erections – completely absent, not firm enough, lost during sex, etc.

A physical exam will check for genital issues like micropenis, Peyronie’s disease, or foreskin inflammation. Blood tests can assess for diabetes, cholesterol problems, low testosterone, and other conditions related to ED. Nocturnal penile tumescence testing can check for normal erections during sleep. Ultrasound, neurological tests, or vascular imaging may be used depending on suspected underlying causes.

Once the cause is determined, appropriate treatment for ED can begin. Lifestyle changes, medications, counseling, devices, and sometimes surgery may be parts of the treatment plan.

Medical Treatments for Erectile Dysfunction

For the majority of men, erectile dysfunction stems from a physical issue that limits blood flow to the penis. Prescription medications developed to target this mechanism can be highly effective:

  • PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) prevent the breakdown of cGMP to improve erections. They are the first-line pharmacological treatments for ED.
  • Alprostadil injections or suppositories relax smooth muscles to enhance blood flow for erections. They can be used alone or with oral ED medications.
  • Testosterone replacement therapy consisting of gels, patches, injections or pellets can help if low testosterone is causing ED. Bringing levels back to normal boosts sexual desire and functioning.
  • Vacuum erection devices use suction to draw blood into the penis to create an erection suitable for intercourse. They offer a non-invasive treatment option.
  • Penile implants provide an option for severe treatment-resistant ED cases. Surgically inserted devices allow men to mechanically produce erections.

Talk to your urologist or men’s health doctor to determine which medical therapies are optimal for your individual case based on the cause, symptoms, and severity of your erectile dysfunction.

Lifestyle Changes and Home Remedies

Adjusting daily habits related to diet, exercise, weight, medication use, and modifiable risk factors can also improve ED symptoms and enhance treatment efficacy. Potential lifestyle changes and home remedies to discuss with your doctor include:

  • Losing excess weight through diet and exercise
  • Quitting smoking and avoiding tobacco products
  • Limiting alcohol to moderate amounts
  • Managing chronic health conditions like diabetes and heart disease
  • Adding zinc, Ashwagandha, DHEA or other supplements
  • Reducing stress through yoga, meditation, or mindfulness
  • Focusing on sleep quality and getting enough rest
  • Improving relationship and sexual communication skills
  • Using ED medication as directed without dependence
  • Seeking counseling or psychotherapy for depression, anxiety or trauma

A meta-analysis in JAMA concluded lifestyle interventions like these can help treat erectile dysfunction. Natural remedies may provide additional benefits when combined with standard medical therapies.

Patient Examples of Recognizing and Treating ED

Here are some examples of real patients who noticed symptoms of ED and worked with doctors to determine the cause and find effective solutions:

“I’m only 28 but was having trouble getting firm erections with my girlfriend. Turns out my porn habit had rewired my brain and caused ED. Quitting porn and taking Cialis restored normal function.” – Lucas S.

“My erections started fading during sex after I gained 40 lbs. and developed diabetes. I’ve lost weight through diet and exercise and started Viagra. My ED has improved dramatically.” – Max T.

“Stress at work led to some ED issues. A mix of relaxation techniques, therapy and ED medication helped get my sex life back on track.” – Juan R.

“I noticed weaker erections as I got older. My doctor said it was low testosterone and prescribed testosterone gel. My ED is much better controlled now.” – Stephen U.

The key is identifying symptoms early and working with a doctor or urologist to determine the best treatment options for your individual needs, lifestyle and health status. Consistency and patience is also crucial when implementing lifestyle regimens or using ED medications.

When to See a Doctor About ED

Don’t hesitate to see a physician if you are experiencing persistent erectile difficulties. The earlier underlying causes are identified, the sooner effective treatment can begin. Warning signs to get evaluated for ED sooner rather than later include:

  • Inability to achieve an erection more than 50% of the time
  • Significant ED symptoms make intercourse difficult
  • Issues getting/maintaining erections that worsen over time
  • Erection troubles that start suddenly or seem related to trauma
  • Noticing poor morning erections on awakening
  • ED that occurs at a younger age – under 40 years old
  • Presence of other urological symptoms along with ED

Don’t assume erectile dysfunction at any age is just a natural consequence of aging. See a doctor to uncover any medical issues while ED is still mild and most treatable.


Erectile dysfunction symptoms like the inability to achieve/maintain erections for sex can stem from varied physical and psychological underpinnings. Diabetes, heart disease and low testosterone are common medical causes, while stress, anxiety and depression often contribute as well. Diagnosing the root cause is the first step. Lifestyle changes combined with ED medications, devices or procedures can effectively treat symptoms in most men. Tackling ED early maximizes treatment options and helps restore sexual functioning and satisfaction.

By Dr. David Kahan, PhD

  • Education: – B.S. in Kinesiology, 1990, UCLAM. Ed. in Teacher Education, 1991, UCLA Ph.D. in HPER, 1995, The Ohio State University
  • Professional Memberships: American Alliance for Health, Physical Education, Recreation & Dance (AAHPERD), National Association for Kinesiology and Physical Education in Higher Education (NAKPEHE)
  • Research Areas: My initial focus in graduate school was directed at coaching behavior with special emphasis on gender dynamics (e.g., males coaching female athletes). At my first appointment, I changed my focus to better match a major job responsibility—the preparation and supervision of preservice (student teachers and undergraduate field practicum students) teachers. To this end, I spent 5 years on projects to better understand cooperating teacher behavior and beliefs. Beginning in the Fall of 2001, I again switched my focus to issues involving the relationship between physical activity and religion/culture. During a sabbatical year in 2009, I added focus by investigating the impact of social-ecological variables on preschool children’s physical activity.