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Erection problems


Alternative Names:

Erectile dysfunction; Impotence; Sexual dysfunction - male

Causes:

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, such as:

  • Disease:
    • Diabetes
    • High blood pressure
    • Heart or thyroid conditions
    • Clogged arteries (atherosclerosis)
    • Depression
    • Nervous system disorders, such as multiple sclerosis or Parkinson's disease
  • Medicines
    • Antidepressants
    • Blood pressure medications (especially beta-blockers)
    • Heart medications (such as digoxin)
    • Sleeping pills
    • Some peptic ulcer medications
  • Other physical causes
    • Low testosterone levels. This can make it difficult to get an erection. It can also reduce a man's sex drive.
    • Nerve damage from prostate surgery.
    • Nicotine, alcohol, or cocaine use.
    • Spinal cord injury.

In some cases, your emotions or relationship problems can lead to ED, such as:

  • Poor communication with your partner.
  • Feelings of doubt and failure.
  • Stress, fear, anxiety, or anger.
  • Expecting too much from sex. This can make sex a task instead of a pleasure.

Erection problems can affect men at any age. But they 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's likely not a physical cause. Most men have 3 to 5 erections at night that last about 30 minutes. Talk with your doctor about how to find out if you have normal nighttime erections.

Common Causes:

An erection involves your brain, nerves, hormones, and blood vessels. Anything that interferes with these normal functions can lead to problems getting an erection.

Common causes of erection problems include:

  • Diseases such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or nervous system disorders (such as multiple sclerosis or Parkinson's disease)
  • Medicines, including blood pressure medications (especially beta-blockers), heart medications (such as digoxin), some peptic ulcer medications, sleeping pills, and antidepressants
  • Nerve damage from prostate surgery
  • Nicotine, alcohol, or cocaine use
  • Poor communication with your partner
  • Repeated feelings of doubt and failure
  • Spinal cord injury
  • Stress, fear, anxiety, or anger
  • Unrealistic sexual expectations, which make sex a task instead of a pleasure

Erection problems become more common with age. However, they can affect men at any age. Physical causes are more common in older men. Emotional causes are more common in younger men.

Low levels of testosterone can lead to erection problems. They may also reduce a man's sex drive.

Home Care:

For many men, lifestyle changes can help:

  • Cut down on smoking, alcohol, and illegal drug use.
  • Get plenty of rest and take time to relax.
  • Exercise and eat a healthy diet to keep good blood circulation.
  • Use safe sex practices to prevent HIV and STDs.
  • Talk openly to your partner about sex and your relationship. If you cannot do this, counseling can help.

Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble talking about their feelings may find it hard to share their anxiety about sexual performance. Counseling can help both you and your partner.

Call your health care provider if:

Call your doctor if:

  • The problem does not go away with lifestyle changes
  • The problem begins after an injury or prostate surgery
  • You have other symptoms, such as low back pain, abdominal pain, or a change in urination

If erection problems seem to be caused by a medication you are taking, talk to your health care provider. You may need to lower the dose or change to another drug. Do NOT change or stop taking any medications without first talking to your health care provider.

Talk to your health care 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 doctor right away or go to an emergency room if the medication you are taking for erection problems gives you an erection that lasts for more than 4 hours.

References:

Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305-312.

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;151:639-649.


Review Date: 9/19/2011
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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