By the Medsmingle Team · Updated 11 November 2026
Erectile dysfunction (ED) means you can’t get or keep an erection firm enough for sex. It’s common, especially as men get older, and it can usually be treated. Because ED can be an early sign of heart disease, diabetes or another health problem, see a doctor if it keeps happening.
What is erectile dysfunction?
ED is trouble getting an erection, keeping it long enough for sex, or both. It used to be called impotence. Between 30 million and 50 million men in the US have ED. About 40% of men are affected at age 40 and about 70% by age 70, but ED isn’t a routine part of aging.
Occasional problems are normal. Most men sometimes can’t get or keep an erection, usually because of stress, tiredness or heavy drinking. It’s worth looking into when it keeps happening.
What causes ED?
An erection depends on healthy blood vessels, nerves and hormones, so anything that affects them can cause ED:
- Health conditions: diabetes, heart and blood vessel disease (including atherosclerosis and high blood pressure), stroke, chronic kidney disease, obesity, low testosterone, thyroid problems, multiple sclerosis, spinal cord injury, pelvic surgery, Peyronie’s disease.
- Medicines: some antidepressants, blood pressure medicines and diuretics, antihistamines, appetite suppressants, pain relievers, sedatives, ulcer medicines, and chemotherapy or hormone medicines.
- Mind and mood: anxiety, depression, stress, low self-esteem and worry about sex.
- Lifestyle: smoking, drinking too much alcohol, using recreational drugs and not getting enough physical activity.
Why ED can be a warning sign for your heart
The American Urological Association advises that men be told ED is a risk marker for underlying cardiovascular disease. Conditions that damage blood vessels, such as atherosclerosis, can reduce blood flow to the penis as well as to the heart. ED that keeps happening is a good reason to get your blood pressure, cholesterol and blood sugar checked.
How is ED diagnosed?
A doctor will ask about your symptoms, health, medicines and lifestyle, and examine you. Blood tests can look for diabetes, high cholesterol and hormone problems, and US guidelines recommend measuring testosterone in men with ED. You may also be asked about your mood and relationship, because these often play a part.
How is ED treated?
Treatment starts with the cause, where one is found. Choosing a treatment is personal, and many couples decide together.
Lifestyle changes
Stopping smoking, cutting down on alcohol, avoiding recreational drugs, keeping to a healthy weight, eating well and staying active can prevent or improve ED. Aim for at least 150 minutes of moderate activity a week. Ask your healthcare professional about a suitable weight-management plan.
Counseling
If stress, anxiety, depression or relationship problems are involved, counseling can ease anxiety about sex. A partner can join the sessions.
Reviewing your medicines
If a medicine may be causing ED, your doctor may lower the dose or switch you to another one. Don’t stop a medicine on your own.
Prescription tablets
The most common treatment is a PDE5 inhibitor: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Stendra). These medicines improve blood flow to the penis, but only during sexual stimulation. They don’t increase desire and they don’t cure ED. A doctor decides whether one is safe for you and at what dose.
Important safety information: never take these medicines if you use nitrate medicines for chest pain, such as nitroglycerin, or recreational nitrites known as “poppers.” Do not combine them with riociguat. Get medical help right away for an erection that lasts longer than 4 hours, sudden loss of vision or hearing, or chest pain during sex.
Other treatments
- Vacuum devices: a tube and pump draw blood into the penis, and an elastic ring helps keep the erection.
- Injections or urethral suppositories: medicine that causes an erection, used in or on the penis. A doctor shows you how.
- Testosterone: for men who have both ED and low testosterone.
- Surgery: usually a penile implant, considered when other treatments haven’t worked.
Talk to a professional before taking ED medicine
ED medicines can interact with other medicines and cause serious side effects. Don’t order ED medicine online without talking to a doctor or pharmacist first. Tell them about everything you take, including over-the-counter medicines, vitamins, supplements and herbal products.
When to see a doctor
- Erection problems keep happening.
- You’re worried ED could be linked to another health problem, such as diabetes or heart disease.
- Get help right away for an erection that lasts longer than 4 hours.
Frequently asked questions
Is ED a normal part of getting older?
No. ED becomes more common with age, but it isn’t a routine part of aging, and it can often be treated.
Can stress cause ED?
Yes. Stress, anxiety and depression can cause ED or make it worse. Counseling can help.
Can ED be cured?
Sometimes. If the cause can be treated, such as a medicine, a lifestyle habit or anxiety, erections may come back. ED tablets help you get an erection but don’t treat the underlying cause.
Does losing weight help ED?
It can. Obesity is one cause of ED, and keeping to a healthy weight, staying active and not smoking may prevent or improve it.
Do ED tablets work without arousal?
No. They help blood flow to the penis only during sexual stimulation, and they don’t increase desire.
Reading medicine listings
If your prescriber recommends treatment, learn the difference between medicine strength and pack size before comparing listings. A listed strength is not a personal dose recommendation.
Sources
This article is for general information only and isn’t a substitute for advice from a doctor or pharmacist. Don’t start, stop or change a medicine without talking to a qualified healthcare professional.