Overview
Flaccid and erect penis

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If ED is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse ED. In other cases, medications or other direct treatments might be needed.

Symptoms
Erectile dysfunction symptoms might include persistent:

Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire

Causes
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes ED. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen ED.

Physical causes of erectile dysfunction
In many cases, ED is caused by something physical. Common causes include:

Heart disease
Clogged blood vessels (atherosclerosis)
High cholesterol
High blood pressure
Diabetes
Obesity
Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
Parkinson’s disease
Multiple sclerosis
Certain prescription medications
Tobacco use
Peyronie’s disease — development of scar tissue inside the penis
Alcoholism and other forms of substance abuse
Sleep disorders
Treatments for prostate cancer or enlarged prostate
Surgeries or injuries that affect the pelvic area or spinal cord
Low testosterone

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