Erectile Dysfunction: What’s Causing It and What You Can Do

Erectile dysfunction (ED) means you can’t get or keep an erection firm enough for sex. It happens to men of all ages, but it becomes more common with age. The good news: many causes are treatable. Understanding what’s behind ED is the first step to getting back to normal sexual activity.

Common causes and simple checks

Physical issues that often cause ED include diabetes, high blood pressure, heart disease, obesity, and low testosterone. Some prescription drugs—antidepressants, blood pressure meds, and prostate meds—can also cause problems. Stress, anxiety, and relationship issues are major psychological causes. Start with basic checks: blood sugar, cholesterol, blood pressure, and a testosterone test if you have low sex drive or other signs of low testosterone.

If you smoke, use recreational drugs, or drink heavily, those raise your risk too. Small changes—quitting smoking, losing 10–15 pounds, or cutting back on alcohol—can make a real difference for erections.

Quick practical treatment options

PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil, avanafil) are the first-line treatment for many men. They work by improving blood flow to the penis. Don’t take them with nitrates (used for chest pain)—that combination can dangerously lower blood pressure. Tadalafil lasts longer and can be taken daily or as needed; sildenafil is shorter acting. Talk with your doctor about dosing and side effects like headache, flushing, or vision changes.

Other options if pills don’t work: vacuum erection devices (a pump and ring), injections into the penis (alprostadil), and urethral suppositories. For men with severe tissue damage or when other treatments fail, surgical implants can provide a reliable solution. Implants require a surgical consult and come with recovery time and risks, so discuss pros and cons carefully.

Psychological causes respond well to counseling. If anxiety or relationship issues play a role, sex therapy or cognitive behavioral therapy can help. Sometimes combining a medication with counseling gives the best results.

Watch out for online “miracle” pills. Many unregulated products contain hidden ingredients or inconsistent doses. Buy prescription ED drugs only from licensed pharmacies and follow your doctor’s advice.

When to see a doctor now: if ED appears suddenly, follows a heart problem, or is accompanied by pain, numbness, or urethral discharge. If ED affects your mood or relationship, don’t wait. A medical evaluation can spot underlying heart disease, diabetes, or hormone issues.

Finally, be direct with your partner and your clinician. ED is common and treatable. With the right tests and a tailored plan—lifestyle changes, safe medications, or therapy—you can find an option that works for you and your relationship.