Erectile Dysfunction

What is erectile dysfunction?

All men have difficulties with erections from time to time. The occasional failure to get or maintain an erection, which lasts long enough to have sex, can occur for a variety of reasons, including drinking too much alcohol or being very tired. The inability to get or maintain an erection less than 20% of the time is not unusual.

Erectile dysfunction (ED) is the inability to get or maintain an erection 25% or more of the time. Some men with ED find they are completely unable to achieve an erection, others have an inconsistent ability to achieve an erection, and still others experience only brief erections. ED is a frustrating condition that can have physical or psychological causes. ED can be the first sign of an underlying health condition that needs treatment, so seeking medical evaluation is important.

ED is also different from a lack of sexual desire or problems with ejaculation and orgasm. (If you are able to get an erection but then it goes away because you ejaculate more quickly than you would like, click here to visit our page on premature ejaculation.)

How common is it?

Erectile dysfunction affects 30 million men in the United States. The problem can occur at any age, but the older a man gets, the greater the chance that he will have a health problem that results in ED. According to the National Institutes of Health, approximately 5% of 40-year-old men and between 15 and 25% of 65-year-old men experience ED on a long-term basis.

In young men, erectile dysfunction is less common and when it does occur is more likely to have a psychological cause such as stress or performance anxiety. Still, young men are seeking treatment for this and other sexual problems in increasing numbers. The use of Viagra increased 312% among men aged 18-45 between 1998 and 2002.

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How does an erection occur?

For an erection to occur, several parts of the body must work together. The brain sends messages to control the nerves, hormone levels, blood flow and muscles that cause an erection. If anything interferes with these messages, or if any part of the system doesn’t function correctly, an erection won’t occur.

The penis has two sponge-like cylindrical structures that run along its length, parallel to the urethra (the tube that carries semen and urine). During sexual arousal, these cylinders become engorged with blood, straightening and stiffening the penis. Continued sexual arousal maintains the higher rate of blood flow into the penis and limits the flow out of the penis, keeping the erection firm. After ejaculation or when the sexual excitement passes, the excess blood drains out of the spongy tissue and the penis returns to its non-erect size and shape.

What are the psychological causes of erectile dysfunction?

A number of things can interfere with sexual feelings and lead to or exacerbate erectile dysfunction. These can include:

  • depression
  • anxiety
  • history of physical, emotional, or sexual abuse
  • stress
  • fatigue
  • poor communication or conflict with your partner

Erectile dysfunction as a result of a psychological cause tends to develop rapidly and be related to a recent situation or event. You may find you are able to have an erection in some circumstances but not in others. If you are generally able to experience or maintain an erection when you first wake up in the morning this can suggest that the problem is psychological rather than physical.

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What are the physical causes of erectile dysfunction?

While thoughts and emotions always play a role in getting an erection, erectile dysfunction is most often caused by something physical, such as a chronic health problem or the side effects of a medication. The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.

A variety of physical risk factors can contribute to erectile dysfunction. Factors that may be present for younger men include:

Substance abuse. Chronic use of alcohol, marijuana or other drugs can cause erectile dysfunction and decreased sexual drive.

Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.

Smoking. Smoking can cause erectile dysfunction because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop erectile dysfunction.

Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone.

Taking certain medications. A wide range of drugs — including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.

Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.

Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.

Metabolic syndrome. This syndrome is characterized by unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.

When should I seek treatment?

Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you — and your partner(s). If erectile dysfunction is more than a temporary, short-term problem, see your medical provider.

Brown students can make an appointment at Health Services by calling 401.863-3953. You can request specific providers by name or by gender. Your provider can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.

If you experience occasional or persistent erectile dysfunction, your partner(s) may see your inability to have an erection as a sign of diminished sexual desire. Your reassurance that this is not the case can help. Try to communicate openly and honestly about your condition. Treatment is often more successful if partners address the issue together.

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What treatments are available?

Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

  • Exercise regularly.
  • Reduce stress. Click to learn more about stress management.
  • Get enough sleep. Click for healthy sleep tips.
  • Get help for anxiety or depression.
  • Limit or avoid the use of alcohol.
  • Avoid recreational drugs, including marijuana.
  • Stop or reduce smoking. Access smoking cessation strategies and support here.
  • See your medical provider for regular checkups and medical screening tests.
  • Work with your medical provider to manage conditions that can lead to erectile dysfunction, such as diabetes and heart disease.

For psychological causes, seeking treatment from a mental health professional or from a sex therapist can be very helpful. If you are a Brown student, you can seek help from Psychological Services for issues including stress, depression, and anxiety. AASECT maintains a list of certified sex therapists across the country.

For physical causes, a wide variety of treatments are available, depending on the specific physical issue. The first step is often to try ED medications, like Viagra, since these help most men. Depending on your diagnosis, other treatments range from changing your prescription drugs to hormone replacement therapy, antidepressant therapy, and devices, medications or implants to produce erections.

Campus Resources

Psychological Services 401.863-3476
Psychological Services provides individual appointments, referrals, and groups on a variety of issues.

Health Services  401.863-3953
Health Services provides a range of services including general health care, STI testing, and emergency medical care. You can request a male or female medical provider or you can request a specific provider by name. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

Health Education 401.863-2794            
Health Education is available for individual appointments and group education on a variety of health issues, including premature ejaculation or other sexual health concerns. We also have safer sex supplies available. Come visit us, we are located on the 3rd floor of Health Services. The following titles have good comprehensive discussions of premature ejaculation, including causes and treatments.
The New Male Sexuality- Bernie Zilbergeld
Male Sexual Awareness-
Barry and Emily McCarthy
Both titles are available for loan from Health Education.

Links you can use

American Urological Association           
This site offers information on erectile dysfunction, including treatment options, as well as information on other sexual function issues.

American Association of Sexuality Educators Counselors and Therapists
AASECT offers a directory of certified sex therapists as well as links to sexuality resources.

Sexual Health Network
The Sexual Health Network site includes articles and Q&A sections on erectile dysfunction and other sexual health topics.

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.