Erection Problems

What I need to know about

Erection Problems

U.S. Department 

of Health and 

Human Services

NATIONAL INSTITUTES OF HEALTH

National Kidney and Urologic Diseases

Information Clearinghouse

What I need to know about 

Erection Problems 

U.S. Department 


of Health and 


Human Services
 

NATIONAL INSTITUTES OF HEALTH 

National Kidney and Urologic Diseases 

Information Clearinghouse
Contents
 

What are erection problems? ................................. 1
 

What causes an erection? ....................................... 3
 

What causes erectile dysfunction?......................... 5
 

What will happen in the doctor’s office? .............. 6
 

How is erectile dysfunction treated? ..................... 9
 

Points to Remember ............................................. 13
 

Hope through Research ....................................... 14
 

Pronunciation Guide............................................. 15
 

For More Information .......................................... 16
 

Acknowledgments ................................................. 17
 
What are erection problems? 

Erection* problems can be a difficult topic to 

discuss, but if you have problems getting or keeping 

an erection, you have good reasons to talk with a 

doctor: Erection problems not only interfere with 

your sex life, they can be a sign of other health 

problems. 

Erection problems can be a sign of blocked blood 

vessels or nerve damage from diabetes. If you don’t 

see your doctor, these problems will go untreated 

and can harm your body. 

ED is a medical problem. Your doctor can help. 

*See page 15 for tips on how to say the words in 

bold type. 

1 
Erection problems used to be called impotence. 

Now the term erectile dysfunction is more common. 

Sometimes people just use the initials ED. 

Your doctor can offer several ED treatments. For 

many men, the answer is as simple as taking a pill. 

Other men have to try two or three options before 

they find a treatment that works for them. Don’t 

give up if the first treatment doesn’t work. Finding 

the right treatment can take time. 

2 
What causes an erection? 

Hormones, blood vessels, nerves, and muscles must 

all work together to cause an erection. Your brain 

starts an erection by sending nerve signals to the 

penis when it senses sexual stimulation. Touch may 

cause this arousal. Other triggers may be things 

you see or hear, or sexual thoughts or dreams. 

Penis 

Brain 

Spinal cord 

Nerve signals 

Testes 

Your brain starts an erection by sending nerve signals to the 

penis. 

3 
4

The nerve signals cause the muscles in the penis to 

relax and let blood flow into the spongy tissue in 

the penis. Blood collects in this tissue like water 

filling a sponge. The penis becomes larger and 

firmer, like an inflated balloon. The veins then get 

shut off to keep blood from flowing out.

After climax or after the sexual arousal has passed, 

the veins open back up and blood flows back into 

the body.

Testes

Penis

Blood vessels

Healthy blood vessels are needed for an erection.
What causes erectile dysfunction? 

Many different conditions can lead to ED. Many 

of the causes are health problems that affect the 

heart and blood vessels and need to be treated to 

help prevent more serious problems. 

●	 high blood pressure 

●	 high cholesterol 

●	 diabetes 

Unhealthy lifestyle habits can also contribute to 

ED. Anything that’s bad for your heart is also bad 

for your sexual health. 

●	 alcohol and drug abuse 

●	 smoking 

●	 overeating 

●	 lack of exercise 

Nerve damage from many causes can interfere with 

the signals that start an erection. 

●	 spinal cord injury 

●	 treatments for prostate cancer, including 

radiation and prostate removal 

●	 multiple sclerosis and other nerve diseases 

5 
Some prescription drugs such as some 

antidepressants or high blood pressure medicines 

can cause ED. Your doctor may be able to 

change your drug treatment. Never stop taking a 

prescribed drug without talking with your doctor. 

A small number of ED cases result from a reduced 

level of the male hormone testosterone. 

Doctors used to believe that most cases of ED 

resulted from mental or emotional problems. We 

now know that most ED has a physical cause. But 

depression and worry or anxiety can still cause 

ED. And ED from physical causes can lead to 

depression and worry, making ED worse. 

A person should not assume ED is part of the 

normal process of aging. Another cause most 

likely exists. 

What will happen in the doctor’s 


office?
 

Talking about ED can be difficult. When you meet 

with your doctor, you might use a phrase like “I’ve 

been having problems in the bedroom” or “I’ve 

been having erection problems.” Remember that a 

healthy sex life is part of a healthy life. Don’t feel 

embarrassed about seeking help. ED is a medical 

problem, and your doctor treats medical problems 

every day. 

6 
If talking with your doctor doesn’t put you at 

ease, ask for a referral to another doctor. Your 

doctor may send you to a urologist—a doctor who 

specializes in sexual and urologic problems. 

Your partner may want to come with you to see 

the doctor. Many doctors say ED is easier to treat 

when both partners are involved. 

To find the cause of your ED, your doctor will take 

a complete medical history and do a physical exam. 

Medical History 

Your doctor will ask general questions about your 

health, as well as specific questions about your 

erection problems and your relationship with your 

partner. Bring a list of all the medicines you take, 

or bring them with you to show to your doctor. Tell 

your doctor about any surgery you have had. 

Your doctor will ask about habits like alcohol use, 

smoking, and exercise. 

Your doctor might ask you questions like 

●	 How do you rate your confidence that you can 

get and keep an erection? 

●	 When you have erections with sexual 

stimulation, how often are your erections hard 

enough for penetration? 

7 
●	 During sexual intercourse, how often are you 

able to maintain your erection after penetration? 

●	 When you attempt sexual intercourse, how often 

is it satisfactory for you? 

●	 How would you rate your level of sexual desire? 

●	 How often are you able to reach climax and 

ejaculate? 

●	 Do you have an erection when you wake up in 

the morning? 

The answers to these questions will help your 

doctor understand the problem. 

Physical Exam 

A physical exam can help your doctor find the 

cause of your ED. As part of the exam, the doctor 

will examine your testes and penis, take your blood 

pressure, and check your reflexes. A blood sample 

will be taken to test for diabetes, cholesterol 

level, and other conditions that may be associated 

with ED. 

8 
How is erectile dysfunction treated? 

Your doctor can offer a number of treatments for 

ED. You may want to talk with your partner about 

which treatment fits you best as a couple. Most 

people want the simplest treatment possible. You 

may need to try a number of treatments before you 

find the one that works best for you. 

Lifestyle Changes 

For some men, getting more exercise, quitting 

smoking, losing weight, and cutting back on alcohol 

may solve erection problems. 

Counseling 

Even though most cases of ED have a physical 

cause, counseling can help couples deal with 

the emotional effects. Some couples find that 

counseling adds to the medical treatment by 

making their relationship stronger. 

9 
Oral Medicines
 

Since 1998, doctors have been able to prescribe a 

pill to treat ED. Current brands include Viagra, 

Levitra, and Cialis. If your health is generally 

good, your doctor may prescribe one of these 

drugs. You should not take any of these pills to 

treat ED if you take any nitrates, a type of heart 

medicine. All ED pills work by increasing blood 

flow to the penis. They do not cause automatic 

erections. Talk with your doctor about when to 

take the pill. You may need to experiment to find 

out how soon the pill takes effect. 

Even if taking a pill solves your erection problem, 

you should still take care of the other health issues 

that may have caused your ED. 

Injections 

Taking a pill doesn’t work for everybody. Many 

men use medicines that go directly into the penis. 

Caverject and Edex are injected into the shaft 

of the penis with a needle. MUSE is a tiny pill 

inserted into the urethra at the tip of the penis. 

These medicines usually cause an erection within 

minutes. These medicines can be very successful, 

even if other treatments fail. 

10 
11

Vacuum Device

Another way to create an erection is to use a 

specially designed vacuum tube. The penis is 

inserted into the tube, which is connected to a 

pump. As air is pumped out of the tube, blood 

flows into the penis and makes it larger. A 

specially designed elastic ring is moved from the 

end of the tube to the base of the penis to keep the 

blood from flowing out.

Pump

Pump

Elastic ring

When air is pumped out of the tube, blood flows into the 

penis and causes an erection.
Penile Implant 

If the other options fail, some men need surgery 

to treat ED. A surgeon can implant a device 

that inflates or unbends to create an erection. 

Implanted devices do not interfere with the way 

sex feels. 

Penile implant operations cannot be reversed. 

Once a man has a penile implant, he must use the 

device to have an erection. Talk with your doctor 

about the pros and cons of having a penile implant. 

Testes 

Pump 

Infl atable 

rods 

Penis 

Fluid reservoir 

A pump implanted under the skin fills two rods with fluid 

to cause an erection. 

12 
Points to Remember 

● Erection problems may be a sign of health

problems. 

● A doctor can help you overcome erection

problems. 

●	 Smoking, being overweight, drinking too much 

alcohol, and avoiding exercise can contribute to 

erection problems. 

●	 Most cases of erectile dysfunction (ED) have a 

physical cause, but counseling can help couples 

build a stronger relationship. 

●	 Many men can take a pill to treat ED. These 

men should still treat the health conditions that 

caused ED. 

●	 Taking a pill doesn’t work for all men. 

●	 Men who take medicines called nitrates should 

not take a pill to treat ED. 

●	 Additional treatment options for 

ED include injections, urethral 

inserts, a vacuum device, and 

a surgical implant. 

13
 
Hope through Research 

The National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK) sponsors programs 

aimed at understanding the causes of ED and 

finding treatments to reverse its effects. The 

NIDDK’s Division of Kidney, Urologic, and 

Hematologic Diseases (KUH) supported the 

researchers whose work helped develop the first 

pill to treat ED. The KUH continues to support 

basic research into how erections happen and the 

diseases that can cause ED, including diabetes and 

high blood pressure. 

Participants in clinical trials can play a more 

active role in their own health care, gain access to 

new research treatments before they are widely 

available, and help others by contributing to 

medical research. For information about current 

studies, visit www.ClinicalTrials.gov. 

14
 
Pronunciation Guide 

ejaculate (ee-JAK-yoo-layt) 

erectile dysfunction (ee-REK-tyl) 

 (diss-FUHNK-shuhn) 

erection (ee-REK-shuhn) 

impotence (IM-puh-tenss) 

penis (PEE-niss) 

prostate (PROSS-tayt) 

radiation (RAY-dee-AY-shuhn) 

testosterone (tess-TOSS-tuh-rohn) 

urethra (yoo-REE-thruh) 

urologist (yoo-ROL-uh-jist) 

15 
For More Information 

American Urological Association 

1000 Corporate Boulevard 

Linthicum, MD 21090 

Phone: 1–866–RING–AUA (1–866–746–4282) 

 or 410–689–3700 

Email: aua@auanet.org 

Internet: www.auanet.org 

www.UrologyHealth.org 

American Diabetes Association 

National Office 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–DIABETES (1–800–342–2383) 

Fax: 703–549–6995 

Email: AskADA@diabetes.org 

Internet: www.diabetes.org 

American Association of Sexuality Educators, 

Counselors, and Therapists 

P.O. Box 1960 

Ashland, VA 23005–1960 

Phone: 804–752–0026 

Fax: 804–752–0056 

Email: aasect@aasect.org 

Internet: www.aasect.org 

16
 
17

Acknowledgments

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. The National Kidney and 

Urologic Diseases Information Clearinghouse 

would like to thank the following individuals for 

providing scientific and editorial review of the 

original version of this publication:

Tom Lue, M.D.

University of California at San Francisco

Kevin McVary, M.D.

Northwestern University

Hunter Wessells, M.D.

University of Washington

Thank you also to the following individuals who 

facilitated field-testing of this publication:

Kay Longhi, Research Coordinator

Harborview Medical Center, Seattle

Kevin McVary, M.D.

Northwestern University

Hunter Wessells, M.D.

University of Washington
 

The U.S. Government does not endorse or favor any specifi c 

commercial product or company. Trade, proprietary, or company 

names appearing in this document are used only because they are 

considered necessary in the context of the information provided. 

If a product is not mentioned, the omission does not mean or 

imply that the product is unsatisfactory. 

18 
National Kidney and Urologic 

Diseases Information Clearinghouse 

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Phone: 1–800–891–5390 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov 

The National Kidney and Urologic Diseases Information 

Clearinghouse (NKUDIC) is a service of the National Institute 

of Diabetes and Digestive and Kidney Diseases (NIDDK). The 

NIDDK is part of the National Institutes of Health of the U.S. 

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This publication is not copyrighted. The Clearinghouse 

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This booklet is also available at www.kidney.niddk.nih.gov. 

This publication may contain information about medications. 

When prepared, this publication included the most current 

information available. For updates or for questions about any 

medications, contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit 

www.fda.gov. Consult your doctor for more information. 
–

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 09–5483 

June 2009