Erectile dysfunction, also known as impotence, is the inability to achieve and maintain an erection. Occasional problems are normal for all men, but if erectile dysfunction is an ongoing issue, treatment is available.

Symptoms
Symptoms of erectile dysfunction may include:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire.

Causes and Risk Factors
Erectile dysfunction can be caused by either physical or psychological concerns. The brain triggers the physical events that cause erections, so certain mental and/or emotional feelings can contribute to erectile dysfunction.

Physical causes for erectile dysfunction may include:

• Heart disease.
• Clogged blood vessels (atherosclerosis).
• 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.
• Low testosterone.
• Peyronie's disease, development of scar tissue inside the penis.
• Tobacco use.
• Alcoholism and other forms of substance abuse.
• Treatments for prostate cancer or enlarged prostate.
• Surgeries or injuries that affect the pelvic area or spinal cord.
• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate cancer.
• Prolonged bicycling, which can compress nerves and temporarily affect blood flow to the penis.

Psychological causes for erectile dysfunction may include:

• Depression, anxiety or other mental health conditions.
• Stress.
• Fatigue.
• Relationship problems due to stress, poor communication or other concerns.

Diagnosis
Often, a physical examination and a medical history are all that are needed for your doctor to recommend a treatment. However, if your doctor suspects underlying problems, or you currently have chronic health problems, you may need further tests. Tests for underlying problems may include:

• Physical exam and checking your nerves for feeling.
• Blood tests to check for signs of heart disease, diabetes, low testosterone levels and other health problems.
• Urine tests (urinalysis) to look for signs of diabetes and other underlying health conditions.
• Ultrasound to check blood flow to your penis.
• Overnight erection test to determine whether the cause of your erectile dysfunction is physical or psychological.

Treatment
There are many treatments for erectile dysfunction. The cause and severity of your condition and underlying health problems are important factors in deciding which treatment option is best for you. Your doctor will explain the risks and benefits of each treatment and take your personal preferences into consideration.

Treatment choices may include:

Oral medications—Oral medications are successful for many men. They include: Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra). All three work in much the same way. They enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. As the muscles relax, more blood can flow into the penis and support an erection. These medications vary in dosage, how long they work and their side effects. Your doctor will take your particular situation into account while deciding which medication to prescribe.

Testosterone replacement—Some men have erectile dysfunction caused by low levels of the hormone testosterone and may need testosterone replacement therapy.

Surgery (blood vessel surgery)—In rare cases, a leaking blood vessel can cause erectile dysfunction and surgery is necessary to repair it.

Penis pumps (vacuum constriction device)—A penis pump is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to remove the air from inside the tube. This creates a vacuum that pulls blood into your penis.

Penile implants—This treatment involves surgically placing devices into the two sides of the penis. These implants consist of either inflatable or semirigid rods made from silicone or polyurethane. The inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep the penis firm but bendable. This treatment can be expensive and is usually not recommended until other methods have proven unsuccessful.

Psychological counseling—If your erectile dysfunction is caused by stress, anxiety or depression, your doctor may suggest that you visit a psychologist or counselor, either alone or with your partner. Erectile dysfunction can create stress and tension within a relationship, even if it is caused by something physical.

Prevention
The best way to prevent erectile dysfunction is to make healthy lifestyle choices and manage any existing health problems you may have. Steps can you can take include:

• Good management of any chronic health problems, such as diabetes or heart disease
• Regular checkups and medical screening tests
• Quit smoking
• Don't use street drugs
• Limit or avoid alcohol
• Exercise regularly
• Reduce stress
• Get help for anxiety or depression.