Erectile Dysfunction (ED)

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Erectile dysfunction (ED) or impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.

To initiate and maintain an erection, the penis must fill with blood. One type of blood vessels open wide to allow blood into the penis. Meanwhile, a second type of blood vessel squeezes down to keep the blood from leaving the penis. Nerve signals cause the proper changes in the blood vessels.

Symptoms of ED include:

  • A less firm penis
  • Fewer erections

ED Treatments

If ED becomes an ongoing issue, it can affect your relationship, stress level, and self-esteem. A visit with your doctor can be the first step towards a cure. Urologist Nicolas Ortiz, MD, walks us through the many treatment options offered at UVA. View erectile dysfunction transcript.

What Causes Impotence?

The following factors can cause erectile dysfunction.

Venous Leak

The blood vessels that keep the blood from leaving the penis may be injured or have disease. This can cause a leak in these vessels. Blood can escape through these leaks during an erection. This means that an erection cannot be made or may not last long.

Neurovascular Function

Problems with the nerves and blood vessels can cause impotence. Conditions that can cause problems include:

  • Nerve dysfunction — can reduce feeling in the penis, resulting in impotence
  • Diabetes — interferes with nerve signals
  • Hardening of the arteries — can cause reduced blood flow
  • Peripheral neuropathy, spinal cord injury and surgery — can damage nerves
  • Side-effects from medications

Psychological Factors

Many of the nerve signals needed for an erection come from the brain. Emotional problems may play a role in men who suddenly develop impotence.

Are You at Risk for ED?

Factors that increase your chance of developing impotence include:

  • Age: 65 and older
  • Race: Hispanic
  • Obesity
  • Medical conditions:
    • Diabetes
    • Hardening of arteries
    • Chronic kidney disease
    • Liver failure
    • Peyronie's disease — bending of the penis caused by scar tissue
    • Endocrine disorders
    • Neurological disorders such as multiple sclerosis, peripheral neuropathy and stroke
    • Hypertension
    • Psychiatric disorders, such as anxiety and depression
  • Traumatic conditions:
    • Vascular surgery
    • Pelvic surgeries, particularly for prostate cancer
    • Spinal cord injury
  • Behaviors:
    • Alcohol use
    • Illegal drug use
    • Anabolic steroid use
    • Heavy smoking
    • Interpersonal conflicts with a sexual partner
  • Medications

ED Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam. Expect questions about the frequency, quality and duration of your erections. Your doctor may also test your bodily fluids with blood tests. 

Nocturnal Penile Tumescence Testing

This test monitors erections while you sleep. Involuntary erections during sleep are normal. If you have impotence but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical.


Doppler imaging is used to look at the blood flow. The test checks for blood flow in the penis. It also looks for blockage in the arteries or veins that supply the penis.

Treatment for Erectile Dysfunction

Your doctor may prescribe certain ED medications. Use caution and talk to your doctor before taking any over-the-counter medications for impotence. Some of them may be unsafe.

Vacuum Devices

A vacuum device pulls blood into the penis. A band placed around the penis helps to keep the erection. A vacuum device may include:

  • Plastic cylinder for the penis
  • Hand pump for pumping air out of the cylinder
  • Elastic band for holding the erection after removal of the cylinder

Vascular Surgery

Vascular surgery repairs the blood vessel leaks. 

Penile Implants

Your doctor may put in place a penis implant that inflates to simulate an erection.

Sex therapy may help impotence resulting from:

  • Ineffective sexual techniques
  • Relationship problems
  • Anxiety
  • Depression

Preventing ED

To reduce your chance of becoming impotent:

  • Take medications to manage blood pressure, diabetes or depression.
  • Ask your doctor about changing medications.
  • Maintain a healthy weight.
  • Eat a healthful diet.
  • Quit smoking. Smoking is significantly associated with impotence in older men.
  • Talk to a therapist or counselor.