Erectile Dysfunction: Causes, Evaluation and Care

What erectile dysfunction is

Erectile dysfunction (ED, sometimes called impotence) is a condition that prevents you from getting or keeping an erection firm enough for sex. [1] Most men occasionally fail to get or keep an erection, and this is usually caused by stress, tiredness or drinking too much alcohol. [2] It becomes a health question when it keeps happening.

NIDDK says research suggests 30 to 50 million men in the United States have ED, and that about 40% are affected at age 40 and 70% by age 70. It also says ED is not a routine part of aging. [1]

This page uses the following evidence labels: established recommendation (backed by guidelines or strong reviews), promising but limited, mixed, and insufficient evidence.

Common causes

ED is usually the result of several things working together. NIDDK lists these groups. [3]

• Diseases: diabetes, heart and blood vessel disease, high blood pressure, kidney disease, obesity, nerve damage, low testosterone and thyroid problems, and prostate or penis conditions.
• Medicines: antidepressants, blood pressure medicines and water pills, some pain relievers, sedatives, ulcer medicines, antihistamines and others. Do not stop a medicine on your own; talk with your health care professional first. [4]
• Mind and mood: anxiety, depression, stress, loneliness, low confidence.
• Habits: little physical activity, too much alcohol, smoking and recreational drugs.

Low testosterone is only one possible cause on that list. See Testosterone and low testosterone.

Why it can be a heart signal

In a meta-analysis of 14 studies that followed 92,757 men for an average of 6.1 years, men with ED had a higher risk of cardiovascular events than men without it (pooled relative risk 1.44). [5] That is an association, not proof that ED causes heart disease, and it does not mean everyone with ED has heart disease. It is a good reason to have blood pressure, cholesterol and blood sugar checked. See Everyday health habits for men.

How it is evaluated

A doctor or nurse may ask about your lifestyle, relationships and any problems you have, take your blood pressure and examine your genitals. If you also have urinary symptoms they may examine your prostate. [2] The aim is to find and treat the underlying cause where possible; if no cause is found, treatment focuses on improving sexual function. [4]

Established care

Supplements and "natural" products

NIDDK notes that some people say alternative medicines help ED and advises talking with a health professional before using any supplement. [4]

• A network meta-analysis of 15 trials (1,000 men) concluded there was general ineffectiveness of most nutraceuticals; L-arginine and a carnitine mix appeared somewhat useful, mainly alongside PDE5 inhibitors in ED with a physical cause. [7] Mixed to insufficient.
• A 2026 meta-analysis of 14 trials (1,227 men) reported benefits for herbal supplements overall, with saffron and ginseng singled out, but found evidence for Tribulus and maca insufficient. [8] Promising but limited; the trials were small and short (1 to 6 months).
• A review of marketed products found none of the studies carried out gave enough evidence to consider these products first-line therapy. [9]

See the claim check on "boosters" and male-enhancement products and Medication interactions.