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Erection problems

Male reproductive anatomy
Erection self-test

Definition

An erection problem is when a man cannot get or keep an erection that is firm enough to have intercourse. You may be unable to get an erection at all. Or, you may lose the erection during intercourse before you are ready.

If the condition continues, it is called erectile dysfunction.

Alternative Names

Erectile dysfunction; Impotence; Sexual dysfunction - male

Considerations

Erection problems are common in adult men. Almost all men sometimes have trouble getting or keeping an erection.

In many cases, the problem goes away with little or no treatment. In other cases, it can be an ongoing problem. If you have trouble getting or keeping an erection more than 25% of the time, it is a problem.

An erection problem that does not go away can damage your self-esteem and harm your relationship with your partner. It needs to be treated.

In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as, "don't worry," or "just relax and it will take care of itself." Today, doctors believe that physical factors often cause erection problems.

One way to know if the cause is physical is whether you have nighttime erections. Normally, men have 3 to 5 erections per night. Each erection lasts for up to 30 minutes. Your doctor can tell you how to find out whether you are having the normal number of nighttime erections. If you have erections in the morning, this can also mean that there is not a physical cause.

Erection problems usually do not affect a man's sex drive.

Having an orgasm too quickly (premature ejaculation) is not the same as impotence. Get counseling with your partner for this problem.

Male infertility is also different from impotence. A man who cannot keep an erection may be able to produce sperm that can fertilize an egg. A man who is infertile can usually keep an erection, but he may not be able to father a child due to problems with sperm.

Causes

An erection involves your brain, nerves, hormones, and blood vessels. Anything that interferes with these normal functions can lead to problems getting an erection.

Common causes of erection problems include:

Erection problems become more common with age. However, they can affect men at any age. Physical causes are more common in older men. Emotional causes are more common in younger men.

Low levels of testosterone can lead to erection problems. They may also reduce a man's sex drive.

Home Care

For many men, lifestyle changes can help:

Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble talking about their feelings may find it hard to share their anxiety about sexual performance. Counseling can help both you and your partner.

When to Contact a Medical Professional

Call your doctor if:

If erection problems seem to be caused by a medication you are taking, talk to your health care provider. You may need to lower the dose or change to another drug. Do NOT change or stop taking any medications without first talking to your health care provider.

Talk to your health care provider if your erection problems have to do with a fear of heart problems. Sexual intercourse is usually safe for men with heart problems.

Call your doctor right away or go to an emergency room if the medication you are taking for erection problems gives you an erection that lasts for more than 4 hours.

What to Expect at Your Office Visit

Your doctor will perform a physical exam, which may include:

To help find the cause of the problem, your doctor will ask medical history questions such as:

Tests that may be done include:

TREATMENT

The treatment may depend on the cause of the problem. Talk to your health care provider about the best way to treat your erection problem.

There are many treatment options today, including:

Ask your health care provider about the possible side effects and complications of each treatment.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines called phosphodiesterase-5 (PDE5) inhibitors. They work only when you are sexually aroused. They usually start to work in 15 to 45 minutes.

These drugs can have side effects, which can range from muscle pain and flushing to heart attack. Do not use these drugs with medications such as nitroglycerin. The combination can cause your blood pressure to drop. Some men have died after taking these drugs with nitroglycerin.

Use PDE5 inhibitors with caution if you have any of the following conditions:

If pills do not work, other treatment options include:

Many herbs and dietary supplements are marketed to help sexual performance or desire. However, none of these supplements have been proven effective for treating erectile dysfunction, and they may not always be safe.

References

Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305-312.

Qaseem A, Snow V, Denberg TD, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009;151:639-649.


Review Date: 9/19/2011
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.