If you have trouble getting an erection or maintaining your erection during sex, you may have erectile dysfunction (ED). This can occur for several reasons, both physical and psychological. It’s important to recognize ED symptoms because it can be treated. Medication, counseling, and other treatments can help The right one for you will depend on your ED’s cause.
What Are the Most Common Erectile Dysfunction Symptoms?
ED has many symptoms. You may not have all of them, as certain symptoms depend on the cause of your ED.
Difficulty getting an erection
You may be sexually aroused, but nothing — or nothing much — happens despite stimulation of your penis. Because erections are complex, you can struggle to get an erection for different reasons.
Poor blood flow to your penis may explain your difficulty getting an erection. In order to achieve an erection, blood flow to your penis needs to increase. Sexual arousal can set this in motion. But if the arteries that carry blood to your penis have become clogged due to atherosclerosis, for example, your penis won’t get enough blood for an erection.
Atherosclerosis affects arteries throughout your body, including those in the heart. It’s a leading cause of heart disease, and ED can be an early indicator that your heart health is at risk.
“If you’re in your 60s, if you’re a smoker, if you’re overweight, if you have high blood pressure, your ED may be a marker of your cardiovascular health,” says urologist Boback Berookhim, MD, director of the male fertility and microsurgery program at Northwell Lenox Hill Hospital in New York City.
If you’re young and fit, there’s likely a different explanation. “It’s often more of a stress and anxiety-driven issue,” Berookhim says.
Difficulty maintaining an erection
The blood that flows to your penis and allows you to achieve an erection needs to stay in your penis for your erection to last.
When the veins in your penis can’t keep the blood where it needs to be, you have what’s called venous leak, in which the blood moves out of your penis and back into your bloodstream. The result: You lose some or all of your erection.
Another possible reason you might lose your erection is too little stimulation. If you don’t get enough sensation in your penis, the levels of an erection-essential chemical in the blood called nitric oxide will drop. When that happens, “the outflow [of blood] becomes greater than the inflow,” says urologist Jesse Mills, MD, director of the Men’s Clinic at UCLA in Los Angeles.
You can also lose your erection due to anxiety. “You’re going to lose that erection immediately as your anxiety goes up,” Berookhim says, adding that any source of anxiety, big or small, can put your erection at risk.
If your ability to maintain an erection worsens over time, that’s more likely due to a physical cause than a psychological issue such as anxiety, Berookhim says.
Erections not firm enough
Sometimes, you may be able to achieve a partial erection but not one that’s rigid enough for sex, or it can be less rigid than it used to be.
“Sometimes, men lose the rigidity of their erections over time, and they barely notice it, as they can still have penetrative intercourse,” Mills says. “But sometimes a partner notices that the erection isn't as full during penetration.”
This often happens as you get older. But don’t just write it off as part of aging, Mills says. Talk to your doctor about what may be causing this issue, especially if you’re sexually active.
“There is a higher risk of injuring the penis if it’s hard enough to penetrate but soft enough to buckle during sex,” Mills says. “[That can] cause scar tissue in the penis.”
Difficulty reaching an orgasm
When you have a full erection, it’s easier to stimulate your penis so that you can climax, Mills says. An inability to achieve or maintain an erection can get in the way.
“If a penis isn’t fully engorged [with blood], it isn’t stretching the sensitive nerves as much, and it may be tougher to orgasm,” he says.
The nerves that trigger an orgasm are not the same as those involved in erections, Mills says. Some people who have had nerve-damaging pelvic surgeries can no longer achieve erections, but manual or oral stimulation can still lead to orgasm, he says.
When orgasms become difficult, stress is another common cause. .
“There's a major stress and anxiety component to failure of orgasm,” Mills says.
Other things that may cause problems with orgasms and ejaculation include:
- Low testosterone
- Taking certain types of medications, such as a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and some blood pressure medications
- Nerve damage, from causes such as diabetes, spinal cord injuries, and stroke
Low sexual desire
ED sometimes involves a drop in sex drive, also called low libido. Low testosterone most commonly explains this possible erectile dysfunction symptom, Mills says. In fact, as many as 35% of men with ED have low testosterone. “The first place I go when someone says their libido is down is to check their testosterone, estradiol, and a few other pituitary hormones,” he says.
Low sexual desire also can have a psychological cause. The anxiety that so often leads to ED often has a compounding effect on your sex life, Berookhim says. “Difficulty in the bedroom adds to the anxiety you already have,” he says. “That may lead you to avoid sexual activity and to your libido going down.”
When Should You Worry about Erectile Dysfunction Symptoms?
You can have trouble getting an erection occasionally for a variety of reasons. If you have too much alcohol one evening, for example, you may be unable to perform in the bedroom. Or a stressful situation, such as being with a new partner for the first time, may ruin an erection.
“If you avoid those scenarios and never have another incident of ED, you’re probably fine,” Mills says. “Otherwise, see a urologist.”
One-off difficulty getting or staying erect should not typically be a cause for concern, Mills says. But if you regularly have erection problems, that’s cause for concern, and you should get examined by a doctor. Remember, ED can be an early warning sign of heart disease, particularly if it happens frequently and gets worse over time. ED can also result from treatable psychological conditions, such as anxiety.
“Anxiety is a very real source of ED,” Berookhim says.
Everyday stressors are also a common source of ED, according to Mills.
“I see a lot of men who say they get great erections and have great libido on vacation but not during the busy workweek,” he says. “That’s stress pure and simple.”
Whatever the cause, discuss your ED symptoms with your doctor. Treatment can get your erections back on track.
“If you are distressed by it, then it’s worth it to come in,” Berookhim says.
How common is erectile dysfunction?
Erectile dysfunction is very common. Recent research shows that 30-50 million adults in the U.S. have erectile dysfunction. The older you get, the more likely it becomes. In your 40s, your risk is about 40%. By the time you’re in your 70s, your chances may rise to 70%.
When to Call Your Doctor
Talk to your doctor if your ED worries you so much that it causes anxiety or threatens your sexual relationship. At the very least, your doctor can clear up misinformation.
Also talk to the doctor if it’s painful to get an erection or difficult because your penis is curved (a condition called Peyronie’s disease).
If the problem doesn’t go away, it could be an early warning sign of a more serious, larger condition. For example, the penile artery can get narrower because of atherosclerosis or diabetes.
To help with your erections, your doctor may suggest taking medication as a pill or as an injection in your penis or using a mechanical device. Sometimes taking medication for a short time can get you through a rough patch. You’ll need to deal with the underlying medical condition, too.
Takeaways
Erectile dysfunction symptoms can happen for a variety of reasons. Sometimes, they are nothing to worry about, but if they happen regularly or cause you distress, don’t hesitate to talk with your doctor. Identifying the cause of your erectile dysfunction symptoms may help your overall health, besides restoring your ability to perform in the bedroom.
Erectile Dysfunction Symptoms FAQs
Can stress cause erectile dysfunction symptoms in men?
Yes, stress frequently leads to ED symptoms. It includes stress from work, relationships, and other difficult situations.
How do I know if my ED is physical or mental?
If your ED gets worse over time, it is more likely due to a physical problem, such as clogged arteries. If your erectile dysfunction symptoms come and go — meaning you can get a good erection sometimes but not others — anxiety may explain the problem. Both can be serious problems and should be evaluated by your doctor.
Are ED symptoms reversible?
If your ED symptoms are caused by anxiety, addressing your anxiety can help you regain normal erections. Some causes, such as clogged arteries, can’t be reversed. But your doctor can help you prevent the problem from getting worse, and medications can boost blood flow to your penis so that you’re able to get an erection.
Can erectile dysfunction be a symptom of prostate cancer?
Prostate cancer does not directly cause erectile dysfunction symptoms. But anxiety due to the disease can make ED symptoms more likely. Treatment for prostate cancer is a far more common cause of erectile dysfunction.
