If your doctor suspects that physical causes are involved, he or she will likely want to take blood tests to check your level of male hormones and for other potential medical problems, such as diabetes. Your doctor may also want to try eliminating or replacing certain prescription drugs you’re taking one at a time to see whether any are responsible for erectile dysfunction.

More specialized tests may include:

• Ultrasound. This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. The transducer emits sound waves that pass through body tissues and reflect back, producing an image to let your doctor see if your blood flow is impaired. The test often is done before and after injection of medication into the side of the penis to see if there’s an improvement in blood flow.
• Neurological evaluation. Your doctor usually assesses possible nerve damage by conducting a physical examination to test for normal touch sensation in your genital area.
• Dynamic infusion cavernosometry and cavernosography (DICC). This procedure involves injecting a dye into penile blood vessels to permit your doctor to view any possible abnormalities in blood pressure and flow into and out of your penis. It’s generally done with local anesthesia by a urologist who specializes in erectile dysfunction.
• Nocturnal tumescence test. If your doctor suspects that mainly nonphysical causes are to blame, he or she may ask whether you obtain erections during masturbation, with a partner or while you sleep. Most men experience many erections, without remembering them, during sleep. A simple test that involves wrapping a special perforated tape around your penis before going to sleep can confirm whether you have erections while you’re sleeping. If the tape is separated in the morning, your penis was erect at some time during the night. Tests of this type confirm that there is not a physical abnormality causing erectile dysfunction, and that the cause is likely psychological.

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome

Other causes of erectile dysfunction include:

• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of drug abuse
• Treatments for prostate cancer
• Parkinson’s disease
• Multiple sclerosis
• Hormonal disorders such as low testosterone (hypogonadism)
• Peyronie’s disease
• Surgeries or injuries that affect the pelvic area or spinal cord

In some cases, erectile dysfunction is one of the first signs of an underlying medical problem.

Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, beginning with feelings of sexual excitement. A number of things can interfere with sexual feelings and lead to — or worsen — erectile dysfunction. These can include:

• Depression
• Anxiety
• Stress
• Fatigue
• Poor communication or conflict with your partner

The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.

Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex. Although erectile dysfunction is more common in older men, this common problem can occur at any age. Having trouble maintaining an erection from time to time isn’t necessarily a cause for concern. But if the problem is ongoing, it can cause stress and relationship problems and affect self-esteem.

Formerly called impotence, erectile dysfunction was once a taboo subject. It was considered a psychological issue or a natural consequence of growing older. These attitudes have changed in recent years. It’s now known that erectile dysfunction is more often caused by physical problems than by psychological ones, and that many men have normal erections into their 80s.

Although it can be embarrassing to talk with your doctor about sexual issues, seeking help for erectile dysfunction can be worth the effort. Erectile dysfunction treatments ranging from medications to surgery can help restore sexual function for most men. Sometimes erectile dysfunction is caused by an underlying condition such as heart disease. So it’s important to take erectile trouble seriously because it can be a sign of a more serious health problem.

Symptoms

Erectile dysfunction is the inability to maintain an erection sufficient for sexual intercourse at least 25 percent of the time.

An occasional inability to maintain an erection happens to most men and is normal. But ongoing erection problems are a sign of erectile dysfunction and should be evaluated. In some cases, erectile dysfunction is the first sign of another underlying health condition that needs treatment.

Causes

Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. If something affects any of these systems — or the delicate balance among them — erectile dysfunction can result.