Symptoms

Symptoms of erection problems (erectile dysfunction) include being unable to:

• Have an erection most of the time.
• Maintain an erection firm enough for sexual intercourse.
• Maintain an erection long enough to complete sexual intercourse.

Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate.

What Happens

Most men have occasional erection problems (erectile dysfunction). But when erection problems become persistent, they can affect your self-image, sex life, and relationship. When you have persistent erection problems, "performance anxiety" can make the problem worse. If you cannot maintain an erection that is firm enough for intercourse, or you have an orgasm before or immediately after entering your partner (premature ejaculation), you may feel frustrated and believe you are not pleasing your partner. All of these factors could influence how you view your relationship.

Fortunately, many of the physical and psychological factors that cause erection problems respond to treatment.

What Increases Your Risk

Your risk of having an erection problem (erectile dysfunction) increases with age.

Diseases, physical or psychological problems, and certain activities also may increase your risk.

Diseases that affect blood vessels include:

• Diabetes. About half of men with diabetes develop erection problems.
• High blood pressure or other blood vessel diseases.
• High cholesterol or low HDL (high-density lipoprotein) cholesterol.

Diseases or procedures that affect nerves include:

• Diabetes.
• Multiple sclerosis.
• Stroke.
• Parkinson's disease.
• Having had surgery involving the prostate, bladder, rectum, or urethra. These procedures may cause injury to nerves involved in achieving and maintaining an erection.

Other conditions include:

• Thyroid problems.
• Low levels of the hormones needed for the normal development and function of the sex organs (hypogonadism), leading to low testosterone levels.

Injuries or treatment include:

• Injury to the penis or pelvic region.
• Injury to the spinal cord or nerves to the penis.
• Pelvic surgery.
• Radiation in the pelvic area.

Medicines and other substances that increase your risk include:

• Some medicines to treat high blood pressure or depression.
• Long-term (chronic) alcohol abuse.
• Drug abuse.
• Tobacco use.

Psychological risk factors include:

• Depression.
• Anxiety or stress.
• Relationship problems.
• A recent major life change (birth of a child, retirement, job change, loss or death of a partner, divorce, or marriage).

Activities that constrict blood flow to the penis—such as frequent long-distance bicycle riding on a hard, narrow saddle—may increase a man's risk of developing an erection problem. But experts continue to debate this issue.

A vasectomy usually does not cause erection problems. But pain after the operation may affect sexual performance for a time, and if a man was not comfortable with his decision to have a vasectomy, or is having second thoughts, it could affect him psychologically.