Erectile dysfunction (ED) is the frequent inability to achieve or keep an erection long enough to have sex.
ED is actually a pretty common condition. The chances of developing it tend to
ED might be the cause if you have been experiencing any of the following symptoms several times in a week over the course of 4 or more weeks:
- difficulty achieving a firm erection
- unable to maintain an erection for the duration of sexual activity
- difficulty ejaculating or reaching orgasm during sexual activity
By the year 2025, an estimated 300 million men will experience ED. That’s why it’s important to remember that if you do develop ED, you’re not alone. There are many proven treatments and interventions that can help you.
ED can also have an impact on your relationships and overall mental health if left untreated. Researchers have surveyed men of all ages with ED. They shared that ED can affect quality of life and relationships with intimate partners.
While achieving and losing an erection before ejaculation can happen from time to time, ED is a consistent pattern of being unable to get an erection or ejaculate.
If you find you’re having this difficulty, it might be time to talk with a doctor.
ED can be the result of multiple causes or one targeted cause — this is often the case if you have another health condition that’s known to cause ED.
Most healthcare professionals will divide ED causes into three main categories: blood flow concerns, disorders affecting nerve sensations, and psychological or emotional health concerns.
Let’s take a closer look at these causes.
Blood flow concerns
To achieve an erection, the body diverts blood to the penis, causing the tissues of the penis to swell and expand. Without enough blood flow to these tissues, you can’t achieve an erection.
Conditions that may affect blood flow include:
- overweight or obesity
- chronic kidney disease
- heart or blood vessel disease
- high blood pressure
- certain medications that treat high blood pressure
Nerve sensation concerns
Conditions that damage the nerves in your pelvis and your penis can affect your ability to achieve and maintain an erection. An example of this condition is diabetes mellitus.
Changes or damage to your anatomy can also be a cause of ED symptoms. This generally includes conditions or situations that can cause long-term damage or scarring to the penis or pelvic region.
Examples of anatomical concerns are:
Psychological and emotional health concerns
Your mental health and sexual desire can have a strong connection to potential ED symptoms. Examples of conditions that may affect ED include:
- concerns or fears over sexual performance
- high stress levels
- low self-esteem
- taking medications that may lessen sex drive, such as prescription sedatives
The presence of so many potential causes just goes to show how many aspects of your health play a role in achieving and maintaining an erection.
If any of these health aspects are negatively affected, you could experience ED symptoms.
While research into new ED treatments is ongoing, there are lots of approved treatments that are currently used to effectively treat ED.
When ED is caused by a condition such as diabetes, one of the most important things you can do is work with your doctor to manage your overall health. Lifestyle modifications can also make a significant difference. These include:
- not smoking
- limiting alcohol and drug use
- managing your weight
- creating a healthy sleep routine
- managing sleep apnea
- exercising regularly
- eating a healthy diet
Phosphodiesterase type 5 inhibitors (PDE5) are a first-line therapy for ED. These include:
Newer, second-generation medications currently available include:
- avanafil (Stendra)
- lodenafil (Helleva), not FDA approved
- mirodenafil (Mvix), not FDA approved
- udenafil (Zydena), not FDA approved
In the United Kingdom, you can get sildenafil over the counter following a consultation with a pharmacist. In the United States, ED drugs are available only by prescription.
These medications are effective and fairly well tolerated. They don’t automatically cause an erection. You’ll still need some form of sexual stimulation.
Side effects can include:
- nasal congestion
- upset stomach
- visual changes
ED medications may not be a safe choice if you:
- take nitrates to treat chest pain
- have heart disease
- have low blood pressure
For many men, self-injected drug therapy is as effective as oral medications. It’s a bit more invasive, but it may have fewer side effects. These may include:
- injection site soreness
- prolonged erection
- penile pain
- possible scarring or infection
Injection therapy drugs include:
- aviptadil, not FDA approved
- papaverine, not FDA approved for penile injections
- phentolamine, not FDA approved
Alprostadil suppositories or cream
Alprostadil urethral suppositories are inserted into the urethra with a special applicator. Side effects can include pain and minor bleeding. Alprostadil can also be applied as a topical cream, but it isn’t available everywhere.
In some cases, your doctor may prescribe a penis pump, which involves placing a hollow tube over the penis, then using a hand- or battery-operated pump. This creates a vacuum to get the blood flowing to the penis. A tension ring around the base of the penis helps hold the erection after you remove the device.
If other methods aren’t effective or not a good fit, there are a few surgical options:
- You can have an inflatable implant placed in your penis. The implant can be inflated with a pump, making your penis longer and wider.
- You can have malleable implants inserted. You’ll be able to manually adjust the position of your penis as desired.
- A surgeon can repair arteries to create better blood flow, but this procedure is uncommon.
ED is sometimes due to psychological issues, such as:
On the other hand, ED itself can lead to or exacerbate these problems. Therapy and medication may sometimes be necessary.
External penile prosthesis
Some men with ED can benefit from over-the-counter sex aids, such as:
- penile sleeves
- support devices
- external prosthetic phallus
The devices are:
- more affordable than other methods
- easy to get without a prescription
However, they may not be helpful in all cases. Research on the use of external penile prostheses is lacking. Satisfaction depends a lot on personal and partner preferences.
Currently available treatments are effective for many, but they don’t work for everyone. Side effects and underlying conditions keep some people from using them. That’s why researchers are exploring new avenues of treatment for ED.
Let’s take a look at the latest ED treatments and some innovative therapies that may be available in the coming years.
Researchers are studying several new types of treatment for ED, including:
Stem cell therapy
Stem cell therapy for ED involves the injection of your stem cells into your penis. Both animal studies and phase I studies in humans have had promising results. Research in humans suggests that it could eventually be a safe, effective treatment for ED.
However, many questions about long-term effectiveness and safety remain. Much more research needs to take place before it can be called anything more than an investigational therapy.
Promising as stem cell therapy may be, it isn’t approved for the treatment of ED. Be aware that claims to the contrary might be scams.
Platelets are cell fragments in your blood that can help heal wounds and grow new blood vessels. There have been several preclinical and clinical trials of platelet-rich plasma (PRP) treatment for ED, with few adverse reactions.
In a 2020 review, researchers wrote that PRP therapy has the potential for treating male sexual dysfunction. They warn, however, that studies have been limited by size, short follow-up periods, and lack of control groups.
Although this treatment is currently available, it’s considered experimental and should be approached with caution.
Just as coronary stents can help treat heart disease, there’s some reason to hope that vascular stents might be able to help treat ED. A few small trials have had good results, but larger trials are needed to determine the long-term safety and effectiveness of stents for ED.
Though there have been a few successful penis transplants, the first total penis and scrotum transplant was performed at Johns Hopkins in 2018. The patient, a severely injured soldier, was expected to regain near-normal urinary and sexual functions.
With each transplant, doctors are learning more about long-term safety and efficacy.
In recent years, penile shockwave therapy, or low-intensity extracorporeal shockwave therapy, has garnered much attention. Researchers have been looking at it as a possible treatment for ED caused by vascular disease.
Shockwave therapy involves passing low-intensity sound waves through erectile tissue. The goal is to improve blood function and encourage new blood vessels to grow.
While research has been called encouraging, shockwave therapy isn’t an approved therapy for ED. More clinical trials and longer follow-ups are needed to assess safety and effectiveness.
ED can be caused by underlying conditions that should be diagnosed and treated. You can start with your primary care doctor, but keep in mind that they may refer you to a urologist. These specialists are trained to treat the urinary tract and the male reproductive system.
It’s important to communicate openly. Tell your doctor if you have other health issues or take medications. Explain how long you’ve had symptoms of ED and how it’s affecting your quality of life.
There’s a lot of information about ED online and no shortage of claims for quick fixes. Talk with your doctor before trying anything on your own. Those claims might be scams that won’t help your ED and may have the potential to harm your health.
Still, feel free to discuss any treatment options you’re curious about with your doctor. They can help you figure out what’s safe and effective, and what’s not.
What is the latest treatment for erectile dysfunction in 2022?
Many ED treatments have become available in the past few years. Most involve addressing different aspects of ED treatments beyond restoring blood flow. Examples include the following:
- Melanocortin receptor agonists may help cases of ED that don’t respond to phosphodiesterase inhibitors.
- Stem cell therapy can help regenerate damaged tissue in people with a history of prostate cancer surgery or diabetes. This treatment is still in clinical trials.
- Low intensity shockwave therapy may be another method that improves blood flow. This treatment is also still in clinical trials.
The Food and Drug Administration (FDA) has also approved multiple medications to treat ED, including:
- avanafil (Stendra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
How can I restore my erectile function?
Restoring your erectile function depends on treating the underlying cause or causes of your ED.
A good first step is to talk with a doctor about the symptoms you’re experiencing. They will likely want to look for potential underlying causes, like diabetes and heart disease. When those conditions are properly treated, the symptoms of ED may improve over time.
If the cause of your ED seems to be tied to a mental health condition like depression or anxiety, working with a therapist could help restore erectile function as your therapy and mental health progress.
How can I tell whether my erectile dysfunction is increasing?
Having ED doesn’t always mean you can never achieve an erection; you may find you only have intermittent concerns with ED.
However, if you find that getting or sustaining an erection is starting to become more infrequent, talk with your doctor.
Consider checking in with your partner to see whether they have noticed a change with your erection or stiffness recently. Ask them to share any instances when you were unable to have an erection or lost it prematurely.
If these situations are becoming more frequent, schedule an appointment with a doctor to discuss your concerns.
There have been many advances in treatment for ED over the past several decades. Researchers continue to improve current therapies and seek out better and safer alternatives. Ask your doctor about the latest treatments, what’s in the pipeline, and ongoing clinical trials.