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Most men have trouble getting an erection at some time in their life. But some men can't get an erection at all. And some men have trouble keeping an erection long enough to have sex that is satisfying. But there are treatments that can help. If you have erection problems, talk to your doctor about finding the right treatment for you.

Doctors call this condition erectile dysfunction. The word dysfunction means that something doesn't work properly. This problem used to be called impotence. But erectile dysfunction is a more accurate name.

If you have erection problems, you may feel embarrassed or ashamed. These feelings stop many men from seeing their doctor. But more than half the men in the United States between the ages of 40 and 70 have some problems having erections.¹

Thanks to recent advances in medicine, most men can find a treatment that works.

Try our quiz to see how much you know about erection problems.

• If you have erection problems, you have trouble getting an erection or keeping an erection long enough to have sex that is satisfying.
• As you get older, you're more likely to get erection problems.
• About 8 in 10 erection problems happen because of a physical problem such as diabetes or heart disease. Many drugs can also cause erection problems as a side effect.
• You should see your doctor. Erection problems can be an early sign of heart disease, diabetes or depression.
• Most men with an erection problem feel embarrassed, which can make the problem worse. And these problems can be difficult to talk about.
• Viagra (sildenafil) works well, but not for everyone. There are also some other good treatments.
• If you're married or have a partner, itcan be a good idea to involve them if you talk to your doctor about your erection problems.

To understand erection problems and how they can be treated, it's useful to know something about how your penis works and how erections happen.²

Your penis is mainly made up of spongy tissue and blood vessels.

The tube that carries urine and semen runs through the middle. It's called the urethra.

The tip of your penis is called the glans. The rest of your penis is called the shaft.

Two columns of spongy tissue run through the upper part of your penis. When you have an erection, the spongy columns fill up with blood and get stiff.

There are lots of spaces inside the spongy columns in your penis.

When your penis is limp, these spaces are empty. When you have an erection, the spaces are full of blood. This makes the columns firm.

Blood vessels called arteries supply the extra blood that you need to get an erection.

There are also nerves in your penis. They send messages around your penis to help erections happen.

Other nerves bring messages from your brain about what you're thinking and feeling about sex.

Erections happen when nerves in your penis release certain chemicals that change the way blood flows into your penis.

See More about how erections happen to learn more.

You may have problems getting an erection or keeping an erection long enough to enjoy sex. There are several possible causes.

Stress or unhappiness can cause erection problems. Your emotions can stop you from having an erection or make it disappear too soon.³ This can make you lose interest in sex ,or you may avoid having sex.

If you have erection problems, you may feel anxious or guilty. And if you're worried about whether you'll get an erection, this worry can make it more difficult to get one.⁴ But in more than 8 in 10 men who have had erection problems for more than a year, there is a physical cause.⁴

If you think your erection problems may be caused by stress or unhappiness, it can help to talk to a psychosexual therapist or counselor.

You may get erection problems if your nerves can't tell your penis to make erections happen. This may happen if you have:

• Diabetes (an illness that can damage the nerves in your penis and in other parts of your body)
• Multiple sclerosis, or another neurological disease that stops your nerves from working well
• An injury to your groin area
• Surgery in your groin area, which can damage the nerves in your penis
• Radiation therapy to your pelvis to treat prostate cancer.

If you have a condition called atherosclerosis, where your arteries become clogged, it can stop blood from flowing into your penis. This can cause erection problems.

And if blood isn't kept in your penis but starts leaking out through your veins, then your erection may not be firm or last long. This may happen naturally as you get older. It can also happen if you have an illness called diabetes.

A condition called Peyronie's disease changes the way blood flows through your penis.⁴ See Peyronie's disease.

If you don't have enough of a hormone called testosterone, you may have erection problems. Testosterone is the hormone that gives you your sex drive (libido).

Having too much of a hormone called prolactin can also give you erection problems.

If you have one of these problems, you may need to see a doctor who specializes in hormones.

There may be some things about you or your health that make it more likely that you'll have problems getting erections.

For example, if you're taking drugs to treat another medical condition, the drugs may cause erection problems.

To read more, see Risk factors for erection problems.

Most men who have an erection problem don't talk to their doctor about it.⁵ But there are at least two good reasons for doing so.

• You don't need to suffer. There are treatments that can help you have satisfying sex again. These treatments will help you feel better about yourself and your relationship. If you're feeling depressed, you're more likely to have erection problems. Sorting out these problems can make you feel less depressed.⁶
• Erection problems can be an early warning sign. They could mean you have a serious medical condition, like diabetes or heart disease.⁷ The same thing that goes wrong in your body to give you these illnesses can also cause erection problems. Your doctor can check whether you have these diseases.

To read more, see How do doctors diagnose erection problems?

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.