Erectile dysfunction (ED), the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, can be classified into several types based on the underlying causes.
Healthcare providers separate ED into several categories:
- Vascular erectile dysfunction. Vascular ED includes causes that affect the blood vessels that send blood to the tissues in your penis that allow you to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED.
- Neurogenic erectile dysfunction. Neurogenic ED occurs as a result of nerve problems, which prevent signals from traveling from your brain to your penis to create an erection. This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis and multiple sclerosis (MS).
- Hormonal erectile dysfunction. Hormonal ED refers to ED that happens as a result of testosterone deficiency, or in some cases as a result of thyroid issues.
- Psychogenic erectile dysfunction. Psychogenic ED involves psychological conditions (conditions that affect your thoughts, feelings or behavior) that can cause ED.
Here are the primary categories:
1. Physical (Organic) Erectile Dysfunction
- Vascular ED: Caused by poor blood flow to the penis due to conditions like:
- Atherosclerosis (hardening of the arteries)
- Hypertension (high blood pressure)
- Heart disease
- Neurological ED: Resulting from damage to the nerves that control erections, due to:
- Diabetes
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injuries
- Hormonal ED: Associated with hormonal imbalances, such as:
- Low testosterone levels (hypogonadism)
- Thyroid disorders
- Structural/Anatomical ED: Caused by physical abnormalities in the penis, like:
- Peyronie’s disease (scar tissue causing curvature)
- Penile trauma or surgery
- Medication-Induced ED: Caused by side effects of certain drugs, such as:
- Antidepressants
- Blood pressure medications
- Antiandrogens
2. Psychogenic Erectile Dysfunction
- Caused by psychological factors such as:
- Stress
- Anxiety (including performance anxiety)
- Depression
- Relationship issues
- Typically occurs in younger men and is often associated with sudden onset.
3. Mixed Erectile Dysfunction
- Involves a combination of physical and psychological factors.
- Common in men with chronic illnesses where physical symptoms contribute to psychological stress, compounding the issue.
4. Lifestyle-Related Erectile Dysfunction
- Related to habits or behaviors such as:
- Smoking
- Excessive alcohol consumption
- Drug abuse
- Obesity and lack of exercise
5. Age-Related Erectile Dysfunction
- While ED is not an inevitable part of aging, the risk increases with age due to declining vascular, neurological, and hormonal function.
Addressing ED typically involves identifying and treating the underlying cause(s), lifestyle modifications, counseling, and in some cases, medications or devices. If you’re dealing with this issue, consulting a healthcare professional is essential for a personalized approach.
What is the best way to fix erectile dysfunction?
The first step in treating erectile dysfunction is identifying the underlying cause. A healthcare provider will help determine the best treatment for you. Treatment options may include:
- Cardiovascular exercise. Vigorous cardiovascular exercise for at least 45 minutes three times per week may help reverse some cases of mild ED. Cardiovascular exercises may include brisk walking, jogging, swimming, bicycling and jumping rope.
- Quitting smoking. For men with mild ED, quitting smoking can lead to improvement after several months.
- Talking to a sex therapist.
- Oral medications that help increase blood flow to your penis, including sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) or avanafil (Stendra®). Oral medications start to work within an hour.
- Penile low-intensity focused shockwave therapy (LiSWT). This noninvasive treatment improves blood flow by using sound waves. It can take two months to see improvement.
- Medications you inject directly into your penis to create an erection, including alprostadil (Caverject®), papaverine (Papacon®), phentolamine (Regitine®) or a combination of multiple medications. Injectable medications start to work within 10 minutes.
- Vacuum constriction device (penis pump). Penis pumps start to work almost immediately.
- Testosterone replacement therapy, which is available as a gel, injection, patches and pellets. Testosterone replacement therapy starts to work within four weeks.
- Penile implant procedure. A penile implant is a procedure in which a surgeon places a device into your penis to make it hard. The device doesn’t affect sensation, peeing or orgasm.