Frequently Asked Questions – Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction is a disorder that makes it difficult for a man to get an erection or to keep an erection that is firm enough, or lasts long enough, to have sex. It may be a complete inability to have erections, or as consistently and frequently having trouble with erections (for example, at least 25 percent to 50 percent of the time over at least 3 months).

I don’t know of anyone else who has problems with erections. Am I alone?

Worldwide, about 150 million men are estimated to have erectile dysfunction. In the United States, the number of men with erectile dysfunction is estimated at 10 million to 15 million.

I went out drinking until late, then was humiliated when I couldn’t get an erection. What’s wrong?

The idea that a man can get erections anytime, anywhere, and under any circumstances is a myth. Normal physical limitations prevent men from having erections after drinking, when tired, stressed or sick, immediately after having an orgasm, or occasionally for no reason at all. This is not considered erectile dysfunction needing treatment. The solution is not to overstress your body.

What difference does it make if I smoke? That has nothing to do with sex.

Smoking damages body tissues, and over time may affect the nerves and arteries that make it possible to have erections. If you stop smoking, you will stop stressing these tissues and may make it possible for them to recover function, improving your ability to have erections.

Does erectile dysfunction happen to “real men”?

Yes. Any man can get erectile dysfunction. Men with traditionally “masculine” characteristics are not any more or less likely to develop erectile dysfunction.

But isn’t erectile dysfunction caused by too little testosterone?

Having too little of the male hormone testosterone is now thought to be an uncommon cause of erectile dysfunction, affecting only 2 percent of men with erectile dysfunction. If you suspect you have a hormone imbalance, speak with your doctor, who can find out for certain.

Why can’t I just take testosterone, even if my hormone levels are normal? More is better and will make me more potent, right?

In men with normal levels of testosterone, taking more is ineffective and can be harmful or even dangerous. Too much testosterone can cause liver damage.

Is erectile dysfunction more likely to happen in men with smaller penises?

No. Erectile dysfunction has nothing to do with normal variations in penis size. While it is impossible for all men to have penises of exactly the same size, the minor variations that exist don’t affect the ability to have sex and cannot be physically sensed by the woman during sex.

About 75 percent of men think they have smaller penises – an impossibly high percentage. Unfortunately, there are many scam artists ready to take advantage of men who are worried about their penis size, claiming that useless and potentially harmful drugs and devices make the penis larger. The tragedy is that using them may cause permanent damage to a penis that was normal to begin with.

If you have concerns about your penis, talk to your doctor and ask for a physical examination. If the doctor confirms that your penis is normal and you are still worried, leave your penis alone so it can stay healthy—and ask for a referral to a qualified sex therapist so you can learn how to be more confident with your lovemaking.

Why isn’t sex the same for me now that I’m older? Am I “losing it”?

Certain changes occur normally as a man grows older, compared to when he was in his teens or twenties. It may take direct stimulation before your penis becomes fully erect. Erections may be a little less firm. Men can usually maintain an erection longer before they ejaculate (climax), which is usually considered a benefit. Not all men ejaculate every time they have sex. The penis may go down faster after ejaculation, and it usually takes longer before a man is ready to have another erection, hours or days. These are changes that happen to everyone, and a sexually active couple can adapt to them and maintain their intimacy.

Is erectile dysfunction something I have to live with because I’m older?

Not necessarily. Erectile dysfunction is not always present in men who are older. It is more common in older men, but probably not because of age alone. Erectile dysfunction can be caused by diseases common in older men, such as heart disease or diabetes. It can also be a complication of treatment for disorders common in older men, such as an enlarged prostate. If so, your doctor may be able to recommend alternative treatment.

What can I do to avoid erectile dysfunction as I grow older?

You can reduce your risk for erectile dysfunction by living a healthy lifestyle: following your doctor’s recommendations with respect to diet and exercise, drinking alcohol no more than moderately, and making sure you don’t smoke or use illegal drugs.

Should I ask for help for my problems with erections if I’m older?

Remember that growing older does not mean you have to give up your sexuality. See your doctor if you need help because of problems with erections, and ask to be referred to a urologist or other specialist experienced in treating erectile dysfunction if you believe your concerns are not being taken seriously.

Should I use a pill or a device to get erections?

Remember that there is no effective medication or device for erectile dysfunction that you can get legally without a doctor’s prescription. Medications and devices that are offered for sale outside of U.S. law are not controlled for quality, or not controlled according to the standards of this country, and could do you harm. Be cautious and don’t trust people who would try to sell them to you.

See your doctor for a physical examination to see if you have problems that could be helped by medication. Often there are ways to help that don’t involve taking drugs, and your doctor can guide you to all the alternatives.

Prescription drugs for erections have helped many men, but they are powerful drugs with potentially harmful side effects, and you need to understand from your doctor how to take precautions if you use them. Prescription devices have also helped many men, but also must be used while taking precautions. Devices that are invasive are generally one of the last options considered.

If treatments for erectile dysfunction don’t help me or if I can’t tolerate them, does that mean I have to give up physical pleasure?

Even if there is a physical problem that can’t be overcome, sex is more than having erections. It is physical intimacy between two people in a loving relationship, and is controlled more strongly by your mind than by your erections. Ask your doctor for a referral to a qualified couple’s therapist if you need help developing sexual habits that don’t involve erections.