Common Causes and Features of Erectile Dysfunction
Cause | Common Features* | Tests† |
|---|---|---|
Blood vessel disorders | ||
Blockage of arteries (peripheral vascular disease) | Claudication (painful, aching, cramping, or tired feeling in the muscles of the legs that occurs regularly and predictably during physical activity but is relieved promptly by rest) Usually risk factors (for example, high blood pressure, diabetes, or abnormal blood levels of cholesterol and lipids) | Comparison of blood pressures measured in the ankle and arm at the same time (called the ankle-brachial index) Testing for risk factors (for example, elevated blood glucose [sugar] and blood lipid levels) Ultrasonographic measurement of blood flow in the arteries of the penis |
Venous leak (when the veins in the penis cannot prevent blood from leaving the penis during an erection, as they normally do) | Erections that occur but cannot be sustained | Ultrasonographic testing of the blood vessels of the penis |
Nerve disorders | ||
Nerve damage caused by diabetes (diabetic neuropathy) | Known diabetes Sometimes numbness, burning, or other pains of the feet Sometimes urinary incontinence | A doctor's examination Sometimes electromyography and nerve conduction studies |
Intermittent episodes of weakness or numbness in different parts of the body at different times | MRI of brain and spinal cord Sometimes spinal tap (lumbar puncture) and tests of spinal fluid | |
Nerve injury during pelvic surgery or radiation therapy | Known surgery (such as radical prostatectomy) or radiation therapy | Only a doctor's examination |
Spinal cord disorders (such as tumors or injuries) | Numbness in the area between the penis and anus Usually other symptoms of spinal cord disorder (for example, numbness and weakness of legs and incontinence) | MRI of spine |
Prolonged pressure in the buttocks and genital area (the so-called saddle area), as occurs when riding a bicycle or a horse | Usually competitive athletes who bicycle for long periods Symptoms occur shortly after riding | Only a doctor's examination |
Prostatitis (inflammation of the prostate) | Pain in the pelvic or groin area and bothersome urinary symptoms, such as pain, a burning sensation, blood in the urine, having to urinate frequently, or having difficulty starting to urinate | Urine testing |
Stroke | Known stroke | Only a doctor's examination |
Hormonal disorders | ||
Hypogonadism (testosterone deficiency) | Loss of sex drive, sleep disturbances, and depression or mood changes Eventually, decreases in the size of muscles and testes, bone density, and body hair Eventually, an increase in body fat and breast size | Measurement of the testosterone level in the blood |
Round face, increased body fat in the trunk, purple streaks on the abdomen, high blood pressure, and mood changes | Measurement of levels of cortisol in the urine Sometimes blood tests | |
Severe hyperthyroidism (thyroid hormone excess) | Restlessness, increased heart rate and blood pressure, tremor, weight loss, and inability to tolerate heat | Measurement of levels of thyroid hormone in the blood |
Severe hypothyroidism (thyroid hormone deficiency) | Sluggishness, decreased heart rate and blood pressure, thickened skin, decreased appetite, weight gain, and inability to tolerate cold | Measurement of levels of thyroid hormone in the blood |
Structural disorders | ||
Peyronie disease (formation of scar tissue in the erectile tissue of the penis) | Firm tissue in the penis Often severe curving of the penis during erection Often pain during intercourse | Only a doctor's examination Usually ultrasonography of the penis to detect scar tissue |
Hypospadias (a birth defect) | Urethra located on the underside of the penis | Only a doctor's examination |
Microphallus (a birth defect) | Abnormally small penis | Only a doctor's examination |
Psychological conditions | ||
Sadness, helplessness, hopelessness, loss of appetite, and problems sleeping | Only a doctor's examination | |
Performance anxiety or stress | Full erections during sleep and when masturbating Concern about sexual performance Occurrence of ED only with certain partners or in certain situations | Only a doctor's examination |
Other | ||
Medications (see table Some Commonly Used Medications That Can Cause Erectile Dysfunction) | History of taking a medication known to cause ED | Only a doctor's examination |
Hypoxemia (chronically low blood oxygen levels) | Usually a chronic lung disorder (for example, chronic obstructive pulmonary disease) | Pulse oximetry (measurement of the level of oxygen in the blood) |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Testosterone level is usually measured. If the level is low, doctors measure levels of other hormones. | ||
ED = erectile dysfunction; MRI = magnetic resonance imaging. | ||