More than half of men age 40–70 experience erectile dysfunction (ED) in the United States, according to research. The most common cause of ED is poor blood flow, but it can also be brought on by hormone deficiencies, nerve problems, psychological factors, and certain medications. 

ED is nearly 100 percent treatable, but it’s not a subject that many people want to discuss with their doctors. According to a 360-person survey our Handbook Team conducted in 2023, 70 percent of men with ED felt ashamed about it, and most wanted to seek treatment but didn’t feel comfortable bringing it up to their provider.  

But avoiding the topic of ED can have a negative effect on men’s mental health and quality of life. This decline may be tied to the relationship between self-perceived masculinity—where sexual prowess is of utmost importance—and self-esteem. When men feel reluctant to talk about ED, they may be avoiding another threat to stereotypical masculine ideals: appearing weak or vulnerable.

According to shame researcher Brené Brown, being vulnerable enough to talk about shame is one of the best ways to shatter it and move forward. We think learning about ED will equip you with the confidence and knowledge you need to move forward and have a conversation with your doctor. Our guide to erectile dysfunction causes, diagnoses, and treatments will give you the language and context you need to discuss it with confidence.

What you need to know about erectile dysfunction (ED)

If you only learn six things about erectile dysfunction, this is what you need to know:

Erectile Dysfunction
ED affects more than half of all men over age 50. ED affects more than half of all men over age 50.
It’s highly treatable and easily diagnosed. It’s highly treatable and easily diagnosed.
Poor vascular health is the leading cause of ED. Poor vascular health is the leading cause of ED.
ED can be a side effect of certain medications. ED can be a side effect of certain medications.
Delaying ED treatment can worsen mental health. Delaying ED treatment can worsen mental health.
Symptoms include difficulty getting and maintaining an erection. Symptoms include difficulty getting and maintaining an erection.

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Four out of 10 men in their 40s experience erectile dysfunction (ED), and it becomes more common with age. That means a significant number of men don’t feel satisfied with their ability to perform sexually. We know this can lead to performance anxiety, less intimacy, tension in a partnered relationship, low self-esteem, depression, increased stress, and even increased absenteeism at work. 

“All of these things have been described in patients that I’ve seen and treated with erectile dysfunction,” says urologist Fenwa Milhouse, director of women’s health and cosmetic services at Down There Urology in Chicago. “Feeling less of a man, feeling less worthy, feeling less like an individual and the person they once were.”

If that sounds familiar, there’s nothing to be ashamed of, and you’re certainly not alone. We, the Handbook Team, want to shed light on this topic, help you feel comfortable addressing it, and encourage you to seek help for this highly treatable issue. Ignoring erectile dysfunction means ignoring the impact on your physical and mental health—and the ED may only get worse.

The relationship between these mental health conditions and ED can be cyclical. ED can be a source of considerable anxiety and stress for individuals, leading to a self-perpetuating cycle where the fear of experiencing ED again exacerbates the problem.

Rhiannon John, certified sexologist in Brooklyn, New York

The good news is that oral medications for ED, such as Viagra (sildenafil) and Cialis (tadalafil), are now available in generic forms, making erectile dysfunction treatment far more affordable than it was even five or six years ago. 

The growth in popularity of online telehealth platforms also means you can request a prescription for ED medication without having to visit a doctor or pharmacy in person. This is a solution for people who may feel embarrassed discussing their sexual health with a doctor or collecting an ED prescription at the pharmacy. It’s also safer than turning to “gas station” remedies. These unregulated supplements are often found in dispensers inside gas stations restrooms, and they have been known to contain hidden ingredients. 

However, not all of these online telehealth platforms use the same screening process, charge the same prices, or let you directly message your provider. We don’t want you to feel frustrated and hampered by low-quality platforms or misled by false information. We want to make it easy to feel like yourself again.

That’s why we mystery shopped at more than 25 online ED medication platforms, interviewed more than 20 urologists, sexologists, pharmacists, and psychologists, read dozens of academic journal articles, ran a focus group of real users, and surveyed 360 real people about their experiences with erectile dysfunction. We got really comfortable with this topic and hope to help you do the same by reading our guides and reviews.

Read more about our erectile dysfunction testing methodology.

What is erectile dysfunction (ED)?

The medical community defines erectile dysfunction as “the inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity.” In other words, ED happens when the erection isn’t rigid enough for penetration or doesn’t stay rigid until orgasm. 

While 30–60 percent of men with erectile dysfunction also experience premature ejaculation, they are considered separate conditions with different causes and treatments. 

Symptoms of erectile dysfunction

Recognizing the symptoms of erectile dysfunction is the first step toward seeking appropriate treatment and improving your sexual health.

Symptoms of erectile dysfunction may include:

  • Difficulty getting and maintaining an erection
  • A complete inability to get an erection
  • Reduced libido

If you’re experiencing these symptoms or sexual problems in general, you should consult with your doctor.

What causes erectile dysfunction? 

Erections depend on the health of your nervous, endocrine, and vascular systems, which govern nerves, hormones, and blood vessels. Without the right neurotransmitters and a healthy nerve pathway, the brain can’t send signals to the penis to start the erection process. And without healthy blood vessels, there won’t be adequate pressure inside the penis to form a rigid erection. 

Heart disease, diabetes, anxiety, stress, and other conditions associated with erectile dysfunction also affect the nervous, endocrine, or vascular systems in some way, and the damage is often more noticeable in the penis than elsewhere in the body. Some drugs and prescription medications are also known to affect these systems and cause ED.

Here’s a closer look at what causes erectile dysfunction. 

Vascular disease

Vascular disease affects the heart and blood vessels and is the cause of most erectile dysfunction. When the vascular system is unhealthy, the penis is less likely to receive or maintain adequate blood flow for achieving or maintaining an erection. 

Erectile dysfunction is often one of the first cardiovascular disease symptoms to appear and can predate a heart attack by up to five years. That’s why doctors want to listen to your heart, take your blood pressure, and run blood tests when you explain your ED symptoms—they’re screening you for high cholesterol, high blood pressure, and other forms of vascular disease.

“It always amazes me how many patients come in telling me they are healthy and only have ED. Then when I screen them for hyperlipidemia [high cholesterol], diabetes, and hypogonadism [low testosterone], almost always the patient will end up diagnosed with one of them.” —Jonathan L. Davila, urologist at Northwell Health in Staten Island, New York

Diabetes

People with diabetes are at an increased risk of erectile dysfunction and vascular disease. Too much sugar in the bloodstream sparks a molecular chain reaction that decreases the production of nitric oxide. Nitric oxide heals and regenerates blood vessels throughout the entire body, and is also required for an erection. Without sufficient nitric oxide, the blood vessels in the penis won’t dilate and fill with blood. 

Diabetes is also associated with nerve damage and an increased risk of cardiovascular disease, both of which can contribute to ED.

Obesity

Obesity—defined as a body mass index of 30 or higher—increases the risk of erectile dysfunction. This is even true for people who haven’t developed other obesity-related conditions like vascular disease or diabetes.

Where you carry excess weight also affects your risk of ED. Studies show that men with larger waist circumferences are more likely to have ED and to experience more severe symptoms. This may be due to testosterone deficiency, which is also more common among men with larger waists.

“Obesity is, beyond any doubt, an independent risk factor of erectile dysfunction.”—Damian Skrypnik, et. al, Polish Medical Journal

Low testosterone 

Erectile dysfunction is a possible symptom of testosterone deficiency, also called hypogonadism. Testosterone is the primary male sex hormone, and it’s one of the chemicals responsible for widening the blood vessels in the penis for proper blood flow during an erection.

Therefore, low testosterone can make it difficult for blood to fill the penis. It’s also associated with low libido and a decreased ability to orgasm, plus other conditions related to ED like diabetes, depression, and obesity. 

Despite the strong association between testosterone and men’s sexual health, some researchers say low testosterone is one of the rarest causes of ED. However, there’s some debate on whether to use total testosterone or free testosterone levels to diagnose low testosterone. When only free testosterone—the type available to support an erection—is tested, men are more likely to be diagnosed with testosterone deficiency.

Aging

Your age provides a rough estimate of how likely you are to have erectile dysfunction. For example, there’s a 40 percent chance that a 40-year-old man will experience ED and a 70 percent chance for a 70-year-old. 

Some of our tissues break down as we age, including the smooth muscle cells that make up the blood vessels in the penis. Over time, this deterioration makes it difficult for blood to stay in the penis during an erection. 

We’re also at a greater risk for heart disease, diabetes, abdominal obesity, and low testosterone as we age, making erectile dysfunction even more likely. 

“All of us are going to have erection issues, just like we’re all going to need reading glasses and some of us are going to need knee replacements. It’s just part of getting older. Don’t get embarrassed about it; just manage it.” —Michael Werner, urologist and medical director at Maze Men’s Sexual and Reproductive Health in Manhattan

Surgery

Surgeries in the pelvic region can cause erectile dysfunction through nerve damage. Radiation can cause the same problem. 

These procedures are associated with high levels of postoperative erectile dysfunction:

  • Radical prostatectomy (removal of prostate gland in prostate cancer patients).
  • Radical cystectomy (removal of bladder in bladder cancer patients).
  • Abdominoperineal resection (removal of rectum, anus, and part of the colon in rectal cancer patients).
  • Pelvic orthopedic surgeries.

Ask your surgeon about nerve-sparing techniques if you’re scheduled for a pelvic surgery. 

Anxiety and panic disorders

When we feel anxious or start to panic, our body releases chemicals like cortisol and epinephrine (also called adrenaline). Cortisol has a dampening effect on sexual arousal, and epinephrine, the hormone responsible for our fight or flight instinct, constricts blood vessels in the extremities to send more blood to the heart and liver. 

“Don’t underestimate the psychological component of erectile dysfunction,” says Michael Werner, a urologist at Maze Men’s Sexual and Reproductive Health in Manhattan. “I get guys in their early 20s who are so anxious that even when I give them the highest dose of [penile] injections, they can’t get an erection.”

Alexander Sankin, a urologist at Montefiore Medical Center in Bronx, New York, agrees that anxiety is common in younger men with ED. “If they’re able to get an erection and ejaculate no problem during masturbation but can’t with a partner, there’s a problem with anxiety,” he says. “The mechanics are working, the machinery is there. This isn’t a biological problem; it’s psychologic.”  

Chicago-based urologist Fenwa Milhouse warns that partners can accidentally exacerbate the problem: “The partner can add to the anxiety if they put a lot of pressure around the act and make sexual intimacy seem like, ‘I really want to get it on’ and that sort of stuff.” 

Anxious about performing like the pros?

Don’t compare yourself to what you see in the adult entertainment industry. Werner let us in on the behind-the-scenes secret to these actors’ stamina: penile injections that cause spontaneous and long-lasting erections. Don’t hold yourself to this unrealistic standard.

Stress and post-traumatic stress disorder

Chronic stress and post-traumatic stress disorder (PTSD) may contribute to erectile dysfunction. About 85 percent of combat veterans with PTSD have also been diagnosed with ED. But, as with other mental health concerns, it’s difficult to know whether stress causes ED or ED causes stress.

One study found that men with erectile dysfunction are more likely to have high levels of cortisol, a hormone that’s produced during stress, in their blood. Another group of researchers investigated this relationship further by taking blood samples directly from the penis at different stages of arousal. They found that cortisol levels drop significantly during an erection. This suggests that higher levels of cortisol may prevent an erection. 

Research also links chronic stress to an increased risk of cardiovascular disease. Because erections require healthy blood vessels, anything that damages the vascular system may worsen ED.  

Depression

Several studies have found that men with depression are more likely to experience erectile dysfunction.

High levels of serotonin, a body chemical that can impact mood, have been found to decrease sexual arousal. People with depression tend to have low levels of serotonin, so in theory, their sexual activity shouldn’t be affected. However, treating depression with a class of medication called selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels, is associated with an increase in erectile dysfunction.

On the other hand, some people with depression have a dopamine deficiency or a problem with the way dopamine levels are regulated. Dopamine is one of the first chemicals released during sexual arousal, and it sets off a chain reaction that ultimately widens the blood vessels in the penis, causing an erection as blood accumulates. Without sufficient dopamine production, an erection is impossible. 

Prescription medication

Erectile dysfunction is a known side effect of some medications, including popular antidepressants like citalopram (Celexa) and sertraline (Zoloft). Research suggests that around 25 percent of erectile dysfunction cases can be traced to medication intake. 

Researchers have identified the top medications that may cause erectile dysfunction. We’ve listed some common ones below, but keep in mind this isn’t a complete list of all the medications associated with ED. Talk to your doctor to discuss the impact of your current medications on ED.

Generic nameBrand namePrimarily used for
PaliperidoneInvegaSchizophrenia
CitalopramCelexaDepression, obsessive-compulsive disorder (OCD)
SertralineZoloftDepression, anxiety, panic disorder, OCD, post-traumatic stress disorder (PTSD)
IsotretinoinAbsorica, Claravis, Amnesteem, Myorisan, ZenataneAcne
EscitalopramLexapro, CipralexDepression, anxiety
QuetiapineAtrolak, Biquelle, Seroquel, Sondate, ZaluronBipolar disorder, schizophrenia
OlanzapineZyprexaSchizophrenia
FluoxetineProzacDepression, OCD
VenlafaxineEffexor, Vensir, Vencarm, Venlalix, VenlablueDepression, anxiety, panic disorder
RisperidoneRisperdalSchizophrenia, bipolar disorder
AripiprazoleAbilify, AristadaSchizophrenia, bipolar disorder
GabapentinNeurontin, Gralise, Gaborone, FusePaq FanatrexEpilepsy, nerve pain
PregabalinLyricaEpilepsy, nerve pain
OxycodoneOxycontin, Oxydose, Oxaydo, Oxyfast, Oxy IR, Roxicodone, Xtampza ER, Roxybond, Dazidox,Severe pain
AdalimumabHumira, Hulio, Abrilada, Amjevita, Cyltezo, Hadlima, Idacio, Yuflyma, YusimryRheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis

Cigarettes and illicit drugs

Smoking cigarettes increases the risk of developing ED due to nicotine’s harmful effect on blood vessels and nitric oxide production. The decreased amount of nitric oxide prevents the blood vessels from relaxing and filling with enough blood for an erection. In addition, blood vessels damaged by nicotine can’t hold onto the blood, making the erection unsustainable. 

Other recreational drugs are also linked to ED:

  • Opioids (e.g., heroin, fentanyl).
  • Amphetamines (e.g., Adderall).
  • Barbiturates (e.g., phenobarbital).
  • Cocaine. 
  • Marijuana.

How is erectile dysfunction diagnosed? 

Getting diagnosed with erectile dysfunction is usually a straightforward process. Your doctor will ask you a few questions about your ability to get and maintain an erection and diagnose you based on your answers. “It’s really just a diagnosis of symptoms,” says Sankin. “There’s no testing that needs to be done to get a formal diagnosis of it.” 

We know it can be nerve-racking to talk about your sexual health on the spot. Use these resources to preview the kinds of questions you’ll be asked: 

Whereas diagnosing ED can be easy, determining the appropriate treatment can be more complex. Your doctor will ask a few more questions about your ED and medical history. You may need a physical exam or a blood test to rule out some underlying issues that could make popular oral treatments like sildenafil (Viagra) and tadalafil (Cialis) ineffective. 

Medical history 

Here are a few more questions doctors typically ask when evaluating the cause of ED:

  • Did your erectile dysfunction start around the same time as a new romantic relationship? Performance anxiety could be the issue.
  • How often are you able to get and maintain a satisfactory erection when you masturbate? If the dysfunction only occurs around a partner, anxiety could be to blame.
  • Do you ever wake up with an erection? This tells your doctor whether the penis receives adequate blood flow and whether your testosterone levels may be low.
  • Did your ED come on suddenly or has it gotten progressively worse? Systemic concerns, like cardiovascular disease, can contribute to the gradual onset of ED.
  • What medications do you take? Erectile dysfunction can be a side effect of some medications. 
  • Do you smoke or use recreational drugs? Quitting can improve ED.  

Be prepared to answer other questions about your health and habits. It’s important to be honest, so your doctor can recommend a safe and effective treatment. 

Physical exam

Because erectile dysfunction can be a sign of heart disease, high blood pressure, diabetes, and other physical conditions, your doctor may listen to your heart, take your blood pressure, evaluate your body mass index (weight compared to height), ask for a urine sample, schedule a blood test, or perform other routine diagnostic tests to rule out these concerns. 

Your doctor may also examine your penis and scrotum to look for curvature, lumps, and other abnormalities that could make it difficult to get an erection. The exam also looks for signs of other conditions that could affect ED treatment or general sexual health. 

“We evaluate for plaques along the penile shaft that is usually secondary to underlying Peyronies disease,” says Jonathan L. Davila, a urologist at Northwell Health in Staten Island, New York. Davila also looks for signs of inflammation in the foreskin and head of the penis, which are more common in patients with diabetes. 

Even though online telehealth platforms like Hims and GoodRx make it possible to get an ED diagnosis without a physical exam, Milhouse suggests people get checked out anyway, especially if they haven’t seen a doctor in a while. She warns that feeling “young and healthy” can be misleading, citing cases where she has diagnosed uncontrolled diabetes and dangerously high blood pressure in younger men whose original complaint was ED. 

Penile doppler ultrasound

A penile doppler ultrasound allows your doctor to look at the blood vessels in the penis to make sure they’re healthy. “We can see the velocity of blood going in and see if the blood stays in or leaks out. Both things [blood velocity and retention] are necessary for an erection,” says Milhouse.  

To perform the penile doppler ultrasound, your doctor will inject a small amount of medicine in the penis to create an erection. Milhouse describes this injection as “tiny and quick,” and Werner says patients report feeling like they’ve been flicked by a rubber band. The ultrasound itself is painless. 

If the penile doppler ultrasound suggests vascular problems, additional tests may be required.

Testosterone test

Testosterone, the predominant male hormone, is required for a healthy erection. Research suggests that 1.7–35 percent of men with ED also have testosterone deficiency, also called hypogonadism. Testosterone levels are checked through a blood sample, usually taken in the morning when testosterone levels peak. 

Nighttime erection test

If your doctor suspects your ED is caused by a mental health issue, you may be asked to do a nighttime erection test, also called a nocturnal penile tumescence test. The penis becomes erect up to five times during sleep and stays erect for about 30 minutes. The absence of these nocturnal erections indicates a physical problem. On the other hand, if they’re frequent, rigid, and long-lasting, erectile dysfunction is more likely to be caused by mental health factors like anxiety, depression, or stress.

You’ll wear sensors around your penis while you sleep. Wires connect them to a device that records changes in size and hardness. 

How to treat erectile dysfunction

Erectile dysfunction is highly treatable. The urologists we talked to claim they can get any penis erect thanks to the range of options available, including penile implants. Here’s a list of common erectile dysfunction treatments that can restore your sex life and self-esteem, starting with the least invasive options.

Lifestyle changes

Your doctor may suggest lifestyle changes to manage conditions that cause or exacerbate ED, such as heart disease, diabetes, and obesity. Although it’s not a quick fix, researchers note that it’s the least risky and most cost-effective way to manage erectile dysfunction.

Consider adopting these healthy habits to improve ED symptoms: 

  • Quit smoking. 
  • Improve physical fitness.
  • Eat an anti-inflammatory diet.

A review of multiple studies on cigarette smoking and ED shows that around 25–54 percent of smokers see an improvement in their ED within six to 12 months of quitting. One study researchers reviewed found that 25 percent of men who quit smoking experienced improvement in their ED symptoms within one year of quitting. On the other hand, no current smokers had improved their ED over the same time period. 

Physical activity has the potential to improve many of the conditions associated with erectile dysfunction, including vascular disease, low testosterone, and chronic stress and anxiety. Consider working with a physical therapist or personal trainer to develop an exercise plan that’s safe and effective for you.

A healthy diet is also critical to overall health and can improve ED. Researchers recommend the Mediterranean diet for people with erectile dysfunction thanks to its anti-inflammatory qualities, which support vascular health. 

Sex therapy

A sex therapist can help you identify and heal the psychological causes of erectile dysfunction, such as performance anxiety, low self-esteem, poor body image, low libido, and depression. 

Judy Scheel, a licensed psychologist and sex therapist, says sex therapy is all about learning to communicate. “Shame and fear of hurting someone’s feelings are the primary reasons why couples do not communicate with their partner [about sex],” she explains. “Getting couples or individuals comfortable with the language of sex is a primary aim.” 

Here’s what you can expect to learn in sex therapy:

  • Cognitive Behavioral Therapy (CBT): Techniques include challenging irrational or negative thoughts about sex.
  • Sex education: Learning how sexual organs function and what happens during arousal and orgasm in men and women.
  • Sensate focus: A series of meditative touching exercises performed in private with your sex partner to increase intimacy and redefine the sexual experience without concrete goals. 
  • Stimulus control: A useful skill for people who experience premature ejaculation.

Studies show that sex therapy improves ED symptoms whether it’s the sole treatment option or combined with another treatment, like a PDE5 inhibitor.

Communication breakdown is likely also occurring in other areas of life, not just in the bedroom. Sex therapy often becomes an all-inclusive process, and the treatment overall brings greater intimacy to the couple, especially and ultimately regarding sex.

Judy Scheel, psychologist and sex therapist licensed in New York, North Carolina, and California

Pills: PDE5 inhibitors 

ED pills make it easier to get and maintain an erection once you feel aroused, but they don’t cause spontaneous erections. Medically known as phosphodiesterase-5 (PDE5) inhibitors, they bind to the chemicals that cause the penis to become flaccid, allowing the erection to last longer.

Four PDE5 inhibitors are currently available, and all require a prescription:

  • Sildenafil (Viagra). 
  • Tadalafil (Cialis). 
  • Vardenafil (Levitra).
  • Avanafil (Stendra). 

Each PDE5 inhibitor has a different onset time and duration, different side effects, and different rules about when and how to take them. They can be dangerous for people who take certain types of prescription and recreational drugs, so it’s critical to tell your doctor about everything you use when discussing ED treatment options.

Online platforms, such as Hims for men’s health and GoodRX Telehealth, make it easy to access ED medications with more discretion.

To learn more, read our full guides for sildenafil and tadalafil.  

Penile injections

Penile or intracavernosal injections (ICI) deliver medicine directly into the shaft of the penis via a small needle. The penis will spontaneously swell five to 15 minutes after the injection, but urologists warn that you do need to feel some arousal to achieve a full erection. 

Here are some reasons why your doctor may suggest penile injections:

  • PDE5 inhibitors didn’t work.
  • PDE5 inhibitors caused side effects.
  • You have nerve damage in the pelvic region. 

Urologists typically give you the first injection in the office so they can show you how to do it and see the effect of a small dose. Instead of a vial and syringe, your doctor may give you an autoinjector to make the process as easy as pushing the device against your skin. 

“You press a button, and a 30-gauge needle goes into the penis,” explains Werner. “Men literally feel like they’ve been flicked by a rubber band. They’d never believe it just does not hurt.” 

Several medications are available as penile injections, including the following:

  • Alprostadil (Caverject, Edex).
  • Papaverine (Pavagen).
  • Papaverine with phentolamine (Bimix).
  • Papaverine with phentolamine and alprostadil (Trimix).
  • Papaverine with phentolamine, alprostadil, and atropine (Quadmix).

Your doctor will suggest one to start with based on cost, efficacy, and potential side effects.

Urethral suppositories

Another way to get a spontaneous erection is to use a urethral suppository. Transurethral alprostadil (Muse)—the only FDA-approved urethral suppository for ED—is a powder or pellet that gets released into the urethra through a small tube. An erection develops within five to 10 minutes and lasts about 30–60 minutes. 

Studies show that urethral suppositories are effective and well tolerated in only about 56 percent of men, so this isn’t likely to be your urologist’s first suggestion. “It tends to be irritating and just doesn’t have as good outcomes as other options,” says Milhouse. 

Testosterone therapy

People with testosterone deficiency may see an improvement in their erectile function and libido with testosterone therapy. This hormone requires a prescription and is available as an oral medication, injection, skin patch, or gel that’s rubbed into the skin. Research suggests testosterone therapy works best for ED when men have mild symptoms. 

Vacuum erectile device

A vacuum erectile device (VED) is also called a penis pump or a vacuum constriction device (VCD). It consists of a tube that’s placed over the penis immediately before sex. A hand- or battery-operated pump removes air from the tube, creating a vacuum effect that draws blood into the penis. A ring is worn at the base of the penis to prevent the blood from flowing out through the veins. 

VED kits cost around $120–$200 and can produce an erection in about one minute. Side effects are uncommon but may include bruising and painful ejaculation.  

Penile implant

A penile implant, also called a penile prosthesis, is a mechanical device surgically placed inside the penis. Your doctor may recommend this ED treatment if you have damage to the blood vessels or nerves that control an erection and other treatment options have failed. There are two types of penile implants: non-inflatable and inflatable. 

The non-inflatable or malleable penile implant consists of two bendable rods placed inside the penis, keeping it in a rigid state. The rods allow you to manually fold or straighten the penis, leaving very little prep work when you’re ready to have sex.

The inflatable penile implant allows the penis to rest in a more natural flaccid state. Instead of rigid rods, two inflatable cylinders are placed in the penis. A saline-filled bladder connects to the cylinders and is implanted above your urinary bladder. The final components are a manual pump and release valve, which are implanted in the scrotum. 

“Everything’s discreet inside the body,” says Milhouse. “No one sees anything on the outside.” When you want to fill the cylinders with fluid to get an erection, squeeze and release the pump until firm. Later, press the release valve to remove fluid from the cylinders.

Davila says the penile implant surgery preserves the ability to orgasm and ejaculate. “Men with a penile prosthesis do not lose their penile skin sensation,” he explains.

As with any surgery, some risks are associated with the penile implant procedure, including infection, mechanical failure, and a deformity in the glans of the penis. Despite these risks, some experts say a penile implant is the best option for people who don’t see results with ED pills, suppositories, or injections.

Rare or experimental ED treatments

According to the American Urological Association, the following ED treatments are considered rare or experimental:

  • Penile arterial reconstruction: Usually performed in young men with traumatic pelvic injuries, this specialized surgery reroutes blood vessels around damaged areas, allowing sufficient blood to flow into the penis for an erection.
  • Low-intensity extracorporeal shock wave therapy (Li-ESWT): Shock waves are sent through the penis to support the regeneration of blood vessels and muscle tissues.
  • Intracavernosal stem cell therapy: Stem cells are injected into the penis to regenerate damaged muscle and nerve cells.
  • Platelet-rich plasma (PRP) therapy: Your own platelets—cells in the blood that naturally bind to damaged vessels—are injected into the penis to regenerate damaged tissues.

Your doctor may suggest these treatments if other options have failed or are considered too risky based on your medical history. 

You may also hear about alternative therapies (like acupuncture) and herbal supplements (like yohimbine) for treating ED. Limited research has been done on their effectiveness. Before pursuing these options, talk to your doctor about possible contraindications with your medical history or current prescriptions. 

Our final verdict

We know how difficult it can be to start a conversation about ED with your doctor, but there’s no need to feel embarrassed or ashamed. Erectile dysfunction is far more common than you may realize, and highly successful treatment options are available. You deserve a fulfilling sex life and good mental and physical health, and urologists are uniquely capable of helping you get there.

Frequently asked questions

Vascular disease is the main cause of erectile dysfunction, according to the American Urological Association.

Fenwa Milhouse, a urologist in Chicago, says her patients with ED report feeling less like a man, less like themselves, and less worthy. ED can also make a man feel more tense when it comes to intimacy, withdraw from romantic encounters, and feel depressed or anxious about sex.

Erectile dysfunction affects about half of all men by the time they turn 50.

  1. Allen, M. S. (2019). Physical activity as an adjunct treatment for erectile dysfunction. Nature Reviews Urology, 16(9), 553–562. Link
  2. Allen, M. S., & Tostes, R. C. (2023). Cigarette smoking and erectile dysfunction: An updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation. Sexual Medicine Reviews, 11(1), 61–73. Link
  3. Alvarez, S. D. (2020, Oct. 22). Why men wake up with erections. University of Newcastle. Link
  4. Anastasiadis, E., Ahmed, R., Khoja, A. K., & Yap, T. (2022). Erectile dysfunction: Is platelet-rich plasma the new frontier for treatment in patients with erectile dysfunction? A review of the existing evidence. Frontiers in Reproductive Health, 4. Link
  5. Artemi, S., Vassiliu, P., Arkadopoulous, N., Smyrnioti, M. E., Sarafis, P., and Smyrniotis, V. (2019). A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non-modifiable risk factors. BMC Research Notes, 12, 814. Link
  6. Aubin, S., Heiman, J. R., Berger, R. E., Murallo, A. V., and Yung-Wen, L. (2009). Comparing Sildenafil alone vs. Sildenafil plus brief couple sex therapy on erectile dysfunction and couples’ sexual and marital quality of life: A pilot study. Journal of Sex and Marital Therapy, 35(2), 122–143. Link
  7. Barkin J. (2011). Erectile dysfunction and hypogonadism (low testosterone). The Canadian Journal of Urology, 18 Suppl, 2–7. Link
  8. Barnes, A. S. (2011). The epidemic of obesity and diabetes: trends and treatments. Texas Heart Institute Journal, 38(2), 142–144. Link
  9. Bauer, S. R., Breyer, B. N., Stampfer, M. J., Rimm, E. B., Giovannucci, E. L., & Kenfield, S. A. (2020). Association of diet with erectile dysfunction among men in the health professionals follow-up study. JAMA Network Open, 3(11), e2021701. Link
  10. Belujon, P., & Grace, A. A. (2017). Dopamine system dysregulation in major depressive disorders. International Journal of Neuropsychopharmacology, 20(12), 1036–1046. Link
  11. Bocchino, A. C., Pezzoli, M., Martínez-Salamanca, J. I., Russo, G. I., Giudice, A. L., & Cocci, A. (2023). Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities. Investigative and Clinical Urology, 64(2), 118–125. Link
  12. Bodie, J. A., Beeman, W. W., & Monga, M. (2003). Psychogenic erectile dysfunction. The International Journal of Psychiatry in Medicine. Link
  13. Boston University. (n.d.). Penile revascularization surgery. Boston University School of Medicine Sexual Medicine. Link
  14. Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E. S., Graham, C., Nobre, P., and Wylie, K. (2016). Psychological and interpersonal dimensions of sexual function and dysfunction. The Journal of Sexual Medicine, 13(4), 538–571. Link
  15. Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., Nelson, C. J., Sadeghi-Hejad, H., Seftel, A. D., and Shindel, A. W. (2018). Erectile dysfunction: AUA guideline. Journal of Urology, 200, 633. Link
  16. Cannon R. O., 3rd (1998). Role of nitric oxide in cardiovascular disease: focus on the endothelium. Clinical Chemistry, 44(8 Pt 2), 1809–1819. Link
  17. Cayetano-Alcaraz, A. A., Yassin, M., Desai, A., Tharakan, T., Tsampoukas, G., Zurli, M., & Minhas, S. (2021). Penile implant surgery-managing complications. Faculty Reviews, 10. Link
  18. Corretti, G., and Baldi, I. (2007, Aug 1). The relationship between anxiety disorders and sexual dysfunction. Psychiatric Times, 24(9). Link
  19. Creager, M. A., Lüscher, T. F., Cosentino, F., and Beckman, J. A. (2003). Diabetes and vascular disease. Circulation, 108(12), 1527–1532. Link
  20. Davies, K. P. (2015). Development and therapeutic applications of nitric oxide-releasing materials to treat erectile dysfunction. Future Science OA, 1(1). Link
  21. Defeudis, G., Mazzilli, R., Tenuta, M., Rossini, G., Zamponi, V., Olana, S., Faggiano, A., Pozzilli, P., Isidori, A.M., and Gianfrilli, D. (2022). Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes/Metabolism Research and Reviews, 38(2). Link
  22. Elterman, D. S., Bhattacharyya, S. K., Mafilios, M., Woodward, E., Nitschelm, K., and Burnett, A. L. (2021). The quality of life and economic burden of erectile dysfunction. Research and Reports in Urology, 13, 79–86. Link
  23. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., and McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts male aging study. Journal of Urology, 151(1), 54–61. Link
  24. Ferrini, M. G., Gonzalez-Cadavid, N. F., & Rajfer, J. (2017). Aging-related erectile dysfunction—Potential mechanism to halt or delay its onset. Translational Andrology and Urology, 6(1), 20–27. Link
  25. Fillo, J., Levcikova, M., Ondrusova, M., Breza, J., & Labas, P. (2016). Importance of different grades of abdominal obesity on testosterone level, erectile dysfunction, and clinical coincidence. American Journal of Men’s Health. Link
  26. Fode, M., Nolsøe, A. B., Jacobsen, F. M., Russo, G. I., Østergren, P. B., Jensen, C. F., Albersen, M., Capogrosso, P., Sønksen, J., & Group, H. W. (2020). Quality of information in YouTube videos on erectile dysfunction. Sexual Medicine, 8(3), 408–413. Link
  27. Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., Wicker, P. A. (1998). Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338:1397–1404. Link
  28. Graf, A. (2019). 24 Hours in the Life of a Hormone: What Time is the Right Time for a Pituitary Function Test? Endocrinologist. Link
  29. Guay, A. T., Perez, J. B., Newton, R. A., and Jacobson, J. P. (2000). Clinical experience with intraurethral alprostadil (MUSE) in the treatment of men with erectile dysfunction. A retrospective study. Medicated Urethral System for Erection. European Urology, 38(6), 671–676. Link
  30. Harte, C. B., & Meston, C. M. (2008). Acute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: A randomized, double-blind, placebo-controlled trial. The Journal of Sexual Medicine, 5(1), 110. Link
  31. Harvard Health Publishing. (2020, July 6). Understanding the stress response. Link
  32. Hasler, G. (2010). Pathophysiology of depression: Do we have any solid evidence of interest to clinicians? World Psychiatry, 9(3), 155–161. Link
  33. Hodges, L. D., Kirby, M., Solanki, J., & Brodie, D. A. (2007). The temporal relationship between erectile dysfunction and cardiovascular disease. International Journal of Clinical Practice, 61(12), 2019–2025. Link
  34. Janiszewski, P. M., Janssen, I., & Ross, R. (2009). Original research—erectile dysfunction: abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. The Journal of Sexual Medicine, 6(7), 1990–1998. Link
  35. Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. Link
  36. Jura, M., & Kozak, L. P. (2016). Obesity and related consequences to ageing. Age, 38(1). Link
  37. Kaplan-Marans, E., Sandozi, A., Martinez, M., Lee, J. Schulman, A., Khurgin, J. (2022). Medications most commonly associated with erectile dysfunction: Evaluation of the food and drug administration national pharmacovigilance database. Sexual Medicine 10(5), 100543. Link
  38. Keene, L. C., & Davies, P. H. (1999). Drug-related erectile dysfunction. Adverse drug reactions and toxicological reviews, 18(1), 5–24. Link
  39. Kobori, Y., Koh, E., Sugimoto, K., Izumi, K., Narimoto, K., Maeda, Y., Konaka, H., Mizokami, A., Matsushita, T., Iwamoto, T., & Namiki, M. (2009). The relationship of serum and salivary cortisol levels to male sexual dysfunction as measured by the International Index of Erectile Function. International Journal of Impotence Research, 21(4), 207–212. Link
  40. Leisegang, K., & Finelli, R. (2021). Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review. Arab Journal of Urology, 19(3), 323–339. Link
  41. Leslie, S. W. (2024, January 9). Erectile dysfunction. StatPearls – NCBI Bookshelf. Link
  42. Li, J., Lee, D. H., Hu, J., Tabung, F. K., Li, Y., Bhupathiraju, S. N., Rimm, E. B., Rexrode, K. M., Manson, J. E., Willett, W. C., Giovannucci, E. L., and Hu, F. B. (2020). Dietary inflammatory potential and risk of cardiovascular disease among men and women in the U.S., 76(19), 2181–2193. Link
  43. Long, V. O. (1989). Relation of masculinity to self-esteem and self-acceptance in male professionals, college students, and clients. Journal of Counseling Psychology, 36(1), 84–87. Link
  44. Martínez-Jabaloyas, J.M., Queipo-Zaragozá, A., Pastor-Hernández, F., Gil-Galom, M., and Chuan-Nuez, P. (2006). Testosterone levels in men with erectile dysfunction. BJU International, 97: 1278–1283. Link
  45. McCabe, M. P., Price, E., Piterman, L., & Lording, D. (2008). Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. International Journal of Impotence Research, 20(3), 324–330. Link
  46. McMahon, C. N., Smith, C. J., & Shabsigh, R. (2006). Practice pointer: Treating erectile dysfunction when PDE5 inhibitors fail. BMJ: British Medical Journal, 332(7541), 589–592. Link
  47. U.S. National Library of Medicine. (n.d.). Alprostadil urogenital: Medlineplus Drug Information. MedlinePlus. Link
  48. U.S. National Library of Medicine. (n.d.). Drugs that may cause erection problems: MedlinePlus Medical Encyclopedia. MedlinePlus. Link
  49. Mikhail N. (2006). Does testosterone have a role in erectile function? The American Journal of Medicine, 119(5), 373–382. Link
  50. Mirone, V., Imbimbo, C., Palmieri, A., Longo, N., & Fusco, F. (2003). Erectile dysfunction after surgical treatment. International Journal of Andrology, 26(3), 137–140. Link
  51. Montorsi, P., Ravagnani, P. M., Galli, S., Ali, S. G., Briganti, A., Salonia, A., & Montorsi, F. (2009). The triad of endothelial dysfunction, cardiovascular disease, and erectile dysfunction: Clinical implications. European Urology Supplements, 8(2), 58–66. Link
  52. Mount Sinai. (n.d.) Aging changes in organs – tissue – cells. Link
  53. Munjack, D. J., Schlaks, A., Sanchez, V. C., Usigli, R., Zulueta, A., and Leonard, M. (2008). Rational-emotive therapy in the treatment of erectile failure: An initial study. Journal of Sex and Marital Therapy, 10(3), 170–175. Link
  54. Naouar, S., Braiek, S., and El Kamel, R. (2017). Erectile dysfunction secondary to pudendal nerve injury complicating orthopedic surgery: practical recommendations. Journal of Current Surgery, 7(1–2), 1–3. Link
  55. Nobre, P. J. (2017). Treating men’s erectile problems. The Wiley Handbook of Sex Therapy, 40–56. Link
  56. Pérez-Aizpurua, X., Garranzo-Ibarrola, M., Simón-Rodríguez, C., García-Cardoso, J. V., Chávez-Roa, C., López-Martín, L., Alonso-Román, J., Maqueda-Arellano, J., Gómez-Jordana, B., Osorio-Ospina, F., González-Enguita, C., & García-Arranz, M. (2023). Stem cell therapy for erectile dysfunction: A step towards a future treatment. Life, 13(2). Link
  57. Pizzol, D., Demurtas, J., Stubbs, B., Soysal, P., Mason, C., Isik, A. T., Solmi, M., Smith, L., & Veronese, N. (2019). Relationship between cannabis use and erectile dysfunction: A systematic review and meta-analysis. American Journal of Men’s Health, 13(6). Link
  58. Rahardjo, H. E., Becker, A. J., Märker, V., Kuczyk, M. A., & Ückert, S. (2023). Is cortisol an endogenous mediator of erectile dysfunction in the adult male? Translational Andrology and Urology, 12(5), 684–689. Link
  59. Rajfer, J. (2000). Relationship between testosterone and erectile dysfunction. Reviews in Urology, 2(2), 122–128. Link
  60. Rizk, P.J., Kohn, T.P., Pastuszak, A.W., Khera, M. (2017). Current opinion in urology, 27(6), 511–515. Link
  61. Rodgers, J. L., Jones, J., Bolleddu, S. I., Vanthenapalli, S., Rodgers, L. E., Shah, K., Karia, K., & Panguluri, S. K. (2019). Cardiovascular risks associated with gender and aging. Journal of Cardiovascular Development and Disease, 6(2). Link
  62. Rojanasarot, S., Williams, A. O., Edwards, N., & Khera, M. (2023). Quantifying the number of US men with erectile dysfunction who are potential candidates for penile prosthesis implantation. Sexual Medicine, 11(2). Link
  63. Sadovsky, R. (2003). Asking the questions and offering solutions: The ongoing dialogue between the primary care physician and the patient with erectile dysfunction. Reviews in Urology, 5(Suppl 7), S35. Link
  64. Sara, J. D. S., Toya, T., Ahmad, A., Clark, M. M., Gilliam, W. P., Lerman, L. O., & Lerman, A. (2022). Mental stress and its effects on vascular health. Mayo Clinic Proceedings, 97(5), 951–990. Link
  65. Satriyo Arif Wibowo, D. N., Soebadi, D. M., & Soebadi, M. A. (2021). Yohimbine as a treatment for erectile dysfunction: A systematic review and meta-analysis. Turkish Journal of Urology, 47(6), 482–488. Link
  66. Schardein, J. N. and Hotalin, J. M. (2022). The impact of testosterone on erectile function. androgens: Clinical research and therapeutics, 3(1), 113–124. Link
  67. Shankar, G. S. (2015). Serotonin and sexual dysfunction. Journal of Autacoids and Hormones, 5(e129). Link
  68. Shindel, A. W. and Rosenfeld, S. (n.d.). Successful self-penile injection hints, questions, and answers. UCSF Health. Link
  69. Simonsen, U., Comerma-Steffensen, S., & Andersson, E. (2016). Modulation of dopaminergic pathways to treat erectile dysfunction. Basic & Clinical Pharmacology & Toxicology, 119, 63–74. Link
  70. Skrypnik, D., Bogdański, P., & Musialik, K. (2014). Otyłość–istotny czynnik ryzyka zaburzeń potencji u mezczyzn [Obesity–significant risk factor for erectile dysfunction in men]. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 36(212), 137–141. Link
  71. Sooriyamoorthy, T., and Leslie, S.W. (2023, May 30). Erectile dysfunction. StatPearls. Link
  72. Szasz, I. (1998). Masculine identity and the meanings of sexuality: A review of research in Mexico. Reproductive Health Matters, 6:12, 97–104. Link
  73. [TED]. (2012, March 16). Listening to shame | Brené Brown | TED [Video]. YouTube. Link
  74. Trussell, J. C., Kunselman, A. R., & Legro, R. S. (2010). Epinephrine is associated with both erectile dysfunction and lower urinary tract symptoms. Fertility and Sterility, 93(3), 837. Link
  75. University of Utah. (n.d.) Erectile Dysfunction: Trimix Injections. Link
  76. U.S. Food and Drug Administration. (2023, May 5). Platinum 69000 Rhino 69 Contains Hidden Drug Ingredient. Link
  77. Wang, J., Zhou, Y., Dai, H., Bao, B., Dang, J., Li, X., Wang, B., & Li, H. (2019). The safety and efficacy of acupuncture for erectile dysfunction: A network meta-analysis. Medicine, 98(2). Link
  78. Welner, L., and Avery-Clark, C. (2014). Sensate focus: clarifying the masters and Johnson’s model. Sexual and Relationship Therapy, 29(3), 307–319. Link
  79. World Health Organization. (n.d.). Obesity. Link
  80. Yan, Z., Cai, M., Han, X., Chen, Q., & Lu, H. (2023). The Interaction between age and risk factors for diabetes and prediabetes: A community-based cross-sectional study. Diabetes, Metabolic Syndrome and Obesity, 16, 85–93. Link