Question 1

What causes erectile dysfunction?

Accepted Answer

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity; it affects an estimated 30 million men in the United States and becomes more prevalent with age. Common causes include cardiovascular disease and atherosclerosis (reduced penile blood flow), diabetes, hypertension, obesity, hypogonadism (low testosterone), psychological factors (anxiety, depression, relationship issues), and medications such as antidepressants, antihypertensives, and antiandrogens — identifying the underlying cause is an important first step in treatment.

Question 2

What medications are used to treat erectile dysfunction?

Accepted Answer

Phosphodiesterase type 5 (PDE5) inhibitors are the first-line pharmacological treatment for ED, with sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) all demonstrating efficacy across a wide range of patients. Tadalafil is unique in offering both on-demand dosing (10–20 mg) and a once-daily low-dose option (2.5–5 mg) for spontaneous activity; PDE5 inhibitors are contraindicated with nitrate medications (including recreational nitrites) due to risk of severe hypotension — consult your healthcare provider before starting any ED medication.

Question 3

Is ED a sign of heart disease?

Accepted Answer

Yes — ED is recognized as an early warning sign of cardiovascular disease, particularly in men under 60, because arterial dysfunction in the smaller penile arteries often precedes detectable disease in the larger coronary arteries by several years. The Princeton Consensus Panel and major cardiovascular guidelines recommend that men with new-onset ED and risk factors (hypertension, diabetes, smoking, dyslipidemia) undergo cardiovascular risk assessment; consult your healthcare provider so that the underlying vascular health can be evaluated and optimized.

Question 4

Are there non-drug treatments for erectile dysfunction?

Accepted Answer

Lifestyle modifications — weight loss, regular aerobic exercise, smoking cessation, limiting alcohol, and managing cardiovascular risk factors — can significantly improve erectile function, particularly in men with obesity or metabolic syndrome, as shown in multiple randomized trials. Other non-pharmacological options include vacuum erection devices, penile rehabilitation after prostate surgery, testosterone therapy in men with confirmed hypogonadism, and psychological counseling for performance anxiety; consult your healthcare provider to determine which combination of approaches is most appropriate for your situation.

Erectile Dysfunction

Overview

Drug classes used to treat erectile dysfunction

Medications for erectile dysfunction

Drug comparisons for erectile dysfunction

Frequently asked questions