Erectile dysfunction (ED) is a common sexual problem that affects the ability to get or maintain an erection firm enough for sex. Most males have occasional erectile issues, but when ED happens regularly, it can negatively affect aspects of a person’s life.

ED affects about 30 million males in the United States, according to the Centers for Disease Control and Prevention (CDC). It is more common in middle-aged and older males, although it can occur at any age. Males with diabetes are three times more likely to develop ED than those without.

Physical, emotional, or relational problems can all contribute to ED. The occasional inability to get or maintain an erection is not ED. Likewise, ED is not a lack of interest in sex or problems with ejaculation.

ED specifically relates to getting an erection and sustaining it long enough for fulfilling sex. To diagnose ED, a doctor will ask questions related to a person’s erections and sexual activity.

This article explains the symptoms of ED, how doctors diagnose it, and the possible effects.

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Symptoms of ED may be short or long term. They include:

  • the inconsistent ability to get an erection for sex
  • the ability to get an erection that does not always last long enough for sex
  • the inability to get an erection at all

ED is more likely to develop with age, but it is not a typical part of aging. Persistent ED may have an underlying medical condition or psychological factor as a root cause. It can also be an adverse effect of certain medications.

A medical professional can assist in identifying the cause and setting up a course of treatment.

Doctors do not advise that males self-test at home for ED. If an underlying health condition is causing it, a person may require treatment, starting with a complete medical evaluation.

Some people advocate an at-home self-test called the “stamp test” to determine whether they are getting erections throughout the night.

The stamp test involves placing a row of stamps around the shaft of the penis overnight. Men without ED will generally experience erections throughout the night, while men with ED will not. The row of stamps will break if an erection occurs. However, an unbroken row does not necessarily mean an individual has ED.

This self-test is not accurate and unsuitable for diagnosis. A better option is the Sexual Health Inventory for Men Questionnaire by the Prostate Cancer Foundation.

A doctor will perform a complete physical and mental health examination to diagnose ED. They will ask a series of questions about general and sexual health, which may include:

  • What is your confidence level in getting and maintaining an erection?
  • How often is your penis firm enough for intercourse when you have erections due to sexual stimulation?
  • How often are you able to maintain an erection throughout sex?
  • How often do you find sex satisfying?
  • Do you have an erection when you first wake up?
  • How would you rate your level of sexual desire?
  • How often can you orgasm and ejaculate?
  • How many, if any, surgeries have you had that may have damaged nerves or blood vessels near the penis?
  • What prescription or over-the-counter medications do you take?
  • What is your intake of alcohol, tobacco, and illegal drugs?

There can be several causes of ED, from underlying medical conditions to psychological factors. Although it may feel embarrassing to discuss sex with a doctor, it is important to be honest. Answering questions can help a doctor pinpoint the causes of sexual dysfunction.

The doctor may order blood tests and an imaging test, such as an ultrasound, to check blood flow. Later, they may order other tests, such as a nighttime erection test or an injection test called an intracavernosal injection.

During this test, the doctor injects medication into the penis to induce an erection and then measures the fullness of the penis and how long the erection lasts.

Nocturnal penile tumescence and rigidity (NPTR) tests

Most males will have several erections during the night. These occur during REM sleep. Erections that are present upon waking up are just one of these nocturnal erections and have nothing to do with the need to urinate, as is commonly thought.

The doctor may order an NPTR test to measure the number of erections that occur overnight. This test sometimes takes place at home or in a special sleep lab.

During the test, a person wears soft, flexible tubes around the shaft of the penis while they sleep. The tubes attach to a machine that measures specific readings about erections during the night. The name of the most commonly used device is RigiScan.

If nighttime erections occur, it indicates that the cause of ED is likely not physical.

Learn about the causes and treatments for ED here.

The psychological effects of ED can be significant for the person with ED and their partner. It can cause:

Psychological stress can make ED worse. Seeking early treatment can help relieve psychological burdens and address potential medical issues.

ED may create a self-perpetuating cycle, where a failed erection causes the individual to be concerned about ED the next time they try to have sex. This diversion of mental involvement away from the sexual stimulation can lead to another failed erection, which sets up a cycle of worry and failure.

The following lifestyle changes may help manage the psychological effects of ED:

  • increasing exercise
  • limiting alcohol and smoking
  • stopping illegal drug use
  • receiving counseling
  • improving communication with a partner


ED can be a frustrating experience for a couple, leading to psychological issues, frustration, and conflict. However, effective treatments are available, and it is imperative to seek medical help early.

One 2016 review published in Nature Reviews Urology noted that treating ED to the satisfaction of a male and their sexual partner can be difficult.

One study of treatment with sildenafil (Viagra) found that the people with ED had the following satisfaction rates: 50% very satisfied, 22% satisfied, and 14% somewhat satisfied. However, their sexual partners’ satisfaction rates were only 22%, 22%, and 14%, respectively.

The same article indicates that men with ED are less likely to discontinue ED treatment when their partners are actively involved in the regimen.

Interestingly, partners often raise the issue of ED before the person experiencing it. This may be because it is easier for them to accept it than for the person with the condition.

Sexual partners may wish to explore other ways of retaining intimacy without an erection and find new ways to enjoy each other.


Sexual fulfillment is highly related to personal satisfaction and overall happiness. ED can hurt self-esteem and quality of life.

One 2021 study evaluated the relationship between ED, self-esteem, and depression. Forty men with ED and a control group of 40 men completed questionnaires regarding their sexual satisfaction, self-esteem, and psychological health.

The study found that despite regular sexual frequency, men with ED were dissatisfied with their sexual life and had significantly lower self-esteem. The researchers concluded that preventing ED could contribute to an increase in self-esteem and overall happiness.

A person should contact a doctor if they regularly have difficulty getting or maintaining an erection or if the problem worsens. ED may indicate another underlying health condition, such as:

Side effects of certain medications can also cause ED. A person should not stop taking medications without consulting a doctor.

Learn more about medications that may cause ED here.

How do you check for erectile dysfunction?

There is no definitive test for ED. Doctors diagnose it by looking for patterns over time. If a person repeatedly has difficulty getting erections or maintaining them long enough for fulfilling sex, they may wish to talk with a doctor.

How can I test for erectile dysfunction at home?

One ED test a person can do at home is the Sexual Health Inventory for Men questionnaire from the Prostate Cancer Foundation. A score of below 21 suggests that a person is positive for ED and should consult a doctor for diagnosis and treatment.

ED is the inability to get or maintain an erection sufficient for satisfying sex. It can be a short-term issue due to transient stress or a long-term problem. There are many causes, so a doctor is best qualified to determine the cause and course of treatment.

ED is common and occurs more frequently as men age, but it is not a normal part of aging. It may indicate an underlying health condition that requires treatment.

To check for ED at home, people may wish to use the Sexual Health Inventory for Men, which indicates the likelihood of ED. A doctor will conduct a much more thorough verbal and physical examination to pinpoint the cause of the issue and formulate a treatment plan.

ED can negatively affect a person’s self-esteem, sexual relationships, and overall happiness. Seeking early treatment can prevent worsening mental health.