Erectile Dysfunction (ED): Symptoms, Causes & Treatment

February 1, 2024

What is Erectile Dysfunction

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to us — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.


With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man’s vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:

  • Low self-esteem
  • Depression
  • Distress for the man and his partner 

If ED is affecting a man’s well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man’s life.


Many different factors affecting your vascular system, nervous system NIH external link, and endocrine system can cause or contribute to ED.

Although you are more likely to develop ED as you age, aging does not cause ED. ED can be treated at any age.

Certain diseases and conditions

The following diseases and conditions can lead to ED:

  • Diabetes
  • Heart and blood vessel disease
  • Atherosclerosis
  • High blood pressure
  • Chronic kidney disease
  • Multiple sclerosis
  • Injury from treatments for prostate cancer, including radiation therapy and prostate surgery
  • Injury to the penis, spinal cord, prostate, bladder, or pelvis
  • Surgery for bladder cancer

Men who have diabetes are two to three times more likely to develop ED than men who do not have diabetes. Read more about diabetes problems.

Taking certain medicines

ED can be a side effect of many common medicines, such as

  • Blood pressure medicines
  • Antiandrogens—medicines used for prostate cancer therapy
  • Antidepressants
  • Tranquilizers, or prescription sedatives—medicines that make you calmer or sleepy
  • Appetite suppressants, or medicines that make you less hungry
  • Ulcer medicines

Certain psychological or emotional issues

Psychological or emotional factors may make ED worse. You may develop ED if you have one or more of the following:

  • Fear of sexual failure
  • Anxiety
  • Depression
  • Guilt about sexual performance or certain sexual activities
  • Low self-esteem
  • Stress—about sexual performance, or stress in your life in general
  • Certain health-related factors and behaviors

The following health-related factors and behaviors may contribute to ED:

  • Smoking
  • Drinking too much alcohol
  • Using illegal drugs
  • Being overweight
  • Not being physically active


  • Sildenafil – A prescription medication taken orally for the treatment of ED. This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication. Sexual stimulation is required for sildenafil citrate to have the best efficacy.
  • Vardenafil – This drug has a similar chemical structure to sildenafil citrate and works similarly.
  • Tadalafil – Studies have indicated that tadalafil citrate stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 4 to 5 hours after taking the pill (slow absorption) and the effects of the medication may last up to 24 to 36 hours.

The Vancouver Laser recommends that men follow general precautions before taking medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or Vardenafil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). We recommend that men have a complete medical history and physical examination to determine the cause of ED.

These medical treatments should NOT be used by women or children. Elderly men are especially sensitive to the effects of these medical treatments, which may increase their chance of having side effects.

Men Hormone Optimization 

Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.

Vancouver Laser offers an evidence-based approach towards hormone optimization, with bio-identical hormone replacement therapy and customized supplementation, to significantly improve your overall well-being. Click here to contact us Learn more.

Erectile Dysfunction (ED): Symptoms, Causes & Treatment