Adam and Eve Erectile Dysfunction (ED) Guide


Dr. Kat

About the Author: Dr. Kat Van Kirk is the resident sexologist at Adam & Eve in addition to being an author and media host. She has a PhD in Clinical Sexology/Human Sexuality. Her professional affiliations include AASECT, SSSS, and the American Board of Sexologists. She also has a Master’s degree in Counseling Psychology a postgraduate degree in Marriage, Family and Addictions Recovery Therapy


Every man at some point in his life will experience some level of erectile dysfunction (ED) -- the inability to achieve or maintain an erection. Occasional erectile failure can happen for a number of reasons, such as drinking too much alcohol, heightened levels of stress, or lack of sleep.

Infrequent occurrences of ED can without a doubt cause embarrassment and stress, but they are usually not a major cause for concern. The good news: according to the newly revised Diagnostic and Statistical Manual (the DSM-V) is that ED is not considered a medical issue unless you experience symptoms of ED at least 75 percent of the time for a minimum of 6 months. However, if you are unable to achieve or maintain an erection 50 percent of the time, you may need to see your doctor in order to improve your quality of life in the long run.

In this guide, you'll learn about ED, its many underlying causes and symptoms, and the various treatment options, from penis pumps to herbal remedies or OTC (over the counter) medications.

What is ED?

Erectile dysfunction, or ED, is the frequent inability to achieve or sustain an erection firm enough for intercourse. Some men may not be able to achieve an erection at all, or may lose their erection during the course of sex. It is estimated that as many as 30 million men in the United States suffer from ED, making it one of the most common sexual problems for men as they age.

What Causes ED?

While erectile dysfunction has a fairly distinct set of symptoms, the causes and types of ED can vary. Though the most prevalent group ED affects is men 40 or older, erectile problems don’t discriminate based on age. Research has found that five percent of men ages 20 to 39 have experienced ongoing ED symptoms. There also seems to be an increase in younger men experiencing symptoms over all. Usually in these cases, ED is caused not by physical factors such as age, but rather psychological issues including depression, performance anxiety, guilt, stress, and other such emotions. Alcohol and drug abuse is also a big contributor to erectile dysfunction in younger men. Beyond the common cause of aging, there are also other well-known causes for ED.

  • ED caused by diabetes35 to 50 percent of men in the United States who have been diagnosed with diabetes also experience erectile dysfunction. ED seen in diabetic men is usually due to the hardening of arteries, which restricts blood flow.
  • Psychological ED — Psychological factors account for 10 to 20 percent of all cases of ED. Depression is a major factor in this type of ED, as well as other psychologically related stressors.
  • ED caused by medications — A wide range of prescription drugs can cause
  • erectile difficulties in men, so be sure to check with your physician about this.
  • Hormonal ED — Hormonal abnormalities, such as too much or too little thyroid hormone, overuse of steroids, and hormones given for prostate cancer commonly cause ED. There is also mounting data that environmental factors may be at play.
  • ED caused by neurological conditions — When an injury or medical condition produces nerve issues, men are more at risk for erectile dysfunction. Multiple sclerosis, spinal cord injuries, damage from pelvic operations, and heavy metal poisoning are all examples of types of neurological conditions that can cause ED.

Nearly 75 percent of all ED cases are caused by a physical condition. Some physical conditions and diseases that can affect your sexual performance include a hardening of the arteries, weak veins, nerve diseases, and injury to the penis. Chronic illness, certain medications you may be taking, as well as a condition that causes scar tissue in the penis (Peyronie’s disease) may also lead to erectile dysfunction.

There are many factors that may contribute to ED, but the most common sign of erectile dysfunction is the inability to stay erect during intercourse. For an erection to happen, the right conditions must be present. A full erection can be inhibited when any of the following factors are not achieved:

  • Adequate blood circulation and retention in the penis
  • Properly functioning nerves to the penis
  • A stimulus from the brain (better known as sexual arousal)

In addition to physical conditions that can develop, there are certain other risk factors involved that may increase your chances for ED. Some of the most common risk factors include:

  • Age
  • Diabetes
  • High cholesterol
  • High Blood Pressure
  • Smoking
  • Alcoholism and drug use
  • Cardiovascular disease
  • Obesity
  • Low testosterone levels

As mentioned earlier, psychological elements can also have an impact on your sexual health, and in some cases, they can contribute to the cause of ED. Stress, depression, and anxiety are all examples of the types of mental obstacles that can influence your ability to achieve or keep an erection.

Remember: ED is only diagnosed when a man is unable to get or keep an erection more than 75 percent of the time. While the sporadic failure to get an erection isn’t cause for concern, an ongoing erectile problem can affect your sexual performance and place a strain on your relationships, mental health, and self-confidence.

What Are the Symptoms of ED?

Alfred KinseyIf you are experiencing the persistent inability to achieve or maintain an erection, don’t hesitate to see a doctor. Though sexual issues can be awkward to talk about, visiting with your medical provider is a necessary step on the road to efficiently and quickly resolving your ED.

ED symptoms may include:

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

If you think you may have ED, or you have other symptoms that seem related, make an appointment to see your doctor. ED can sometimes be a sign of a more serious illness, so it is crucial for both your sexual and overall health to have any concerns properly diagnosed and treated.

In most cases, a physical exam and questions about your symptoms may be all your doctor needs to make a diagnosis and recommend treatment. However, if your doctor feels that there may be any underlying issues at hand, he or she may perform a variety of tests, or refer you to a specialist for further consultation. These tests may include blood or urine tests, an ultrasound, or a psychological exam.

What Are the Treatment Options for ED?

Today, there are many options for treating erectile dysfunction. The solution to your ED could be as simple as taking a pill every day, though there are many choices beyond prescribed oral medication. Your doctor can help you explore other alternatives, such as sex therapy, penile injections, pumps, and surgery.

While each option offers its own advantages and disadvantages, it’s important to find a treatment that works best for you. When reviewing treatment options with your doctor, make sure you take into consideration any existing health conditions, lifestyle, and the preferences of you and your partner. Overall, the course of treatment should be specialized to you and specific to the underlying cause(s) of your ED.

Don’t become discouraged if a particular treatment doesn’t work for you right away. Certain medications may adversely affect you or cause side effects that may take time for you to adjust to. With a little patience, you and your medical provider will be able to find the best solution for you.


A penis pump, or vacuum erection device, can help improve the firmness of your penis by increasing the flow of blood to the area. When the tube is placed over your penis and the pump is engaged, the vacuum that is created pulls blood into your penis. Once an erection is achieved this way, a tension ring is slipped around the base of your penis to hold the blood and keep your erection firm. Around 80 percent of men who use a penis pump correctly are able to maintain an erection hard enough for intercourse, making this a good alternative option.

Natural Cures for ED

Lifestyle Changes

ED can be caused by certain lifestyle choices. Making a change to particular elements of your lifestyle can often help or resolve erectile issues. Adopting a healthier lifestyle is often enough to improve ED. This includes lifestyle changes such as:

  • Losing weight
  • Getting treatment for alcohol or drug problems
  • Talking with your partner to improve your relationship
  • Exercising regularly
  • Eating well-balanced meals
  • Quitting smoking

Psychotherapy or Counseling

  • Therapy or counseling may be the best route to take if your ED is caused by stress or anxiety. Everyday stressors, such as work and home life or financial worries, can lead to erectile problems. Talking about these issues with a licensed therapist can help you reduce stress and develop healthy approaches to everyday stressors. Often your therapist will be able to provide strategies to increase intimacy, so bringing your partner along to the sessions could be beneficial.

Sex Therapy

  • Erectile dysfunction can make being intimate with your partner extremely difficult and even stressful at times, which is why many people turn to sex therapy as a healthy solution to ED. During your session, your sex therapist may give you and your partner assignments to do at home, such as touching exercises designed to take the pressure off of performing during sex, reading books about sexuality, or practicing better sexual communication. He or she may also introduce you and your partner to alternative sexual techniques that can be pleasurable without intercourse.
  • Sex therapy is a form of treatment that enables communication with your partner. It is especially helpful for men who have ED caused by non-physical aspects, such as psychological factors or relationship issues.

Alternative Remedies

Many men may feel embarrassed to seek the help of a medical provider for their ED, but there are numerous OTC and herbal remedies available. These include:

  • Supplements such as flaxseed, zinc, vitamin C, vitamin E, arginine, and bioflavonoids
  • Acupuncture
  • Dehydroepiandrosterone (DHEA) which may promote testosterone
  • Ginseng root

Though it’s not necessary to have a prescription or consult a doctor before purchasing and using these alternative cures, keep in mind these options are not approved by the FDA, nor have they been proven effective through research, trials, or studies.


There is a wide variety of medications available to men with ED, ranging from oral treatments to medicines that are inserted into the urethra or injected into the penis.

Oral Medications

  • Oral medications are a successful treatment option for many men and are often the first remedy that is tried. Generally taken by mouth one or more hours before sex, phosphodiesterase (PDE) type 5 inhibitors relax the smooth muscles in the penis, allowing for greater blood flow and helping the penis to become erect during sexual stimulation. The most common medications in this group include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra and Staxyn).

Hormonal Treatments and Therapy

Though low testosterone is not the most common cause of ED, it can contribute to erectile problems in some men. After age 30, a man’s natural amount of testosterone in his body starts to decline. Besides a gradual decrease in testosterone as a man ages, there are other causes of low testosterone production:

  • Chemotherapy or radiation treatment
  • Genetic abnormalities
  • Too much iron in the body
  • Pituitary gland issues and conditions
  • Injury, infection, or loss of testicles
  • Chronic illness
  • Kidney failure
  • Medications which contain hormones
  • Alcoholism
  • Stress
  • Obesity
  • Potential environmental factors

Physical changes such as loss of muscle mass and increase in body fat, decrease in body hair, shifts in cholesterol levels, and anemia are indicators of low testosterone levels. If you suspect you may be experiencing erectile dysfunction caused by a lack of testosterone, see your doctor. In cases such as these, testosterone replacement therapy may prove to be helpful. Your doctor will be able to perform the proper tests to diagnose and treat hormonal ED.

A deficiency in testosterone can be treated multiple ways. Your doctor may suggest intramuscular injections, a patch, gel, or oral tablets. Other possible solutions include a testosterone stick (used like deodorant) or a hormonal implant.

Penile Injections

In clinical trials, 80 percent of men achieved firmer erections after receiving penile injection treatment for ED. One of the advantages of injections to treat erectile issues is that they usually work for a wide range of men with varying health conditions. Aprostadil can be given either through injection or a suppository. When injected, it is done so directly into the side of the penis. With the suppository method, the medication is placed into the opening at the tip of the penis. Both forms of aprostadil cause the blood vessels to expand, allowing for increased blood flow and an erection.

Because an erection achieved through this form of treatment only lasts from 30 minutes to an hour, the patient must learn to perform the injection or insert the suppository himself.

Surgical Options


Surgery is an option usually reserved for when all other treatments have failed to resolve erectile dysfunction. During surgery, a penile prosthesis can be placed into the penis. The prosthesis is either bendable or inflatable, though the inflatable option is much more popular and common among patients today.

When considering any major surgery, including a penile prosthesis, it’s important to consider both the advantages and risks. After opting for an implant to help improve erectile issues, most men cannot naturally get an erection without the device if it is removed. Fortunately, the satisfaction rate with a prosthesis implant is very high. Around 90 to 95 percent of men achieve erections firm enough for intercourse and 80 to 90 percent of men say they would choose the surgery again.

Vascular Reconstruction

Vascular reconstruction surgery can be performed to repair any blood vessel blockages to improve blood flow to the penis. In this procedure, blood vessels are intentionally blocked in order to help reduce blood loss from the penis and surrounding areas of tissue. The success rate for this surgery is usually higher in younger men, and the long-term effectiveness is as yet unknown.

The Link Between ED and What You Eat

Because being overweight can put you at greater risk for ED, it’s important to stick to a healthy diet to decrease your chances of experiencing erectile failure.  Studies have found that the same diet that is likely to cause heart attacks and high blood pressure due to restricted blood flow in the arteries is also likely to cause erectile dysfunction by inhibiting blood flow to the penis as well. This blood flow is vital to achieve and maintain an erection.

Diets that are high in fatty, fried, and processed foods are often responsible for decreased blood flow throughout the body. To prevent your diet from affecting your erectile ability, try to stick to a healthy, well balanced diet that includes plenty of fruits, vegetables, whole grains, and lean proteins. Some foods that may specifically reduce your risk of ED are:

  • Leafy greens and beets — Leafy greens, such as kale and spinach, have high concentrations of nitrates, which may increase circulation. Beet juice also contains high levels of nitrates.
  • Dark chocolate — Dark chocolate can satisfy your sweet tooth and potentially improve your ED. This is due to the flavonoids in dark chocolate, which have been shown to improve circulation. Flavonoids are antioxidants that also help to lower blood pressure and decrease cholesterol, two potential causes of ED.
  • Pistachios — Pistachios are a great source of protein, and they have been proven to mitigate sexual issues and erectile problems. Men who ate the nuts every day for three weeks reported more sexual desire, increased overall sexual satisfaction, and decreased ED. This is most likely due to the protein arginine, which is found in pistachios and can help to relax blood vessels.
  • Oysters — For years oysters have been heralded as an aphrodisiac, but few people know what makes oysters the romance boosters they are. Zinc, which plays a critical role in the production of testosterone, is found in high levels in oysters and other raw shellfish. So, men with hormone-related ED could benefit greatly from eating more oysters.
  • Tomatoes and grapefruit — Both of these fruits contain lycopene, a phytonutrient that boosts circulation and can improve erectile dysfunction. Research shows that in addition to improving the symptoms of ED, lycopene may also help reduce the risk of male infertility and prostate cancer.

Can Smoking Cause ED?

In short, yes. Smoking cigarettes or using other forms of tobacco is not only bad for your general health, it affects your sexual health as well. New research shows a definite link between smoking and erectile dysfunction. The plaque build-up in arteries caused by smoking leads to poor circulation throughout the body. This includes a decrease in blood flow to the penis and surrounding areas. These recent studies have found that men who smoke more than 20 cigarettes a day have a higher risk of ED, and that current smokers are 30 percent more likely to experience erectile issues.

Men who successfully quit smoking report erections that are thicker and firmer. They also reach maximum sexual arousal faster than when they were using tobacco products. These findings aren’t all that surprising, as smoking can damage blood vessels and impede proper blood flow. But it’s not smoking alone that can cause ED; any sort of nicotine product, such as gum or the patch, can negatively affect your erectile function.

If you are experiencing erectile dysfunction or want to reduce your risk, avoiding nicotine altogether is the best course of action. Quitting smoking can improve your ability to achieve and maintain an erection and lower your risk for other conditions that might cause ED, including heart disease and high blood pressure.

Short-Term and Long-Term Effects of Alcohol on ED

It’s fairly common knowledge that too much alcohol consumption can cause infrequent erectile failure (the kind that may happen only every once in a while). While drinking might increase sexual desire, it inhibits performance. Excessive drinking before sex decreases blood flow to the penis, making it difficult or even impossible to get an erection. It can also diminish the intensity of your orgasm and make sex less exciting (and pleasurable) overall.

But while having a few too many beers may cause temporary erectile issues, chronic alcoholism can lead to long-term erectile dysfunction. Research has suggested that men who are dependent on alcohol have a 60 to 70 percent chance of experiencing sexual problems, including ED, premature ejaculation, and lower sex drives.

Though alcoholism is often overlooked as a disease, it can affect erectile function in the same way other chronic conditions can. Erections begin in the brain, which sends signals through the nerves to the blood vessels in the penis, prompting arousal. Excessive drinking over a span of years can damage these nerves, slowing, or even stopping, the transmission of the signals required for an erection.

Blood PressureED and High Blood Pressure Medication

In addition to contributing to cardiovascular issues and putting you at risk for a heart attack or stroke, high blood pressure can also negatively affect your sex life. The American Heart Association estimates that around 78 million Americans have high blood pressure, or hypertension. High blood pressure outs a strain on your heart and other organs, potentially causing damage to blood vessels and arteries. Blood flow through the arteries and veins is a key component in achieving and maintaining an erection, so high blood pressure increases the chances of ED.

While high blood pressure is a common cause of ED, for some men even high blood pressure medication can cause erectile dysfunction, which prompts many to stop taking it altogether. If you are on high blood pressure medication and experience ED while taking it, talk to your doctor about other medications that may be less likely to cause erectile issues. Often, a combination of medications may work best for both controlling high blood pressure and decreasing your risks for ED. Some types of high blood pressure medications that rarely cause ED include ACE inhibitors, ARBs, alpha-blockers, and calcium channel blockers.

To prevent or control high blood pressure, and therefore the erectile issues that can be caused by it, the following steps are often recommended:

  • Eating nutritious foods
  • Avoiding a diet high in salt
  • Regularly exercising
  • Maintaining a healthy weight
  • Limiting alcohol intake
  • Avoiding smoking and other tobacco use
  • Managing stress

ED and Depression Work on a Two-Way Street

Depression is a common underlying cause of ED. It is also common for some men with ED to feel angry, sad, frustrated, or insecure because of their erectile difficulties, which can ultimately lead to depression. Depression is very treatable. Keep in mind that it is crucial to be honest with yourself, your partner, and your doctor during the process.

Common signs of depression include a feeling of hopelessness, a pessimistic perspective, and persistent sadness. More specific symptoms are:

  • Low self-esteem
  • Fatigue
  • Changes in appetite
  • Loss of interest in activities
  • Irregular sleep patterns
  • Apathy

Without treatment, symptoms of depression can last for an extended period of time or even worsen. With the right treatment, you can overcome your depression and start feeling like yourself again. Treating depression when you have ED may include therapy as well as taking medications such as antidepressants. Some medications can affect your erectile dysfunction, so being open and straightforward with your doctor about all of your symptoms and conditions will enable him or her to make the best decision for treatment.

Living with ED

Whatever the cause of ED, it can affect more than just your sexual health. ED can put a strain on your relationships in addition to your physical and psychological health. Though you may be the one directly experiencing erectile dysfunction, it can impact your partner, too. Your partner may view your ED as a sign of sexual disinterest or an inability to keep you satisfied on his or her end. Make sure to keep open lines of communication with your partner about your ED and what it means for your relationship.

While it’s often easy to jump to conclusions about erectile dysfunction, don’t assume you have a long term problem or that your ED is a reflection of your masculinity. This outlook can cause anxiety and worsen your erectile difficulties. Know that living with ED does not have to be a constant struggle. There are many ways to treat your condition and ultimately find a solution that best suits you. It’s important to address any concerns you may have regarding your ED, whether they are physical, mental, or emotional, so you can resolve and improve any issues you may be having right away.

Adam and Eve Erectile Dysfunction Guide Recap

  • Erectile dysfunction affects more than 30 million men in the United States, most of them over the age of 40.
  • If you frequently are unable to get or keep an erection, you may have ED.
  • There are many causes of ED, which may involve diet, medications, depression, or other medical conditions.
  • ED is a very treatable condition, and it is not always a long-term problem.
  • Sometimes, a few simple lifestyle changes resolve ED.
  • There are many alternatives to treating ED beside medication, including penis pumps, sex therapy, and herbal remedies.
  • ED can affect more than just your sexual health; erectile problems can place stress on your relationships, overall health, and mental state.
  • Always be open with your partner and doctor about your ED, as this can help improve your symptoms more quickly.
  • Remember that improving blood flow is key to treating ED. Eating less fried food, quitting smoking, and increasing cardio are just a few of the ways to help improve blood flow.

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