What is Erectile Dysfunction (ED)? Complete Guide to Causes, Symptoms & Solutions

Erectile dysfunction (ED), often referred to as impotence, can be a challenging and frustrating experience for many men. Because sexual health is still a sensitive and sometimes taboo topic, it’s common for men to hesitate when it comes to seeking help. While occasional difficulties with erections are normal, ongoing or frequent issues may point to an underlying concern that deserves attention. ED can affect emotional well-being, confidence, and relationships, and in some cases, may be linked to other health conditions. The important thing to remember is that support and treatment options are available, and speaking with a professional is a valuable first step.

What is erectile dysfunction?

Erectile dysfunction, or ED, is when a man has trouble getting or maintaining an erection firm enough for satisfying sexual activity. ED can show up in different ways - for some, it’s an occasional issue, while for others, it’s a more regular or ongoing challenge. It can affect men at almost any age, and sometimes the exact cause isn’t clear. In other cases, ED may be linked to underlying health conditions or the effects of certain medications.

An erection is the result of a coordinated process between the brain, nerves, hormones, muscles, and blood vessels. When a man is sexually aroused, the brain sends signals that relax the blood vessels in the penis, allowing increased blood flow. This fills spongy tissues in the penis, causing it to become firm. If anything disrupts this system - whether physical, hormonal, or psychological - it can make it difficult to achieve or maintain an erection..

What causes erectile dysfunction?

Erectile dysfunction can have many possible causes, ranging from physical health conditions to psychological and lifestyle factors. Sometimes, it’s the result of an underlying medical issue; other times, emotional or hormonal factors may play a role. Common contributors to ED include:

• Diabetes
• Cardiovascular conditions such as heart disease
• Smoking and tobacco chewing
• Depression or anxiety
• Certain medications, including those for high blood pressure or depression
• Parkinson’s disease
• Atherosclerosis (narrowed or blocked blood vessels)
• Low testosterone levels
• Spinal cord injuries
• History of prostate cancer treatments
• Excessive alcohol consumption
• Thyroid disorders
• Chronic kidney disease
• Obstructive sleep apnea

Because ED can stem from so many different factors, it’s important to work with a doctor - whether a urologist, endocrinologist, or Ayurvedic practitioner - to identify the specific cause and explore treatment options.

Erectile dysfunction and age

Erectile dysfunction and other sexual health concerns, such as reduced libido, tend to become more common as men age. Studies suggest that by age 40, around 40% of men experience some level of sexual function decline, with rates increasing by about 10% per decade (Feldman, 1994). This may be linked to the natural decrease in testosterone levels, which often begins after age 30, as well as a higher risk of lifestyle diseases like diabetes and heart disease - both of which are rising rapidly in India.

However, ED isn’t only a problem of aging. Many younger men in India also experience erectile difficulties, often related to stress, anxiety, or modern lifestyle pressures. The good news is that, regardless of age, ED can often be addressed with proper lifestyle changes, counseling, medical care, or natural wellness approaches.

ED at a young age

Although erectile dysfunction is often seen as a condition that comes with age, research shows that around 25% of those affected are actually under the age of 40. In younger men, ED is often linked to a combination of health conditions, lifestyle habits, and mental well-being (Capogrosso, 2013).

Health issues like diabetes and obesity, both of which are on the rise among young people in India, can play a major role. Obesity, in particular, is often associated with lower testosterone levels, which can contribute to difficulties with erections. Encouragingly, research suggests that weight loss in people with obesity and ED can help improve sexual function (Diaz-Arjonilla, 2009).

Lifestyle habits such as alcohol consumption, smoking, and recreational drug use are also significant contributors. While many people notice short-term erection difficulties after drinking too much, frequent or heavy drinking can lead to more persistent problems (Arackal, 2007). Tobacco use, whether through cigarettes or chewing tobacco, is another well-known risk factor for ED.

Mental health plays a central role as well. Emotional states like anxiety and depression can activate the body’s stress response, often called the fight-or-flight system, which can interfere with sexual arousal and erection. Performance anxiety is especially common among young men, particularly with new partners. Worries about getting or maintaining an erection, concerns about premature ejaculation, or discomfort using condoms can all add to stress levels - and that stress can, in turn, make it even harder to achieve or maintain an erection.

COVID and erectile dysfunction

Since the start of the COVID-19 pandemic, scientists and doctors around the world have been working to understand not just the short-term symptoms of the virus, but also its potential long-term effects. One emerging area of interest is whether COVID-19 may have an impact on erectile function.

Although research is still in its early stages, some studies have raised the possibility that COVID-19 could contribute to an increased risk of erectile dysfunction. A small study found that men who had recovered from COVID-19 reported higher rates of ED compared to those who had never been infected. While the evidence is not yet strong enough to say definitively that COVID-19 causes ED, some experts suggest that the virus’s effects on the body’s blood vessels may play a role. COVID-19 is known to cause inflammation and damage to the delicate lining of blood vessels, which may interfere with blood flow - including to the penis - potentially making it more difficult to achieve or maintain an erection (Sansone, 2021).

In India, where large numbers of people have been affected by COVID-19, these early findings are important to watch. Anyone experiencing ongoing sexual health concerns after recovering from COVID-19 should consider discussing them with a doctor.

Can porn cause erectile dysfunction?

Watching pornography is not inherently harmful and, for some people, it can even play a positive role in exploring sexual preferences. However, growing research suggests that excessive or compulsive use of pornography may contribute to sexual difficulties, including erectile dysfunction, for some individuals.

Some studies indicate that frequent exposure to pornography may desensitize a person to real-life sexual experiences, making it harder to become aroused or maintain an erection with a partner (Dwulit, 2019). In some cases, heavy porn use has also been linked to reduced interest in actual sexual activity, a condition sometimes referred to as “sexual anorexia,” which can further contribute to ED (Park, 2016).

Diabetes and erectile dysfunction

Diabetes is one of the most well-established risk factors for erectile dysfunction. While ED affects roughly 20% of men in the general population, studies show that among men with diabetes, the prevalence can rise to around 50% (Kouidrat, 2017).

Diabetes is a condition in which the body struggles to properly use or regulate blood sugar. As a result, high blood sugar levels can damage delicate nerves and blood vessels throughout the body, leading to complications like kidney problems, poor wound healing, and circulation issues. This same damage can affect the nerves and blood vessels involved in achieving and maintaining an erection.

When the blood vessels and nerves in the penis are affected, it can become much more difficult to experience normal sexual function. In some cases, this damage can become long-lasting or permanent if the diabetes remains poorly controlled. For men in India, where diabetes rates are rising sharply, paying attention to blood sugar management is an essential part of protecting both overall health and sexual well-being.

Treatment Options for Erectile Dysfunction

When it comes to treating ED, men today have a wide range of options - from fast-acting prescription medications to holistic approaches rooted in Ayurveda. Modern medicine offers effective pharmaceutical solutions like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra), all of which work by improving blood flow to the penis. Depending on individual needs, these medications can be taken on demand or daily, and some, like tadalafil, also help with urinary symptoms related to prostate health.

Beyond medications, there are other medical tools such as vacuum erection devices (ED pumps) that manually increase blood flow, and emerging treatments like low-intensity shockwave therapy, which aims to improve blood vessel function, though more research is needed in this area.

Ayurveda, India’s ancient healing system, offers a complementary approach by focusing on restoring balance within the body. Ayurvedic herbs like ashwagandha, safed musli, gokshura, krounchbeej (mucuna pruriens), and panax ginseng are traditionally used to support vitality, stamina, and reproductive health. Rather than offering immediate effects like pharmaceuticals, Ayurvedic remedies work gradually over time, aiming to improve the root causes of imbalance and support overall wellness.

Choosing the right treatment depends on the underlying cause of ED, individual health factors, and personal preferences. Some men benefit from a combination of medical treatment, Ayurvedic support, and lifestyle changes like improved diet, exercise, stress management, and better sleep. 

Treating the underlying causes of ED

When ED is linked to an underlying medical condition, addressing that root cause can often improve sexual function. Conditions like diabetes, obesity, or Peyronie’s disease (curvature of the penis) are known to contribute to ED, and managing them effectively can sometimes make it easier to achieve and maintain an erection.

In some cases, medications prescribed for other health conditions may be part of the problem. Certain drugs can affect sexual function, but the solution is rarely as simple as stopping them. If you suspect that your medication may be impacting your erections, it’s essential to speak with a healthcare provider. They can help explore alternative treatments or adjust the dosage safely. Never stop a prescribed medication on your own, as doing so may have serious health risks.

Common medications that may contribute to ED include:

• Blood pressure drugs (such as beta blockers, thiazide diuretics)
• Antidepressants (including selective serotonin reuptake inhibitors, or SSRIs)
• Antihistamines (used for allergies)
• Opioid pain medications
• Some medications for acid reflux
• Chemotherapy or radiation treatments for cancer
• Parkinson’s disease medications

For men in India and globally, working closely with a doctor - can help identify the underlying causes of ED and create a treatment plan that balances overall health and sexual well-being.

Erectile dysfunction exercises

For many men, adding regular exercise to their daily routine can play an important role in improving erectile function - especially when ED is linked to conditions like heart disease, diabetes, high blood pressure, or obesity. Since these health issues are becoming increasingly common in India, lifestyle-focused strategies like exercise are more relevant than ever.

Among the most effective exercises for ED are pelvic floor exercises (commonly known as Kegels) and cardiovascular exercise such as running, swimming, brisk walking, or cycling.

Pelvic floor exercises:
While Kegels are often recommended for women, particularly after pregnancy, they’re just as beneficial for men. Strengthening the pelvic floor muscles can improve the ability to achieve and maintain an erection. Research has shown that men who performed Kegel exercises consistently over six months had significantly better erectile function compared to those who didn’t. In one study, 40% of men who practiced these exercises regained normal erections, and another 36% saw noticeable improvements (Dorey, 2005).

Cardiovascular exercise:
Regular aerobic activity has also been shown to help with ED by improving blood flow and overall heart health. Activities like swimming, jogging, cycling, or even fast-paced walking help strengthen the heart and blood vessels, which in turn benefits circulation throughout the body - including to the penis. Studies have found that moderate to vigorous exercise can significantly improve erectile function, especially when combined with other healthy lifestyle habits.

For men in India, where a sedentary lifestyle, desk jobs, and urban stress are increasingly common, making time for regular physical activity can have both sexual and overall health benefits. Starting with 30 minutes of moderate activity most days of the week, along with stress management, a balanced diet, and good sleep, can make a meaningful difference.