Erectile Dysfunction: Symptoms, Causes and Treatment
Erectile dysfunction (ED) is when you cannot get or keep an erection firm enough for sex. It is common, it has physical and psychological causes, and it is often the first sign of another health problem such as heart disease or diabetes.
This article is general information only. It covers what erectile dysfunction is, what causes it, how a practitioner assesses it, and when to seek help. Outcomes vary between individuals.
On this page
- What is erectile dysfunction?
- How common is erectile dysfunction in Australia?
- What are the symptoms of erectile dysfunction?
- What causes erectile dysfunction?
- Why erection problems can be a warning sign for your heart
- When should you see a practitioner?
- How is erectile dysfunction assessed?
- How is erectile dysfunction treated?
- Can erectile dysfunction be prevented?
- Frequently Asked Questions
What is erectile dysfunction?
Healthdirect defines erectile dysfunction as not being able to get or keep an erection, which may cause problems for sexual intercourse. Healthy Male describes it as a persistent difficulty getting or keeping an erection firm enough for satisfactory sexual activity.
The word "persistent" matters. Erection problems that come and go happen to many people. Erectile dysfunction is the pattern that keeps happening.
Is impotence the same as erectile dysfunction?
Yes. Impotence is an older name for the same condition, and healthdirect lists erectile dysfunction, ED and impotence as one and the same. Australian health services now use the term erectile dysfunction because it names one specific problem. Erectile dysfunction does not cover problems with ejaculation, fertility or sex drive, which are separate conditions.
How common is erectile dysfunction in Australia?
Erectile dysfunction is very common. Healthdirect states that it affects more than 1 in 10 males. Healthy Male reports that more than half of Australian men aged over 50 have some form of erectile dysfunction, and that up to 10% of men under 40 are affected.
The largest Australian study, published in the Medical Journal of Australia, surveyed 108,477 New South Wales men aged 45 or older. Among the men with no history of prostate cancer, 25% had mild erectile dysfunction, 19% moderate and 17% complete. The odds of moderate or complete erectile dysfunction rose by about 11% with each year of age from 45.
Many men never raise it. Healthy Male cites a survey of nearly 6,000 Australian men aged 40 or older in which only 30% of those with moderate to severe erectile dysfunction had discussed it with a health professional.
Erectile dysfunction becomes more likely with age, but Healthy Male is clear that the higher rates in older men are usually due to other health conditions or medicines, rather than ageing itself.
What are the symptoms of erectile dysfunction?
Healthdirect and Healthy Male list these symptoms:
difficulty getting an erection
difficulty keeping an erection
problems having sexual intercourse because the penis is not hard enough
erections that are not as hard as they used to be
How do I know if I have erectile dysfunction?
Occasional erection problems are something many people experience, and healthdirect says you might not need medical help if they only happen now and then. The signal to act is a problem that continues, or one that worries you.
Healthy Male adds that erectile dysfunction is diagnosed based on how satisfied you are with your ability to get and keep an erection. If weak erections, trouble keeping an erection or difficulty getting hard have become a pattern, that is reason enough to talk to a practitioner.
Erectile dysfunction or something else?
A 2022 peer-reviewed review by Lowy and Ramanathan notes that erectile dysfunction and premature ejaculation are often confused, and that the two can occur together. A man with premature ejaculation may say he has erectile dysfunction because he loses his erection soon after ejaculating. A man with erectile dysfunction may rush to ejaculate before he loses his erection. Describing exactly what happens helps a practitioner work out which problem you have.
What causes erectile dysfunction?
An erection depends on blood flow into the penis in response to nerve stimulation, so anything that interferes with blood vessels or nerve signals can cause erectile dysfunction. The causes are physical, psychological or a combination, and the cause is not always clear. Lowy and Ramanathan describe the factors as biological, psychological, sociocultural, relational and sexual, often several at once. Our separate guide on the causes of erectile dysfunction goes deeper on each one.
Physical causes
Healthdirect lists these physical factors and conditions:
| Cause group | Examples |
|---|---|
| Blood flow | Atherosclerosis (clogged arteries) |
| Long-term conditions | High blood pressure, diabetes, high cholesterol |
| Heart and metabolism | Cardiovascular disease, obesity, metabolic syndrome |
| Nerves | Spinal cord injury, Parkinson's disease, Alzheimer's disease |
| Hormones | Low testosterone, underactive thyroid, high cortisol |
| Reproductive system | Peyronie's disease, prostate disease and its treatment |
| Sleep | Sleep disorders |
Two of these carry hard numbers. Healthy Male reports that you are more than twice as likely to have erectile dysfunction if you have diabetes than if you do not. In the Medical Journal of Australia study, 85% of men who had been treated for prostate cancer reported moderate or complete erectile dysfunction.
Medicines and substances
Some medicines used to treat high blood pressure, high cholesterol, depression or prostate cancer can cause erection problems, according to healthdirect. Healthy Male adds medicines for depression and for lowering blood pressure, as well as some recreational drugs. Alcohol, smoking and substance abuse all appear on the healthdirect list. You should not stop a medicine on your own; a practitioner can review what you take.
Psychological causes
Healthdirect lists:
unresolved problems or conflict within a sexual and emotional relationship
anxiety about sexual performance, most common at the start of a new relationship
stress
mental health conditions such as depression or anxiety
Why erection problems can be a warning sign for your heart
Healthdirect states that erectile dysfunction is often the first sign of cardiovascular disease, diabetes, high blood pressure or high cholesterol. Healthy Male goes further: if you have erectile dysfunction, you are at higher risk than normal of coronary heart disease, stroke and death, and it describes erectile dysfunction as an early warning sign of serious disease that requires a full investigation to find the cause.
The reason is plumbing. Healthy Male explains that the artery in the penis is small, about 1 to 2 millimetres, so plaque build-up shows there before it shows in the heart or brain. Research cited by Healthy Male found that erectile dysfunction can precede cardiovascular symptoms by two to three years, and a heart attack or stroke by three to five years.
When should you see a practitioner?
Healthdirect's advice is simple: if the problems continue, or if you have any concerns, see your doctor.
Three situations make an assessment more pressing:
erection problems that have become a pattern rather than an occasional event
erection problems alongside a known condition such as diabetes, high blood pressure or heart disease
erection problems that started after a new medicine
This article cannot diagnose erectile dysfunction or tell you which treatment suits you. Burst Health connects you with an Australian-registered doctor or nurse practitioner who assesses your health history and decides whether treatment is suitable. You can complete an online assessment to check whether you are eligible, or contact Burst Health with a question first.
If erection problems have become frequent, Burst Health provides erectile dysfunction treatment online after review by an Australian-registered doctor or nurse practitioner, so check whether you are eligible.
How is erectile dysfunction assessed?
Lowy and Ramanathan state that the diagnosis can usually be made from a detailed history and examination. Here is what that involves.
Questions. Your doctor will ask about your sexual history, general health, current and previous relationships and your psychological relationship with sex. The key questions in the review are: Is the problem intermittent, global or situational? Is it recent or long term? Is there unusual curvature of the erection? Have you ever had mental health problems? The quality of your morning erections also tells a practitioner a lot about the likely cause.
Medicines review. The review recommends going through every medicine you take, because the timeline between starting one and the onset of erection problems can point straight to the cause.
Physical checks. The minimum is weight, waist circumference, body mass index, blood pressure and an examination of the genitals.
Blood tests. Where tests are needed, the minimum is blood lipids and a diabetes check (fasting glucose or glycated haemoglobin). If low testosterone is suspected, a testosterone test is taken on a morning blood sample, before 11 am.
Referrals. Your doctor may refer you for imaging such as ultrasound, or to a specialist such as a urologist.
How is erectile dysfunction treated?
Your doctor will first treat any underlying condition that may be causing the erectile dysfunction, and may recommend lifestyle changes such as eating a healthy diet and exercising regularly. Lowy and Ramanathan describe management as multimodal: lifestyle changes, medical treatment, and psychosexual counselling or therapy. More than one approach may be needed.
Medical treatment options exist, and a registered practitioner decides whether any of them is suitable after assessing you. Healthdirect notes that treatment does not always remove the problem completely, and that it cannot fix things that have always been an issue, such as problems with ejaculation or sensation. For psychological causes, cognitive behavioural therapy and sex therapy are options, and may include your partner. Outcomes vary between individuals.
Can erectile dysfunction be prevented?
Healthdirect says there is evidence that some causes of erectile dysfunction can be prevented if you stop smoking, increase exercise, lose weight and eat healthy food. The same habits protect the heart. The Medical Journal of Australia study found that men who had quit smoking more than 25 years earlier had the same odds of erectile dysfunction as men who had never smoked.
Burst Health also has guides on hair loss and premature ejaculation.
Frequently Asked Questions
What are the symptoms of erectile dysfunction?
Healthdirect lists three: difficulty getting an erection, difficulty keeping an erection, and problems having sexual intercourse because the penis is not hard enough. Healthy Male adds erections that are not as hard as they used to be. Problems with ejaculation, fertility or sex drive are separate conditions, not erectile dysfunction, although they can occur at the same time.
What causes weak erection in men?
Weak erections usually come from reduced blood flow, nerve problems, hormone changes, medicines or psychological factors, often in combination. Healthdirect lists atherosclerosis, diabetes, high blood pressure, high cholesterol, low testosterone, some medicines, alcohol, smoking, stress and anxiety. The cause is not always clear, so a practitioner takes a history and may order blood tests to find it.
How to help a man with ED?
Healthy Male suggests raising it outside the bedroom when you are both relaxed, keeping it about the two of you rather than blame, and encouraging a visit to a doctor. Erectile dysfunction is often an early sign of heart disease or diabetes, so a check matters beyond sex. Intimacy without penetrative sex is still intimacy.
How to deal with erectile dysfunction in a relationship?
Healthy Male says erectile dysfunction affects both people in a relationship, and that how you talk about it matters as much as how it gets treated. Healthy Male advises against pushing for an instant fix, since working out the cause takes a few steps. If it is straining the relationship, a psychologist or sexual health therapist can help you both, and a GP can refer you.
Can erectile dysfunction be treated?
Yes, treatment options exist, although healthdirect notes that erectile dysfunction cannot always be removed completely. A practitioner first treats any underlying condition, then considers lifestyle changes, counselling and medical treatment options. More than one approach may be needed, and outcomes vary between individuals.
Can erectile dysfunction be assessed online in Australia?
Yes. An Australian-registered doctor or nurse practitioner can take your history through an online consultation, ask about your symptoms and general health, and decide whether treatment is suitable or whether you need blood tests or an in-person examination first. Burst Health connects you with a registered practitioner for that assessment. The practitioner makes the decision, not the website.
Erectile dysfunction treatment, online
In three steps.
- 1Answer a quick questionnaireOnline, no appointment, no in-person visit.
- 2A practitioner reviews itAn Australian-registered doctor or nurse practitioner decides whether treatment is suitable for you.
- 3Start your planIf treatment is suitable, you start your plan with the practitioner supporting you throughout.
References
Healthdirect Australia. Erectile dysfunction - symptoms and treatment (last reviewed February 2025).
Healthy Male. Erectile dysfunction: Causes, diagnosis and treatment.
Healthy Male. Why erectile dysfunction is a major red flag for cardiovascular disease.
This article is general information only and is not medical advice. Please speak with a registered Australian healthcare practitioner about your own situation.