Understanding ED

Understanding ED

Erectile dysfunction (ED) can be equally devastating for a man and his partner. There is hope for every man with ED to regain the confidence, control and wholeness to enjoy an active, satisfying sex life.

Did You Know?

The prevalence of ED in men over age 40 increases with age.2

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Erectile Dysfunction: A Men's Health Issue

Life can get in the way of a rock-hard erection: stress, anxiety and outside factors play a role. Occasional erectile dysfunction (ED) is a common condition that affects many men and impacts their partners. Many men experience it during times of stress. Once these problems are managed, you should return to smooth sailing in the bedroom; but continued problems getting or keeping an erection may indicate a more serious health condition.

ED is defined as the inability to achieve or maintain an erection that is firm enough to have sexual intercourse.6 In other words, the penis doesn’t get hard enough to allow you to have sex. It may begin in the bedroom, but it can have a profound effect on a man, his self-esteem and his relationships.7

How an Erection Works72

When aroused, the nerves surrounding the penis become active. The muscles around the arteries relax and more blood flows into the penis. This additional blood makes the penis stiff and hard, or erect. The erection tightens the veins so the blood can’t leave the penis, enabling the penis to remain erect.


Erection Hardness Scale: How hard is hard enough?

This Erection Hardness Scale73 may help you and your partner identify if ED is suspected. The measure is done when the erection is active. Note food analogies are for illustrative purposes only.73 If you can’t achieve a Grade 4 erection more than 50% of the time, talk with your GP or urologist about the problem.

Penis is larger but not hard.

Peeled Banana
Penis is hard but not hard enough for penetration.
Unpeeled Banana
Penis is hard enough for penetration but not completely hard.
Penis is completely hard and fully rigid.

Signs, Symptoms and Causes

You may be surprised when you experience ED for the first time.  ED can manifest in multiple ways, signs of ED include:48

  • A significant increase in the amount of time it takes to achieve an erection.
  • Difficulty maintaining an erection long enough to have intercourse.
  • Decreased frequency of spontaneous erections.

In fact, more than half of men over 40 suffer from some degree of ED.1 If you can’t get an erection more than 50% of the time, you should see your GP or a urologist.

One Condition, Many Causes

ED happens when blood flow to the penis is limited or nerves are damaged.  There are several possible causes physical and/or psychological reasons for ED, some common causes include: 1, 7-9, 46-47

  • Prostate cancer treatment, trauma to the pelvic area can cause nerve and vascular damage.
  • Diabetes, which can compromise the blood flow to the penis.
  • Cardiovascular problems including high blood pressure and heart disease, can compromise the blood flow to the penis.
  • Other surgery (prostate, bladder, colon, rectal), trauma to the pelvic area can cause nerve and vascular damage.
  • The side effects of some medications,1, 9 including some for high. blood pressure and antidepressants can interfere with blood flow to the penis.
  • Lifestyle choices (smoking, excessive alcohol, obesity, lack of exercise, stress, lack of sleep), can also affect your performance.
  • Spinal cord injuries.
  • Hormone problems.
  • Depression and anxiety.
  • Men with ED can also have Peyronie’s disease, and ED can sometimes be a symptom of low testosterone.

In other words, ED affects men of every ethnicity, age and lifestyle.

Understand how ED affects partner and couples.

ED is a difficult topic for couples to discuss. Talking openly can help reduce stress and improve your relationship. Acknowledge your feelings, reassure each other and resolve to work through the problem, together.

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Talking about ED can change your life.

Recovery can start with a simple question. Millions of couples deal with this and you can, too.

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Treatment Options for ED

ED is treatable at any age.  Treating the underlying cause of ED is a good place to start, such as adjusting your lifestyle, quitting smoking and reducing your stress. Oral medications are typically the first line of therapy, but some men may need more. Medications are typically followed by one or more of these treatments:  vacuum devices, penile implants or penile injections.

Questions to Ask

Helpful hints on how to start the conversation with your GP or urologist, and other useful resources.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.  All images are the property of Boston Scientific. All trademarks are the property of their respective owners.

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