Impotence
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Try one of these related symptoms.
Premature ejaculation
Impotence
Delayed ejaculation
Low libido
No sex drive
Losing erection with new partner
Sudden loss of erection
Unable to maintain an erection
Difficulty maintaining erection
About the Symptom
Erectile dysfunction or impotence describes consistent and recurrent inability to achieve or maintain an erection firm enough for sex.
When to See a Doctor
Seek professional care if you experience any of the following symptoms
- Numbness / sensory disorder
- double vision
- Headache
- Abnormal sensation (tingling, prickling)
- Difficulty breathing / breathlessness
- Muscle weakness in the limbs
Possible Causes
Generally, Impotence can be related to:
- Erectile Dysfunction
Idiopathic erectile dysfunction is a sexual dysfunction in which the penis fails to become or remain erect during sexual activity. Idiopathic means the cause is unknown.
- Low Testosterone
Low testosterone, or late-onset hypogonadism, is a condition characterized by reduced levels of testosterone in aging males, leading to symptoms such as fatigue, reduced libido, depression, and decreased muscle mass.
- Hyperprolactinemia
Excessively high prolactin (hormone that releases milk) levels in the blood. Causes include medications and brain tumors.
- Depression
- Bipolar Disorder
- Familial Amyloid Polyneuropathy
- Adjustment Disorder
- Pituitary Adenoma
- Multiple Sclerosis (MS)
- Striatal Substantia Nigra Degeneration
Doctor's Diagnostic Questions
Your doctor may ask these questions to check for this symptom:
- Are you worried about your sexual performance because you can't get or keep an erection for sex?
- How long have you had difficulty achieving or maintaining an erection?
- How is your difficulty achieving or maintaining an erection now?
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Nao Saito, MD (Urology)
After graduating from Tokyo Women's Medical University School of Medicine, Dr. Saito worked at Tokyo Women's Medical University Hospital, Toda Chuo General Hospital, Tokyo Women's Medical University Yachiyo Medical Center, and Ako Chuo Hospital before becoming Deputy Director (current position) at Takasaki Tower Clinic Department of Ophthalmology and Urology in April 2020.
Content updated on Feb 6, 2025
Following the Medical Content Editorial Policy
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This questionnaire is customized to your situation and symptoms, including the following personal information:
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History - considers past illnesses, surgeries, family history, and lifestyle choices.
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- Inability to maintain an erection
- Difficulty keeping erection
- Experiencing dysfunction or difficulties with the functioning of the penis
- My penis is not standing
- Trouble getting erection
Find Similar Symptoms
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FAQs
Q.
Can’t Reach Orgasm? Why Your Body Is Non-Responsive & Medical Next Steps
A.
Trouble reaching orgasm is common and often treatable; causes include stress and mental health factors, antidepressants and other medications, hormone shifts, aging-related changes, relationship or technique mismatches, and nerve or blood flow problems from conditions like diabetes or after pelvic surgery. If it is persistent, new, distressing, or paired with pain, numbness, reduced sensation, erectile changes, or other health symptoms, see a clinician who can review your history and meds, examine you, and order targeted labs such as testosterone, thyroid, glucose, and prolactin to guide treatment like medication adjustments, counseling or sex therapy, hormone care, pelvic floor therapy, and lifestyle changes. There are several factors to consider, and important details that could change your next steps, including when to seek urgent care, are covered below.
References:
* Shifren, J. L., & Segraves, R. T. (2017). Male Anorgasmia: A Systematic Review of Etiology and Treatment. *Journal of Sexual Medicine*, 14(7), 981–987. https://pubmed.ncbi.nlm.nih.gov/28526553/
* De Sante, L. A., & Clayton, A. H. (2018). Sexual dysfunction in depression and anxiety. *Progress in Neuro-Psychopharmacology & Biological Psychiatry*, 84(Pt A), 46–53. https://pubmed.ncbi.nlm.nih.gov/28859942/
* Komisaruk, B. R., Wise, R. D., & Whipple, B. (2020). The neurobiology of orgasm: current understanding and future directions. *Sexual Medicine Reviews*, 8(1), 166–173. https://pubmed.ncbi.nlm.nih.gov/31662241/
* Worsley, R., Goldmeier, D., & Pfaus, J. G. (2021). Female Orgasm Dysfunction: A Contemporary Review. *Sexual Medicine Reviews*, 9(3), 398–410. https://pubmed.ncbi.nlm.nih.gov/33931327/
* Shifren, J. L., & Al-Safi, Z. A. (2023). Diagnosis and Treatment of Female Sexual Dysfunction: A Review. *Current Sexual Health Reports*, 15(3), 141–152. https://pubmed.ncbi.nlm.nih.gov/37602073/
Q.
Is It Just Stress? Why Your Penis Is ‘Misfiring’ & Medically Proven Next Steps
A.
There are several factors to consider. Stress can make your penis misfire in the moment, but frequent or persistent issues, fewer morning erections, or risks like diabetes, high blood pressure, high cholesterol, obesity, or smoking often point to physical causes such as blood flow, nerve, hormone, or medication effects, and ED can be an early sign of cardiovascular disease; see the complete explanation below. Medically proven next steps include an honest self check or symptom screener, timely discussion with a doctor for evaluation and labs, lifestyle improvements, addressing stress or performance anxiety, and considering FDA approved medications when appropriate, with urgent care for chest pain, a prolonged erection, or sudden neurologic symptoms. Important exceptions and how to choose your best next step are detailed below.
References:
* Shamloul R, Ghanem H. Psychological Distress and Erectile Dysfunction: A Narrative Review. Sex Med Rev. 2022 Jan;10(1):64-70. doi: 10.1016/j.sxmr.2021.08.003. Epub 2021 Sep 10. PMID: 35010620; PMCID: PMC8719588.
* Yafi FA, Shiers SM, Kan-Dydo J, Sayegh N, Sadek F, Shahrour W, Azizi M, Jani S, Perito P, Ziegelmann MJ, Albersen M, Hatzimouratidis K. Update on the mechanisms of erectile dysfunction. Transl Androl Urol. 2021 Aug;10(8):3613-3626. doi: 10.21037/tau-20-1377. PMID: 34509503; PMCID: PMC8419614.
* Raheem OA, Kumi-Diaka J, Raheem T, Daly S, Alrabeeah K, Al-Awadi B, El-Bardisi H. Erectile dysfunction: Aetiology, diagnosis and treatment. Transl Androl Urol. 2017 Oct;6(5):764-771. doi: 10.21037/tau.2017.06.31. PMID: 29061014; PMCID: PMC5642878.
* Burnett AL, Nehra A, Breau RH, Cohan P, Das S, Katz D, MacMahon DR, Miner M, Nelson CJ, Sadeghi-Nejad H, Shindel AW, Sigman M. Erectile Dysfunction: AUA Guideline. J Urol. 2018 Sep;200(3):633-641. doi: 10.1016/j.juro.2018.06.004. Epub 2018 Jun 15. PMID: 29909260.
* Capogrosso P, Ventimiglia E, Cakir OO, Montorsi F. Management of Erectile Dysfunction. Eur Urol Focus. 2020 May 15;6(3):398-406. doi: 10.1016/j.euf.2020.03.006. Epub 2020 Mar 27. PMID: 32379377.
Q.
Sex Feels Like a Chore? Why Your Internal Engine Is Stalling
A.
There are several factors to consider. When sex starts to feel like a chore, it often reflects common, treatable issues like chronic stress, hormonal shifts, erectile dysfunction, mental health or relationship strain, or medical conditions that affect blood flow, including diabetes, thyroid disease, sleep apnea, and early heart problems. See below for key red flags and practical next steps, from improving sleep and exercise, addressing health conditions, reducing alcohol and smoking, and honest partner communication, to when to see a doctor and which treatments or an ED symptom check may help.
References:
* Samadi A, Khera M. Causes of Low Libido in Men: A Systematic Review. Sex Med Rev. 2022 Oct 28:S2050-1161(22)00078-X. doi: 10.1016/j.sxmr.2022.09.006. Epub ahead of print. PMID: 36368403.
* Maric I, Saletto F, Muggia C, Papini D, Di Lorenzo G. Hypoactive Sexual Desire Disorder in Premenopausal Women: Current Therapies and Emerging Drugs. Int J Mol Sci. 2023 Aug 24;24(17):13233. doi: 10.3390/ijms241713233. PMID: 37622668; PMCID: PMC10488185.
* Nassan F, Zant N, Abushab S, Oyelami E, Batur P. Sex Hormones and Sexual Function: A Narrative Review. Curr Opin Endocrinol Diabetes Obes. 2023 May 16. doi: 10.1097/MED.0000000000000832. Epub ahead of print. PMID: 37375267.
* Sarzi-Puttini P, Tassan Din C, Di Venere MM, Cassiello F, Cerni V, Papi A, Burlina A, Bini C, Santilli F, Tola MR. Sexual dysfunction in the context of stress: A systematic review. Int J Environ Res Public Health. 2022 Jun 21;19(12):7584. doi: 10.3390/ijerph19127584. PMID: 35741697; PMCID: PMC9224376.
* Mura G, Sanna L, Contu A, Casu F, Sani G, Fadda V. Chronic Diseases and Sexual Dysfunction: A Narrative Review of the Literature. Int J Environ Res Public Health. 2023 Aug 9;20(16):6560. doi: 10.3390/ijerph20166560. PMID: 37571344; PMCID: PMC10454370.
Q.
Can smoking weed everyday cause erectile dysfunction?
A.
Some studies suggest that daily cannabis use may be linked to a greater chance of experiencing erectile dysfunction, though effects can differ from person to person.
References:
Pizzol D, Demurtas J, Stubbs B, Soysal P, Mason C, Isik AT, Solmi M, Smith L, Veronese N. Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Mens Health. 2019 Nov-Dec;13(6):1557988319892464. doi: 10.1177/1557988319892464. PMID: 31795801; PMCID: PMC6893937.
Shiff B, Blankstein U, Hussaen J, Jarvi K, Grober E, Lo K, Lajkosz K, Krakowsky Y. The impact of cannabis use on male sexual function: A 10-year, single-center experience. Can Urol Assoc J. 2021 Dec;15(12):E652-E657. doi: 10.5489/cuaj.7185. PMID: 34171210; PMCID: PMC8631840.
Q.
Does baking soda and apple cider vinegar help with erectile dysfunction?
A.
There is no strong medical evidence that baking soda and apple cider vinegar can treat erectile dysfunction.
References:
Hadzic M, Eckstein ML, Schugardt M. The Impact of Sodium Bicarbonate on Performance in Response to Exercise Duration in Athletes: A Systematic Review. J Sports Sci Med. 2019 Jun 1;18(2):271-281. PMID: 31191097; PMCID: PMC6544001.
Jafarirad S, Elahi MR, Mansoori A, Khanzadeh A, Haghighizadeh MH. The improvement effect of apple cider vinegar as a functional food on anthropometric indices, blood glucose and lipid profile in diabetic patients: a randomized controlled clinical trial. Front Clin Diabetes Healthc. 2023 Nov 13;4:1288786. doi: 10.3389/fcdhc.2023.1288786. PMID: 38028980; PMCID: PMC10679383.
Q.
Does diabetes cause erectile dysfunction?
A.
Yes, diabetes is a common cause of erectile dysfunction because high blood sugar can damage nerves and blood vessels needed for a strong erection.
References:
Ledda A. Diabetes, hypertension and erectile dysfunction. Curr Med Res Opin. 2000;16 Suppl 1:s17-20. doi: 10.1185/0300799009117035. PMID: 11329816.
Bahar A, Elyasi F, Moosazadeh M, Afradi G, Kashi Z. Sexual dysfunction in men with type II diabetes. Caspian J Intern Med. 2020 May;11(3):295-303. doi: 10.22088/cjim.11.3.295. PMID: 32874437; PMCID: PMC7442469.
Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev. 2022 Feb;38(2):e3494. doi: 10.1002/dmrr.3494. Epub 2021 Sep 21. PMID: 34514697; PMCID: PMC9286480.
Q.
Does masturbation cause erectile dysfunction?
A.
No, masturbation by itself does not cause erectile dysfunction; it is generally considered a normal sexual activity.
References:
Rowland DL, Castleman JM, Bacys KR, Csonka B, Hevesi K. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res. 2023 Sep;35(6):548-557. doi: 10.1038/s41443-022-00596-y. Epub 2022 Jul 15. PMID: 35840678.
Q.
Does porn cause erectile dysfunction?
A.
Some research shows that heavy use of online pornography may be linked with erectile dysfunction, but it is not proven that porn directly causes ED since many factors can influence sexual function.
References:
Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):E55. doi: 10.3390/bs8060055. PMID: 27527226; PMCID: PMC5039517.
Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill. 2021 Oct 21;7(10):e32542. doi: 10.2196/32542. PMID: 34534092; PMCID: PMC8569536.
Adarsh H, Sahoo S. Pornography and Its Impact on Adolescent/Teenage Sexuality. Journal of Psychosexual Health. 2023;5(1):35-39. doi:10.1177/26318318231153984
Q.
How long after quitting smoking does erectile dysfunction improve?
A.
Many studies show that some improvement in erectile dysfunction can begin within a few weeks of quitting smoking, with greater benefits appearing over several months.
References:
Guay AT, Perez JB, Heatley GJ. Cessation of smoking rapidly decreases erectile dysfunction. Endocr Pract. 1998 Jan-Feb;4(1):23-6. doi: 10.4158/EP.4.1.23. PMID: 15251760.
Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004 Dec;94(9):1310-3. doi: 10.1111/j.1464-410X.2004.05162.x. PMID: 15610111.
Q.
How much does erectile dysfunction surgery cost?
A.
Erectile dysfunction surgery, such as penile prosthesis implantation, can cost anywhere from around $10,000 to over $30,000, depending on many factors.
References:
Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. Eur Urol Focus. 2022 May;8(3):803-813. doi: 10.1016/j.euf.2021.05.003. Epub 2021 May 24. PMID: 34034995.
Nguyen V, McGovern AM, Rojanasarot S, Patel DP, Bhattacharyya S, Hargens LM, Aworunse O, Hsieh TC. Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis. Int J Impot Res. 2025 Jan;37(1):45-50. doi: 10.1038/s41443-024-00903-9. Epub 2024 Jun 26. PMID: 38926632; PMCID: PMC11706773.
Q.
How much is the cost of injections for erectile dysfunction?
A.
The cost of injections for erectile dysfunction can vary widely—ranging from a few hundred dollars per session to over a thousand dollars—depending on the treatment type, frequency, and insurance coverage.
References:
Sun P, Seftel A, Swindle R, Ye W, Pohl G. The costs of caring for erectile dysfunction in a managed care setting: evidence from a large national claims database. J Urol. 2005 Nov;174(5):1948-52. doi: 10.1097/01.ju.0000176739.44725.49. PMID: 16217364.
Britt D, Blankstein U, Lenardis M, Millman A, Grober E, Krakowsky Y. Availability of platelet-rich plasma for treatment of erectile dysfunction and associated costs and efficacy: A review of current publications and Canadian data. Can Urol Assoc J. 2021 Jun;15(6):202-206. doi: 10.5489/cuaj.6947. PMID: 33212009; PMCID: PMC8195577.
Masterson TA et al. Platelet-rich plasma for the treatment of erectile dysfunction: A prospective, randomized, double-blind, placebo-controlled clinical trial. _J Urol_ 2023 Jul; 210:154.
Q.
What are the most likely drugs to cause erectile dysfunction?
A.
Drugs used to treat high blood pressure—like beta blockers and diuretics—are some of the most common medicines linked with causing erectile dysfunction, along with certain antidepressants.
References:
Kaplan-Marans E, Sandozi A, Martinez M, Lee J, Schulman A, Khurgin J. Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Sex Med. 2022 Oct;10(5):100543. doi: 10.1016/j.esxm.2022.100543. Epub 2022 Jul 14. PMID: 35843193; PMCID: PMC9537247.
Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023 Nov 3;19:691-705. doi: 10.2147/VHRM.S439334. PMID: 37941540; PMCID: PMC10629452.
Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023 Nov 3;19:691-705. doi: 10.2147/VHRM.S439334. PMID: 37941540; PMCID: PMC10629452.
Q.
What are the worst foods for erectile dysfunction?
A.
Foods that are high in unhealthy fats, added sugars, and heavily processed ingredients—like fast food, fried items, and processed meats—are linked with an increased risk of erectile dysfunction.
References:
Agarwal, S. K. (2022). The Role of Diet in the Pathogenesis of Erectile Dysfunction. _Cardiology and Angiology: An International Journal_, _11_(2), 19–30. https://doi.org/10.9734/ca/2022/v11i230191
Bauer SR, Breyer BN, Stampfer MJ, Rimm EB, Giovannucci EL, Kenfield SA. Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study. JAMA Netw Open. 2020 Nov 2;3(11):e2021701. doi: 10.1001/jamanetworkopen.2020.21701. PMID: 33185675; PMCID: PMC7666422.
Q.
What is porn induced erectile dysfunction?
A.
Porn induced erectile dysfunction is a term used when watching too much pornography is thought to make it harder for some men to initiate or maintain an erection in real-life situations.
References:
Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):E55. doi: 10.3390/bs8060055. PMID: 27527226; PMCID: PMC5039517.
Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill. 2021 Oct 21;7(10):e32542. doi: 10.2196/32542. PMID: 34534092; PMCID: PMC8569536.
Adarsh H, Sahoo S. Pornography and Its Impact on Adolescent/Teenage Sexuality. Journal of Psychosexual Health. 2023;5(1):35-39. doi:10.1177/26318318231153984
Q.
What is the best drink for erectile dysfunction?
A.
No single drink is a magic cure for erectile dysfunction, but some drinks—like pomegranate juice, green tea, and watermelon juice—may help improve blood flow and overall health, which can support erectile function.
References:
Neves D, Assunção M, Marques F, Andrade JP, Almeida H. Does regular consumption of green tea influence expression of vascular endothelial growth factor and its receptor in aged rat erectile tissue? Possible implications for vasculogenic erectile dysfunction progression. Age (Dordr). 2008 Dec;30(4):217-28. doi: 10.1007/s11357-008-9051-6. Epub 2008 Apr 18. PMID: 19424845; PMCID: PMC2585648.
Rahimi HR, Arastoo M, Ostad SN. A Comprehensive Review of Punica granatum (Pomegranate) Properties in Toxicological, Pharmacological, Cellular and Molecular Biology Researches. Iran J Pharm Res. 2012 Spring;11(2):385-400. PMID: 24250463; PMCID: PMC3832175.
Rotimi DE, Asaleye RM. Impact of Watermelon (Citrallus lanatus) on Male Fertility. JBRA Assist Reprod. 2023 Jul 7;27(4):702–8. doi: 10.5935/1518-0557.20220075. Epub ahead of print. PMID: 37417854; PMCID: PMC10718552.
Q.
What level of spinal cord injury leads to erectile dysfunction?
A.
Erectile function is mostly affected when the injury involves the sacral segments (S2-S4) of the spinal cord, since these segments control the reflex needed for an erection.
References:
Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016 Feb;5(1):88-101. doi: 10.3978/j.issn.2223-4683.2016.01.07. PMID: 26904415; PMCID: PMC4739980.
Sinha V, Elliott S, Ibrahim E, Lynne CM, Brackett NL. Reproductive Health of Men with Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2017 Winter;23(1):31-41. doi: 10.1310/sci2301-31. PMID: 29339875; PMCID: PMC5340507.
Alexander MS, Aisen CM, Alexander SM, Aisen ML. Sexual concerns after Spinal Cord Injury: An update on management. NeuroRehabilitation. 2017;41(2):343-357. doi: 10.3233/NRE-172202. PMID: 29036845.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Irwin GM. Erectile Dysfunction. Prim Care. 2019 Jun;46(2):249-255. doi: 10.1016/j.pop.2019.02.006. Epub 2019 Apr 1. PMID: 31030826.
https://www.sciencedirect.com/science/article/abs/pii/S0095454319300090?via%3DihubShamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013 Jan 12;381(9861):153-65. doi: 10.1016/S0140-6736(12)60520-0. Epub 2012 Oct 5. PMID: 23040455.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60520-0/fulltextMobley DF, Khera M, Baum N. Recent advances in the treatment of erectile dysfunction. Postgrad Med J. 2017 Nov;93(1105):679-685. doi: 10.1136/postgradmedj-2016-134073. Epub 2017 Jul 27. PMID: 28751439.
https://pmj.bmj.com/content/93/1105/679Ludwig W, Phillips M. Organic causes of erectile dysfunction in men under 40. Urol Int. 2014;92(1):1-6. doi: 10.1159/000354931. Epub 2013 Nov 21. PMID: 24281298.
https://www.karger.com/Article/FullText/354931Erectile dysfunction (impotence)
https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/