Men's health guide
Erectile Dysfunction: A Plain Guide to Causes and Care
Erectile dysfunction means trouble getting or keeping an erection firm enough for sex. It affects 30 million to 50 million US men, but it is not a routine part of aging. Common causes include diabetes, heart disease, some medicines, stress and smoking. ED can be an early sign of heart disease, so see a doctor.
Written by the Vapofil editorial teamUpdated
The basics
What is erectile dysfunction?
Erectile dysfunction, or ED, is a condition that makes it hard to get or keep an erection firm enough for sex (NIDDK, ED facts).
NIDDK estimates that 30 million to 50 million men in the United States have ED. About 40% of men are affected at age 40, and 70% report it by age 70. Even so, NIDDK says ED is not a routine part of getting older (NIDDK, ED facts). It usually has a cause that can be found.
Causes
What causes erectile dysfunction?
An erection depends on blood vessels, nerves, hormones and mood working together. NIDDK sorts the causes into four groups.
Health conditions
Diabetes, heart disease, high blood pressure, nerve damage, low testosterone and thyroid problems (NIDDK, ED causes).
Side effects of drugs
Some antidepressants, blood pressure medicines, diuretics and sedatives (NIDDK, ED causes).
Stress and emotions
Anxiety, depression, stress and relationship strain can all play a part (NIDDK, ED causes).
Lifestyle
Smoking, heavy drinking and too little activity raise the risk (NIDDK, ED facts) (NIDDK, ED causes).
Often more than one cause is at work. Medicines and conditions that call for extra care with supplements are on the side effects page.
The heart link
Is ED an early sign of heart disease?
It can be. The American Urological Association calls ED a risk marker for heart and blood vessel disease, and says men with ED should be checked for it (AUA, ED guideline). NIDDK lists diabetes and heart disease among the most common causes (NIDDK, ED causes).
An erection problem can be the first sign of heart disease or diabetes. That makes it worth a doctor visit, not just a quick fix.
Risk factors
Which ED risk factors can you change?
Some risks are fixed. Many respond to everyday changes that also protect the heart.
| Risk factor | Can you change it? | What the sources advise |
|---|---|---|
| Smoking | Yes | Quit; NIDDK and Mayo Clinic both list it first |
| Extra weight | Yes | Mayo Clinic says being overweight can cause ED or make it worse |
| Too little activity | Yes | CDC: 150 minutes a week plus 2 days of strength work |
| Heavy drinking | Yes | NIDDK advises limiting alcohol |
| Short sleep | Yes | CDC: 7 or more hours a night for most adults |
| Diabetes, heart disease | Often managed | Regular care and treatment from your doctor |
| Age | No | Risk rises with age, but ED is not a normal part of aging |
The visit
What will a doctor check for ED?
The visit starts with a conversation. A doctor takes a medical, sexual and mental health history, and asks about medicines, vitamins and supplements (NIDDK, ED diagnosis).
History and exam
Questions about your health, your habits and when the problem started. A short physical exam often follows.
Blood tests
Tests may check blood sugar, thyroid and prostate markers (NIDDK, ED diagnosis). If low testosterone is suspected, the AUA advises two early-morning tests on separate days, with below 300 ng/dL as the usual cut-off (AUA, Testosterone deficiency guideline).
More tests, if needed
Some men need an ultrasound of blood flow or an overnight erection test (NIDDK, ED diagnosis).
When to act
When should you see a doctor about ED right away?
Most ED is not an emergency. A few signs are. Tick what applies to you.
Treatment
What treatments for erectile dysfunction work?
Doctors start with the cause and the habits, then add medicine if needed.
- 1Start hereStrong advice from the AUA and NIDDK
- A checkup for heart disease and diabetesED can be the first sign(AUA, ED guideline) (NIDDK, ED causes)
- Quit smoking(NIDDK, ED treatment) (Mayo Clinic, ED treatment)
- Move more150 minutes a week(NIDDK, ED treatment) (CDC, Physical activity for adults)
- Reach a healthy weight(Mayo Clinic, ED treatment)
- Limit alcohol(NIDDK, ED treatment)
- 2Prescription optionsTested drugs, approved by the FDA, prescribed by a doctor
- PDE5 inhibitor pillsnever with nitrates(AUA, ED guideline) (MedlinePlus, Sildenafil)
- Testosterone therapyonly for confirmed deficiency(AUA, Testosterone deficiency guideline)
- Help for stress or anxietya known cause(NIDDK, ED causes)
- 3Limited evidenceSmall or mostly animal studies
- Tongkat ali, 100-200 mg extractmild hormone rises if low(LiverTox, Tongkat ali) (Leisegang 2022, Tongkat ali meta-analysis)
- Horny goat weedlab and animal data(MSKCC, Epimedium) (LiverTox, Horny goat weed)
VapofilHolds 10 mg of tongkat ali extract and 8 mg of horny goat weed extract, far below the studied amounts, and the product itself has never been tested.
- 4AvoidWarned against by FDA or NIDDK
- "Herbal" sexual products with hidden drugsFDA warnings(FDA, Hidden drug notice) (NCCIH, Sexual enhancement supplements)
- ED pills ordered online without a doctor(NIDDK, ED treatment)
Based on the 2018 American Urological Association ED guideline (AUA, ED guideline), NIDDK (NIDDK, ED treatment) and NCCIH (NCCIH, Sexual enhancement supplements). Your doctor can tell you which steps fit your health and your other medicines.
Prescription PDE5 inhibitors are oral medicines that improve blood flow (NIDDK, ED treatment). The AUA guideline says men should be told about them unless their health rules them out (AUA, ED guideline). Mayo Clinic says treating normal aging with testosterone therapy is not advisable (Mayo Clinic, Testosterone and aging).
Supplements
Do supplements like Vapofil help ED?
No supplement has earned that claim. NCCIH says there is no definite evidence that any herbal product is safe or effective for ED, and much of the research is in animals (NCCIH, Sexual enhancement supplements). Some products sold for sexual enhancement also hide prescription drugs.
Vapofil is a dietary supplement, not an ED treatment. It holds small amounts of seven herbs and minerals, and no trial has tested it. See how it stacks up on the ED options comparison. The sales page makes sexual and hormone claims we do not repeat; they are checked on the sales claims page.
NIDDK advises talking with a health care professional before using any dietary supplement for ED, because interactions can cause serious side effects (NIDDK, ED treatment).
Talking about it
How do you talk about ED with a partner?
Choose a calm moment, away from the bedroom, and keep it simple and honest.
- Say that ED is common and usually has a cause.
- Explain that you plan to see a doctor, and why the heart link matters.
- Ask whether your partner would like to come to the visit.
FAQ
Erectile dysfunction FAQ
Is erectile dysfunction normal with age?
ED gets more common with age, but it is not a normal part of aging. NIDDK says about 40% of men have it at 40 and 70% by 70. It usually has a cause, such as diabetes, heart disease, a medicine or stress, and many of those causes can be treated.
Can stress cause erectile dysfunction?
Yes. NIDDK lists mental and emotional issues, including anxiety, depression and stress, among the main causes of ED. Stress often mixes with physical causes, so a doctor can check both and suggest help, such as counseling, alongside other care.
Can medicines cause ED?
Yes. NIDDK names some antidepressants, blood pressure medicines, diuretics and sedatives as possible causes. Do not stop a prescribed medicine on your own. Ask the doctor who prescribed it whether a different drug or dose could help.
Is ED a sign of low testosterone?
Sometimes, but not usually on its own. Low testosterone is one of several causes NIDDK lists. The AUA diagnoses it only when two early-morning blood tests are low, usually under 300 ng/dL, and symptoms are present. Heart and blood vessel causes are more common.
What tests are done for erectile dysfunction?
Most men need a health history, a physical exam and blood tests. NIDDK says tests can include blood sugar, thyroid and prostate checks, and sometimes an ultrasound of blood flow or an overnight erection test. Your doctor picks tests based on your history.
Do herbal supplements help erectile dysfunction?
No herbal product has definite evidence of safety or benefit for ED, according to NCCIH. Much of the research was done in animals, and some products sold for sexual enhancement were found to hide prescription drugs. Talk with your doctor before trying any supplement.
Who wrote this
Written and reviewed by
Plain-language pages built from the label, the sales page and linked public health sources.
Last updated . Our editorial standards explain how we check reviews. This website is run by Vapofildaily, a U.S. stocking partner for Vapofil, not by the manufacturer or the distributor named on the label. Purchases through our order links earn us a commission.
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