Erectile dysfunction is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance and it affects 30% to 50% of adult men aged 40 to 79. It can be classified into psychogenic and organic types, with the latter including neurogenic, vasculogenic, and iatrogenic causes.

Men with erectile dysfunction may struggle to achieve or maintain an erection, and symptoms vary between organic and psychogenic causes. Additional signs can include lower urinary tract symptoms, penile deformities, prostate disease, and hypogonadism.

Erectile dysfunction (ED) is diagnosed through a comprehensive evaluation that includes a medical, sexual, and psychosocial history, physical examination, and laboratory tests, along with validated questionnaires like the International Index of Erectile Function (IIEF). In some cases, specialized tests such as vascular testing, nocturnal penile tumescence, and neuropsychological testing may also be conducted.

The main medical treatments for erectile dysfunction include phosphodiesterase-5 inhibitors (PDE5Is) like sildenafil and tadalafil, which are often combined with testosterone therapy. Other options include vasodilators, low-intensity extracorporeal shockwave therapy, vacuum erection devices, psychosexual counseling, cognitive behavioral therapy (CBT), vascular surgery, and penile prostheses; the the strongest evidence supports CBT, alprostadil injections, and penile implants.

Several supplements have been studied for erectile dysfunction — including ginseng, saffron, Tribulus terrestris, Pycnogenol, maca, and Tongkat ali — and may improve ED symptoms, though evidence is limited. Additionally, L-arginine, especially when combined with other compounds like citrulline or yohimbine, has been shown to enhance erectile function.

Diets such as the Mediterranean and plant-based diets — which are rich in fruits, vegetables, nuts, and fish and low in red meat and processed foods — are associated with a lower risk of erectile dysfunction (ED). However, the relationship between diet and ED may diminish when considering factors like age and BMI, and weight loss from various diet types can improve erectile function in men with diabetes or obesity.

Weight loss through diet, physical activity, or bariatric surgery can improve erectile dysfunction (ED) in men with obesity, and moderate-to-vigorous exercise has been shown to enhance erectile function. Additionally, emerging experimental treatments for ED include gene therapy, stem cell therapy, and various other innovative therapies.

Erectile dysfunction (ED) can be caused by various factors, including deficits in nitric oxide release, nerve signaling issues, vascular diseases, hormonal imbalances, and certain medications. Psychological factors such as stress and anxiety can also contribute to ED, making it a multifaceted condition.