What is erectile dysfunction? Causes, signs and treatment

This guide covers what ED is, the symptoms to look out for, how common it is at each age, why it matters for your heart, how a doctor works out the cause, and every treatment option, from lifestyle changes and tablets to devices and surgery. It is written for men in the Philippines, so it also covers privacy, cost and how to see a doctor here.

What is erectile dysfunction?

Erectile dysfunction is a persistent difficulty getting or keeping an erection that is firm enough for satisfying sex. Doctors call it ED when the problem happens regularly, usually for at least a few months, rather than on an occasional night.

The European Association of Urology (EAU) defines ED as the persistent inability to attain and maintain an erection sufficient for satisfactory sexual performance. "Persistent" is the key word. Almost every man has the odd night when an erection does not happen, usually because of tiredness, stress or alcohol. That is not a medical condition.

ED is also different from three things it is often confused with:

• Low desire. ED is about the erection, not about wanting sex. Many men with ED have normal desire. Low desire is more often linked to hormones, mood or relationship strain.
• Premature ejaculation. Climaxing sooner than you want is a separate condition, although the two often appear together. Our guide to premature ejaculation covers it.
• Infertility. ED does not mean you cannot father a child. Sperm production is a separate process.

Is impotence the same as erectile dysfunction?

Yes. Impotence is the older term for the same condition, and doctors now prefer "erectile dysfunction" because it describes the problem precisely and carries less stigma.

You will still see "impotence" on older websites, in some medicine leaflets and in everyday speech. Searching for either term leads to the same information.

What does impotent mean in Tagalog?

There is no single everyday Tagalog word for impotence. Filipinos usually describe it: hindi tinitigasan, hindi tumitigas ang ari, or nawawala ang tigas. You may also hear the clinical phrase kawalan ng kakayahang tumigas.

One common mix-up is baog. Baog means infertile or sterile, which is about having children, not about erections. A man with ED is usually not baog, and a man who is baog usually has normal erections. If you prefer reading in Taglish, our page Hindi tumitigas: mga dahilan at solusyon covers the causes.

How does an erection work?

An erection is a blood flow event controlled by nerves. When you are aroused, nerves release a chemical called nitric oxide, the blood vessels in the penis relax, and blood fills two sponge-like chambers until the tissue traps it there.

Step by step:

1. Arousal. The brain responds to touch, thoughts or sight and sends signals down the spinal cord.
2. Nerve signal. Nerves in the pelvis release nitric oxide into the erectile tissue.
3. Relaxation. Nitric oxide raises a messenger molecule called cGMP, which relaxes the smooth muscle in the arteries and the spongy tissue.
4. Filling. Blood flows in faster than it flows out, and the chambers expand.
5. Ending. An enzyme called PDE5 breaks down cGMP, the muscle tightens again, and blood drains away.

Every step depends on something: healthy arteries, working nerves, enough testosterone, and a mind that is not flooded with stress hormones. A problem with any one of them can cause ED. This is also why the main ED medicines, called PDE5 inhibitors, work: they slow step 5, so the relaxing signal lasts longer once arousal starts. They do not cause an erection without arousal.

What are the symptoms of erectile dysfunction?

The main symptoms are trouble getting an erection, trouble keeping it, and erections that are less firm than they used to be. Many men also notice fewer erections on waking in the morning.

Other things men describe:

• Needing more stimulation than before.
• An erection that is firm at first but fades before or during sex.
• Erections that happen in some situations (for example alone, or in the morning) but not with a partner.
• Worry before sex that it will not work, which then makes it less likely to work.
• Lower confidence or avoiding intimacy.

The pattern gives your doctor useful clues. ED that came on gradually over months or years, with fewer morning erections, points towards a physical cause such as narrowed arteries. ED that started suddenly, that happens only with a partner, while morning erections stay normal, points more towards stress or anxiety. Most men have a mix.

If you would like a private sense of where you stand before talking to a doctor, our five-question self-check scores your answers on your phone and stores nothing.

Free toolFree ED self-checkFive questions, two minutes, nothing stored.→

How common is erectile dysfunction by age?

ED is common and becomes more so with age. In the Massachusetts Male Aging Study, a landmark survey of 1,290 men aged 40 to 70, about 52% reported some degree of ED, from mild to complete.

The same study found that complete ED, meaning no usable erections at all, tripled from about 5% at age 40 to about 15% at age 70. Mild and moderate ED were far more common than complete ED at every age.

Age group	What the evidence shows
20s and 30s	Less common, but not rare. In one Italian clinic study, about one in four men seeking help for new ED were 40 or younger.
40 to 70	About half of men report some degree of ED (Massachusetts Male Aging Study).
40	Complete ED in about 5% of men.
70	Complete ED in about 15% of men.

There are no large national surveys of ED in Filipino men, so we will not quote a Philippine figure. What we do know is that the conditions that drive ED are common here. The World Health Organization estimates that about one in three Filipino adults aged 30 to 79 has high blood pressure, and the International Diabetes Federation estimates that around 7.5% of Filipino adults have diabetes, about half of them undiagnosed. Our page on what causes erectile dysfunction looks at each of these in detail.

ED is not an inevitable part of ageing. Many older men keep good erections, and when ED does appear in older age it is often a sign of a treatable health problem rather than of age itself.

Why is ED an early warning sign for heart disease?

ED and heart disease often share the same root cause: damaged, narrowed arteries. The arteries that supply the penis are smaller than those that supply the heart, so they can show the damage first, sometimes years before chest pain or a heart attack.

The evidence for this is strong:

• In a JAMA study of 9,457 men aged 55 and over, men who developed ED were about 25% more likely to have a heart attack, angina or other cardiovascular event over the following years, even after accounting for other risk factors. Men who already had ED at the start were about 45% more likely.
• A 2011 meta-analysis of 12 long-term studies with over 36,000 men found ED raised the risk of cardiovascular disease by about 48%, coronary heart disease by 46% and stroke by 35%.
• In an Italian study of 300 men with confirmed coronary artery disease, about two in three of those who also had ED said the erection problems came first, on average a little over three years before their heart symptoms.

This is why a good doctor treats a first visit for ED as a chance to check your heart health, not only to prescribe a tablet. Expect questions about chest pain, breathlessness and family history, and checks of your blood pressure, blood sugar and cholesterol.

This applies especially if you are in your 40s or 50s, smoke or vape, carry extra weight around your waist, or have a parent who had a heart attack or stroke young. Finding high blood pressure or diabetes early protects your heart, your kidneys and your eyes, and often helps your erections too.

What causes erectile dysfunction?

Most ED has a physical cause, most often reduced blood flow from narrowed or stiffened arteries. Psychological factors, medicines and lifestyle habits also play a part, and most men have more than one cause at once.

The main groups are:

• Blood vessels: high blood pressure, high cholesterol, atherosclerosis, smoking.
• Metabolism: diabetes, obesity and a large waistline, fatty liver.
• Nerves: diabetic nerve damage, spinal injury, multiple sclerosis, pelvic or prostate surgery.
• Hormones: low testosterone, thyroid problems, high prolactin.
• Mind: stress, performance anxiety, depression, relationship strain.
• Medicines: some blood pressure medicines, antidepressants, and others.
• Lifestyle: heavy drinking, smoking and vaping, little exercise, poor sleep and night-shift work.

In the Philippines, diabetes and high blood pressure are the causes doctors see most often in middle-aged men, along with smoking. For men who work BPO night shifts, disrupted sleep is another factor worth raising. Our full guide to what causes erectile dysfunction explains how each one works.

If you are younger, the balance shifts towards anxiety, alcohol, vaping and sleep, though physical causes still need checking. See ED in your 20s and 30s. If you also have low desire, tiredness or low mood, read ED and low testosterone.

How is erectile dysfunction diagnosed?

Most ED is diagnosed from a conversation and a basic check-up, not from complicated tests. A doctor will ask about your symptoms and health, examine you briefly, and usually order a few blood tests.

The conversation

Your doctor will ask how long the problem has been going on, whether it came on suddenly or gradually, whether morning erections still happen, and how it affects you. They will ask about your medicines (including anything bought over the counter or online), smoking, vaping, alcohol, sleep, stress and mood. Many doctors use a short questionnaire such as the International Index of Erectile Function (IIEF-5) to grade how severe the ED is.

The questions are practical and clinical. You do not have to share details you are uncomfortable with, and doctors in the Philippines who work in men's health ask these questions every day.

The examination

A physical check usually includes blood pressure, weight and waist measurement, and sometimes a brief genital examination to check for conditions such as Peyronie's disease (a curve caused by scar tissue). Many teleconsultations skip the examination at first and arrange an in-person check if something needs looking at.

Blood tests

The EAU and AUA guidelines recommend these basic tests for most men with ED:

• Fasting blood sugar or HbA1c, to check for diabetes or prediabetes.
• Cholesterol (lipid profile), to check heart risk.
• Morning total testosterone, especially if you also have low desire, tiredness or low mood. It is best taken early in the morning, when levels peak.

Depending on your history, your doctor may add kidney and liver tests, thyroid tests or prolactin. These tests are widely available at hospital labs and diagnostic centres across the Philippines, and many clinics can arrange them after a teleconsultation.

Specialist tests

Most men never need more than this. If ED does not respond to treatment, follows an injury or surgery, or a doctor is considering surgery, a urologist may arrange specialist tests such as a penile Doppler ultrasound, which measures blood flow. Our page on urologists and men's health clinics lists verified clinics.

What is the treatment for erectile dysfunction?

Treatment works as a ladder: start with the underlying causes and lifestyle, add a prescription medicine if needed, and move to devices, injections or surgery only if simpler steps do not help. Most men find an effective option on the first or second step.

The EAU and AUA guidelines both encourage a shared decision between you and your doctor, so the order can change to suit your health and preferences.

Step 1: Lifestyle and the underlying cause

Changing the things that damage blood vessels can improve erections on its own, and it protects your heart at the same time.

• Exercise. Regular aerobic exercise is linked to better erectile function. In hot weather, walking early in the morning or in an air-conditioned mall, swimming, or cycling in the evening all count.
• Weight. In a two-year Italian trial of obese men with ED, those who lost weight and exercised more improved their erection scores, and about one in three regained normal function, compared with very few in the control group.
• Stopping smoking. Nicotine narrows blood vessels. Stopping helps your arteries recover over time, and the DOH Quitline (1558) offers free support.
• Alcohol. Cutting heavy drinking helps both short term and long term.
• Sleep. Seven or more hours, as regular as your shifts allow.
• Treating diabetes, blood pressure and cholesterol. Good control slows further damage to vessels and nerves.
• Reviewing medicines. If a medicine may be contributing, your doctor may suggest an alternative. Never stop a prescribed medicine yourself.

Step 2: PDE5 inhibitor tablets

PDE5 inhibitors are the first-choice medicine for most men with ED. They help the blood vessels in the penis stay relaxed once arousal starts, and they work for roughly two out of three men who try them.

The two most used in the Philippines are:

• Sildenafil (Viagra) works for a few hours. It is sold as 25, 50 and 100 mg tablets, and many local generics exist, such as Spiagra, Zilden and RiteMed Sildenafil. See sildenafil.
• Tadalafil (Cialis) lasts longer, up to about 36 hours, and also comes as a lower-strength tablet that some men use daily. Local generics include Torfil. See tadalafil and daily tadalafil.

Your doctor decides which medicine suits you, the strength and how often. Our comparison of sildenafil vs tadalafil explains the differences.

Three things are worth knowing:

• You need a prescription. PDE5 inhibitors are prescription medicines in the Philippines. Our page Is Viagra over the counter? explains the legal routes, including teleconsultation e-prescriptions.
• Generics cost far less. A local generic contains the same active ingredient as the original brand, often at a fraction of the price. The cheapest verified sildenafil 50 mg tablet we found was ₱49 (Erecto, TGP). Compare every checked price on our sildenafil price and tadalafil price pages.
• Fake pills are a real risk. Unregistered "herbal" products and pills from online marketplaces can contain hidden or wrong doses of drugs. Read how to spot fake ED pills.

For common side effects such as headache, flushing and a blocked nose, and for drug interactions, see ED medicine side effects and safety.

Step 3: Talking therapy

Psychosexual therapy and cognitive behavioural therapy (CBT) help when anxiety, depression or relationship strain is keeping ED going. They work well alongside tablets, and many couples attend together.

Performance anxiety can create a loop: one difficult night leads to worry, the worry releases adrenaline, adrenaline narrows the blood vessels, and the next attempt is harder. Therapy breaks that loop. In the Philippines, psychologists and psychiatrists offer this in person and online, and some urology clinics work with them.

Step 4: Vacuum erection devices

A vacuum device is a clear tube placed over the penis with a pump that draws blood in, and a soft ring at the base holds it there. It needs no medicine and suits men who cannot use PDE5 inhibitors, such as those taking nitrates.

It takes some practice, and the ring should not be left on for more than about 30 minutes. A doctor can advise on a reputable device.

Step 5: Injections and other medicines given locally

If tablets do not work, a urologist can teach you to inject a medicine such as alprostadil directly into the side of the penis. It produces an erection within minutes, without relying on the nerve signal, and works for most men who try it, including many with diabetes or after prostate surgery.

A urologist decides the medicine and strength and trains you in the clinic first. The main risk is an erection that lasts too long, which needs urgent care.

Step 6: Surgery

A penile implant is a device placed inside the penis during an operation, which lets you create an erection when you want one. It is reserved for men in whom other treatments have not worked, and satisfaction rates among men who have one are high.

A small number of younger men with a specific blood vessel injury may be offered vascular surgery. Both are specialist decisions made with a urologist.

What about shockwave therapy and supplements?

Low-intensity shockwave therapy is offered by some clinics in Metro Manila and elsewhere. The EAU says it may help some men with mild ED caused by blood vessel problems, but the evidence is still building, and it is not a first-line treatment.

Supplements such as tongkat ali, maca and products sold as "pampatigas" are not proven to treat ED. Some products sold online as herbal have been found by the FDA Philippines to contain hidden sildenafil, which is dangerous for men on heart medicines.

When should you see a doctor about ED?

See a doctor if erection problems happen on most attempts for a few weeks or more, or if they worry you. See one sooner if you also have diabetes, high blood pressure, chest pain, or a family history of early heart disease.

Get urgent medical help if:

• You have chest pain, especially during sex or exertion.
• An erection lasts more than four hours.
• You have sudden loss of vision or hearing after taking an ED medicine.
• ED appears suddenly after an injury to the pelvis or back.

Many men in the Philippines put off a consultation because of embarrassment, because they live with family and worry about privacy, or because they are not sure where to go. A teleconsultation can be done by phone from wherever you feel comfortable, and an e-prescription can be filled at a pharmacy such as Watsons or Mercury Drug, or delivered. Our page on online ED consultation compares providers.

Can erectile dysfunction be reversed?

Often, yes. ED caused by stress, alcohol, a medicine, or weight and fitness can improve substantially once the cause changes, and ED from blood vessel disease can be managed well with treatment.

Some causes, such as nerve damage after surgery or long-standing diabetes, are harder to reverse fully, but even then, injections, devices or an implant can restore a satisfying sex life. The earlier you look into it, the more options you have.

What can you do today?

Take the self-check, book your blood pressure and blood sugar check, and talk to a licensed doctor about what you found. Those three steps answer most of the questions this page raises.

You do not need to figure this out alone, and you do not need to feel embarrassed. ED is one of the most common reasons men see a doctor, and most men who ask for help find something that works.

Frequently asked questions

What is the difference between erectile dysfunction and impotence?+

They mean the same thing. Impotence is the older word; doctors now say erectile dysfunction or ED because it is more precise and carries less stigma. Neither term has anything to do with fertility.

What does impotent mean in Tagalog?+

There is no single everyday Tagalog word. People usually describe it, for example hindi tinitigasan or hindi tumitigas ang ari. Baog is often confused with impotence, but baog means infertile, which is a different problem.

What are the first signs of erectile dysfunction?+

Common early signs are erections that take longer to come, are less firm than before, or fade before you want them to. Fewer morning erections can also be a sign. One bad night is not ED; a pattern over several weeks is worth checking.

Can erectile dysfunction go away on its own?+

Sometimes. ED linked to stress, a short illness, heavy drinking or a new medicine can improve once that changes. ED from narrowed arteries or diabetes usually needs the underlying condition treated, and often a prescription medicine as well.

Is ED a normal part of ageing?+

It becomes more common with age, but it is not inevitable. Many men in their 60s and 70s have no erection problems, and when ED does appear in older men it is often linked to treatable conditions such as high blood pressure or diabetes.

What is the best treatment for erectile dysfunction?+

There is no single best treatment for everyone. Doctors usually start with lifestyle changes and treating any underlying condition, and many men are also prescribed a PDE5 inhibitor. The right choice depends on your health, your other medicines and your preferences.