Erectile Dysfunction Symptoms: What Counts, What Does Not and When to Get Checked

Erectile dysfunction (ED) is trouble getting or keeping an erection that is firm enough for sex.² NIDDK lists three symptoms: getting an erection sometimes but not every time you want to have sex, getting one that does not last long enough for sex, and being unable to get one at any time.¹ A single bad night is not a diagnosis, but a pattern that keeps repeating is worth bringing to a clinician, because ED can be a sign of another health problem.¹ This page explains what counts, what does not, and which clues matter.

What are the symptoms of erectile dysfunction?

The core symptom is a change in erections that affects sex. NIDDK describes it in three forms.¹

MedlinePlus puts it more simply: ED is when a man has trouble getting or keeping an erection.⁵ NIDDK adds that ED is sometimes called impotence, but that term is used less now.²

Is it ED if it only happens once in a while?

Not by itself. The three patterns above are defined by what keeps happening, and nothing in the NIDDK description sets a number of failed attempts or a fixed time. What matters in practice is whether the change persists, whether it is getting worse, and whether it bothers you or your partner. A rough week during illness, heavy drinking, poor sleep or high stress is a common setting for a one-off problem. If it repeats over weeks, treat it as a symptom worth looking at rather than as bad luck.

It also helps to notice whether the problem is general or situational. Erections that are normal when alone, on waking or in some situations but fail with a partner point toward a different mix of causes than erections that have faded everywhere. NIDDK says mental health or emotional issues, including anxiety, depression and stress, can cause ED or make it worse.¹ That does not rule out a physical cause, and a physical cause often brings anxiety with it. Our guide to what is linked to ED sorts the causes in detail.

What is not an ED symptom?

Several other sexual problems are often lumped in with ED but are different questions. When a clinician diagnoses ED, NIDDK says they ask about sexual activity, including climax, ejaculation, erection and sexual desire.⁶ Asking about each separately is how a clinician tells them apart.

• Low sex drive. Reduced desire is not the same as being unable to get an erection, though low testosterone can affect both. See is ED related to low testosterone.
• Ejaculation problems. Ejaculating too early or too late is a separate topic from whether an erection can be achieved.
• Anxiety about performance alone. Worry can produce ED symptoms, but the worry is a cause, not the symptom itself.

What are the early signs of ED?

Early signs are usually subtle versions of the same three patterns: erections that take longer or need more stimulation, feel less firm, or fade partway through. Neither NIDDK nor MedlinePlus defines a "stage one" of ED, so be wary of any page that lists exact warning stages. What both agree on is the principle: do not wait for ED to become complete before mentioning it. MedlinePlus says that if you have ED you should tell your doctor, because ED can be a sign of health problems such as clogged blood vessels or nerve damage from diabetes, and those go untreated if you do not see a doctor.⁵

Do morning erections tell you anything?

They can be a clue. NIDDK lists a nocturnal erection test, which checks for erections you have at night, as one way clinicians judge whether ED is due to a physical problem.⁶ In 3,888 men attending an outpatient ED clinic in Italy, 63.6% reported reduced sleep-related erections. After adjustment, that was still linked to higher body mass index, glucose and triglycerides, a higher 10-year cardiovascular risk score, and depressive traits.⁴ This was a clinic population and an association, so noticing fewer morning erections cannot diagnose a cause. If you want the basics, read what morning wood is.

Can ED be a sign of heart disease?

It can be a warning. A meta-analysis of 14 longitudinal studies (92,757 participants, mean follow-up 6.1 years) found that men with ED had a pooled relative risk of 1.44 for total cardiovascular events and 1.25 for all-cause mortality compared with men without ED. The risk was higher in younger men and in intermediate-risk groups.³ In the placebo group of the Prostate Cancer Prevention Trial, 8,063 men aged 55 and older without cardiovascular disease were followed; those who had new ED had a hazard ratio of 1.25 for later cardiovascular events after adjustment for other risk factors, and the authors concluded that ED should prompt a look at cardiovascular risk.⁷

These are group findings, not a prediction for any one man. They are the reason a clinician will usually check blood pressure, blood sugar and cholesterol when ED shows up.

How common is ED, and is it just aging?

NIDDK says research suggests 30 million to 50 million men in the United States have ED, with about 40% affected at age 40 and 70% reporting it by age 70. It also states that ED is not a routine part of aging.² In the Massachusetts Male Aging Study, a community sample of men aged 40 to 70 surveyed in 1987 to 1989, complete impotence tripled from 5% to 15% between ages 40 and 70.⁸ For how the numbers play out by decade, see how common ED is at 40, and for men under 40 see ED in young men.

When should you see a doctor?

Raise it when the pattern persists, when it is new and came with other symptoms, or when it follows a new medicine. NIDDK lists antidepressants, blood pressure medicines and diuretics, antihistamines, sedatives and some pain relievers among medicines that can cause ED, so the full medicine list, including over-the-counter products and supplements, matters.¹ Do not stop a prescribed medicine on your own.

Seek urgent care instead of a routine visit for chest pain, shortness of breath or other symptoms of a heart problem, whatever your erections are doing.

What happens at the appointment?

NIDDK says clinicians use a medical, sexual and mental health history, a physical exam, and sometimes lab or other tests. The exam often checks for blood vessel and nervous system issues, hormone problems, and physical problems of the penis such as Peyronie's disease. Blood tests can include thyroid and prostate tests, and some men have ultrasound of the blood flow in the penis.⁶ If you are unsure who to see, our piece on which doctor to see for ED compares the options, and questions to settle before an online ED prescription covers what to have ready if you use telehealth.

What this page cannot tell you

Symptoms describe a problem, not its cause, and the same symptom can come from blood vessels, nerves, hormones, medicines or mood. The prevalence figures come from older surveys and a clinical summary, the heart findings are associations in groups of men, and the sleep-erection finding comes from men already seeking ED care. None of this replaces an examination.

Your questions

What are the first signs of erectile dysfunction?

NIDDK describes getting an erection sometimes but not every time you want to have sex, or getting one that does not last long enough for sex. Many men first notice it in particular situations before it becomes constant.

Is it ED if it only happens sometimes?

An occasional off night is common and is not on its own a diagnosis. NIDDK lists getting an erection only some of the time as a symptom, so the pattern matters: if it keeps happening, it is worth raising with a clinician.

Can ED be a warning sign of something else?

Yes. NIDDK says ED may be a symptom of another health problem, and a meta-analysis of 14 studies found a higher risk of cardiovascular events in men with ED. It is a reason to have blood pressure, blood sugar and cholesterol checked.

Is losing morning erections a symptom of ED?

It can go along with it. In 3,888 men at an ED clinic, reduced sleep-related erections were linked to higher glucose, body mass index and cardiovascular risk, but they cannot diagnose a cause on their own.

Is low sex drive or early ejaculation the same as ED?

No. NIDDK treats desire, ejaculation and orgasm as separate questions a clinician asks about alongside erections. They can occur together, but each has its own causes.

Read next

Part of our guide: Everyday ED Questions: Age, Alcohol, Testosterone and Myths

• Erectile Dysfunction Causes: What Is Linked to ED and Which Clues Matter
• Erectile Dysfunction in Young Men: How Common It Is, What Causes It and What to Do
• What Is Morning Wood? Why It Happens and What It Says About Sleep and Health
• Is It Unhealthy to Not Get Morning Wood? What Fewer Morning Erections Can Mean