Erectile dysfunction 101

Erectile dysfunction (ED) is when you can’t get or keep an erection firm enough for sex or masturbation (Burnett et al., 2018). It’s pretty common; up to 30% of men under 40 have experienced it (Nguyen et al., 2017). But treatment isn’t always as simple as taking a little blue pill. ED can have psychological causes, physical causes, or both. So before you can address ED, you need to figure out what’s causing it. This guide covers everything you need to know about spotting ED, knowing the causes, and how to speak to a doctor about it.

What is erectile dysfunction?

The clinical definition of ED, according to the American Urological Association, is not being able to get or keep an erection firm enough for sex or masturbation (Burnett et al., 2018).

One soft erection doesn’t mean you have ED. It’s also normal to be harder and softer at different points during sex, so an occasional softer moment is also not cause for concern. However, if it keeps happening, and gets in the way of sex or masturbation, it’s more likely. Check out Mojo’s guide on what ED symptoms look like for a more detailed breakdown.

ED used to be called impotence, but that term is outdated. Most people now just say “getting hard” or “struggling to get it up.” Whatever you call it, feeling like your body isn’t cooperating can knock your confidence.

What causes erectile dysfunction?

ED can have psychological causes, physical causes, or both (Burnett et al., 2018). Here’s a breakdown of each.

Psychological causes of ED

Psychological ED comes from mental, emotional, or situational factors (Nguyen et al., 2017; Burnett et al., 2018), including:

• Performance anxiety, worrying about how you’ll perform instead of focusing on enjoying sex
• Stress, from work, your finances, or anything else weighing on you
• Relationship problems, including conflict, emotional distance, or a new partner
• Depression and low self-esteem, which can reduce your desire and lower your confidence
• Porn-related concerns, if your patterns of arousal have shifted over time

Psychological erectile dysfunction often responds to different approaches to physical ED, because it’s driven by what’s happening in your head and your life rather than a problem with blood flow or nerves.

Physical causes of ED

Physical causes affect the blood flow, nerves, and hormones your body needs to get and hold an erection (Burnett et al., 2018), including:

• High blood pressure and high cholesterol
• Heart disease
• Hormone changes, like low testosterone
• Medication side effects, common with some blood pressure medications and antidepressants
• Smoking, heavy drinking, or diabetes
• Pelvic floor or nerve issues, sometimes from injury, surgery, or cycling

For a more detailed breakdown of the different causes of ED, including less common ones, check out Mojo’s guide to the causes of ED.

Is erectile dysfunction normal?

ED is really common. Up to 30% of men under 40 have experienced erection difficulties, and in one study up to 85% of those cases came down to psychological factors like stress and anxiety (Nguyen et al., 2017). One clinic also found that about a quarter of its new ED diagnoses were in young men (Capogrosso et al., 2013).

Physical vs. psychological ED: how to tell the difference

If you can get a firm erection during masturbation, alone, or while asleep but not with a partner, the cause is more likely psychological. If you can’t get one in any context, it’s more likely physical (Burnett et al., 2018). Here’s how that could look:

This table is a starting point, not a diagnosis. For a deeper look at telling physical and psychological ED apart, read Mojo’s full guide.

When to see a doctor about erectile dysfunction

See a doctor if ED keeps happening and doesn’t go away on its own after a few weeks. It can be an early marker of cardiovascular disease or diabetes, and a medical evaluation is the recommended first step (Burnett et al., 2018).

It’s normal to feel awkward about this, but most doctors have had every version of this conversation already. Read Mojo’s guide on what to expect from that first conversation to help you prepare.

Treatment options for erectile dysfunction

There are lots of ways to work through ED, and medication is only one of them. The right approach depends on what’s causing it (Burnett et al., 2018). For instance, psychological ED often responds to exercises and structured work rather than medication. Here’s a quick comparison:

Mojo’s full guide to ED treatment options breaks down each approach in more detail.

Why ED so often goes untreated

An estimated three-quarters of men with an ED diagnosis go untreated (Cakir et al., 2013, as reported in EurekAlert, 2013).

Stigma is the biggest reason. Most men aren’t encouraged to talk about their health problems, so often hope it will sort itself out, don’t know where to start, or feel embarrassed to talk to a doctor.

Performance anxiety drives erection issues too. If you start worrying about ED happening again, that worry itself keeps the pattern going.

The Erection Reset’s approach to ED

The Erection Reset, built by Dr. Shannon Chavez, a licensed clinical psychologist, AASECT-certified sex therapist, and certified clinical sexologist, helps you work through the psychological and behavioral patterns behind ED using the biopsychosocial model. This means looking at your body, your mind, and your relationships together, instead of treating ED as a purely physical problem.

Most men using Mojo’s The Erection Reset program say their partner’s pleasure is what motivates them most (Mojo, 2026). The goal isn’t to chase a harder erection for its own sake. It’s to rebuild the confidence and connection that erection issues tend to disrupt.

Dr. Chavez sums up her approach this way:

The Erection Reset is not a treatment, diagnosis, or cure for ED.