If you think you have erectile dysfunction (ED), a physical examination and discussion about your medical history are all your doctor needs to make a diagnosis and recommend a treatment plan. If your doctor thinks an underlying health condition may be causing your ED, you might need additional tests including: blood tests, urine tests (urinalysis), ultrasound, or psychological exam.
The good news is that once you’re diagnosed, most cases of ED are treatable, if not totally curable.
What causes erectile dysfunction?
Erectile dysfunction, also known as impotence, is the inability to achieve or maintain an erection. If you’ve experienced erection problems, you’re not alone. Over three million people in the U.S. are diagnosed with ED every year.
Sexual arousal is complex. One reason ED affects so many people is because there are many potential causes of sexual dysfunction: lifestyle, emotional, medical, and physical.
Lifestyle risk factors and causes of erectile dysfunction:
- alcohol use
- inactivity or lack of exercise
- obesity or being overweight
Psychological and emotional causes of erectile dysfunction:
- general anxiety
- performance anxiety
- relationship problems
- guilt about sexual performance or certain sexual activities
- low self-esteem
- lack of sexual desire
Underlying medical conditions that may cause ED:
- cardiovascular disease (heart disease)
- injury from treatments for prostate cancer, including radiation therapy and prostate surgery
- injury to the penis, prostate, bladder, or pelvis
- high blood pressure (hypertension)
- high cholesterol (hyperlipidemia)
- low testosterone levels
- liver or kidney disease
- multiple sclerosis
- nerve damage
- pituitary gland conditions
- Peyronie’s disease
- premature ejactulation
- spinal cord injuries
- surgery for bladder cancer
- nerve damage
Oral medications that may cause ED:
- antidepressants and other psychiatric medicines
- antihistamine medicines
- diuretics (water pills)
- high blood pressure medicines, particularly thiazides and beta blockers
- hormonal medicines
- opiates such as fentanyl and codeine
- Parkinson’s disease medicines
- recreational drugs including marijuana and cocaine
Sexual health can be complicated. It’s important to be open and detailed when speaking to a medical professional, be it your family doctor or a specialist like a urologist.
What are the early signs of erectile dysfunction?
- You’re able to get an erection sometimes, just not every time you want to have sex.
- You’re able to get an erection, but you cannot maintain it long enough to have sex.
- You’re never able to achieve an erection.
These symptoms can come on suddenly, or develop gradually. When ED is sudden, it is likely caused by a medication or psychological trigger such as stress or depression. When symptoms develop gradually, it is more likely caused by a blood flow or nerve issue.
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How do healthy erections work?
The penis is filled with blood vessels. When you are sexually aroused—by either mental or sensory stimulation—your brain sends messages through nerves to the blood vessels and muscles of the corpora cavernosa, a chamber in the penis, to relax.
When the blood vessels relax and open, blood rushes in to fill the spaces. This blood creates pressure in the corpora cavernosa, which expands the penis to create an erection.
The membrane that surrounds the corpora cavernosa traps blood in the penis. This is how a penile erection is sustained.
When an erection stops, it’s because of the contraction of muscles in the penis. This halts the inflow of blood, and triggers its outflow.
How to diagnose erectile dysfunction
It’s possible to self diagnose erectile dysfunction. But, consulting your general practitioner or urologist can help identify the specific cause of your symptoms, and determine the most appropriate treatment for your lifestyle and medical history.
For example, if stress or anxiety is causing your erectile dysfunction, your doctor may recommend counseling as the first line of treatment. If an underlying health problem—like diabetes—is causing your ED, your doctor may prescribe a combination of medication and lifestyle changes.
To effectively diagnose your condition, your doctor will likely perform a physical exam and ask about your medical history, your sexual history, or your relationship with your sexual partner. In some cases, additional testing is required.
Your doctor will ask a number of questions to better understand and identify the root cause of your ED. For example:
- Are you currently taking any medications or over-the-counter supplements? If so, which ones?
- Do you have any chronic illnesses?
- Do you drink alcohol or smoke?
- How often do you exercise?
- What is the frequency or duration of your erections?
During the physical exam, your doctor will listen to your heart and check your blood pressure to find any abnormalities, such as heart murmurs, that could affect blood flow to the penis.
Your doctor will check your testicles and penis for signs of low testosterone. This male hormone is essential in achieving an erection, and physical signs—such as small testicles or hair loss—can indicate a hormone problem.
Additionally, your doctor may conduct a digital rectal exam to check the prostate gland for signs of infection or cancer, both potential causes of ED. Your doctor may also check your reflexes to test for any neurological problems. All in all, the physical exam should take 10 to 15 minutes.
It might feel uncomfortable to get a physical exam, but remember your doctor is a trained professional and there to help. The more your physician knows, the better your treatment can be.
To rule out cardiovascular disease or diabetes, your doctor may also use blood tests and urine tests (urinalysis), to check your testosterone, cholesterol, blood sugar, and triglyceride levels.
Generally performed by a specialist, an ultrasound is a simple procedure that can help identify any blood flow issues to your penis.
Your doctor may ask questions about your mental health to screen for depression, stress, and anxiety, as these can all impair erectile function.
Nocturnal penile tumescence (NPT) testing
This test is particularly helpful if it’s unclear whether your erectile dysfunction is from physical or psychological causes.
Essentially, NPT testing monitors erections while you sleep. Erections while sleeping are normal and common. If you have an involuntary erection during sleep, the cause of your ED is likely emotional rather than physical. If you do not achieve erections when sleeping, it could indicate a physical cause.
How to self diagnose erectile dysfunction
The NPT Stamp Test
This is an at-home, low-tech nocturnal penile tumescence (NPT) test to determine if you’re achieving an erection during normal sleep.
Apply a strip of postage stamps around the base of the penis before going to bed. The strip should be snug enough so the stamps break apart if you have an erection. You should sleep on your back to avoid accidentally tearing or disturbing the stamps.
In the morning, if the strip has broken, it means you had a nocturnal erection, which indicates an erection is physically possible. Your ED is likely caused by psychological issues. If the stamps are intact, it could indicate a physical cause.
For best results, conduct the test at least three nights in a row. If you suspect ED, you may want to see a doctor to confirm.
How does a urologist check for erectile dysfunction?
A urologist is a doctor that specializes in the male reproductive system and urinary tract diseases.
Often your regular family doctor can help run all the tests you need to diagnose and treat ED. However, it’s not uncommon for a general practitioner to refer patients with erectile dysfunction to a urology specialist for more tests. Some patients ask to see a urologist from the start, as they feel more comfortable talking to someone who specializes in men’s health.
Be prepared to answer similar questions for your urologist as you would your regular health care provider, including details about your medical history and your symptoms.
Whenever you visit a doctor, it’s always a good idea to bring a list of questions to remember to ask, such as:
- Is this condition temporary?
- What is causing it?
- What are the treatment options?
- How long until I see improvement?
- Are there any side-effects to treatment?
Treating erectile dysfunction
Your doctor will recommend the best treatment for you, based on the cause of your ED. This could be lifestyle changes, prescription medication, natural therapies, or a combination.
These are the most commonly recommended treatments for erectile dysfunction.
Oral medications for treating ED
- reducing illicit drug and alcohol intake
- quitting smoking
- losing weight
- increasing exercise
- working through relationship issues
- reducing stress
- emotional therapy
- vitamins and supplements
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- penile implants and vacuums
- testosterone hormone therapy
- penile injections or suppositories (alprostadil)
Erectile dysfunction is often curable with the right treatment. It may take some trial and error to find what works best for you, but it’s highly possible you’ll be back enjoying healthy sexual function in no time.