Erectile dysfunction - Diagnosis and treatment (2022)

Diagnosis

Erectile dysfunction FAQs

Urologist Tobias Kohler, M.D., answers the most frequently asked questions about erectile dysfunction.

Hi. I'm Dr. Kohler, a urologist at Mayo Clinic. I'm here to answer some of the important questions you may have about erectile dysfunction.

Problems with erectile dysfunction are super common. If you look at the decade of life, that predicts what percent of men will have problems. So, for example, 50% of 50-year-olds, 60% of 60-year-olds, so on and so forth, will have problems with erections. But that does not necessarily mean that as you get older, you have to have problems of the penis. There are plenty of men in their 60s, 70s and 80s and 90s with great sex lives. In other words, if you take great care your penis, your penis will take great care of you.

So the things that you can do to take care of yourself to help with erections include exercising, eating well, including a diet high in fruits and vegetables, having a slimmer waistline, sleeping well, quitting smoking. A lot of these things I mentioned are as powerful as medications in helping with erections and improving your sex life.

The penis and overall health is so strongly connected, it's really important to remember that the penis is one of the most powerful predictors we have, especially in young men, for heart attacks. The blood vessels that feed the penis are relatively small. Blood vessels in the heart and the neck are a little bit bigger. So therefore, the penis can predict heart attacks or strokes years in advance when they may occur.

Yes and no. So when we talk about what truly is a problem with erectile dysfunction, the definition is a problem that lasts greater than three months and is a consistent inability to obtain or maintain an erection adequate for intercourse. So when young men get problems with erections, which is very, very common because it's normal to have bad nights here and there. And so, if it happens occasionally, you don't need to be as worried about that. But if you have consistent problems, you absolutely should and must get checked out by a doctor to figure out what's going on, not only because there are great treatments available, but because we may discover underlying medical problems.

When young men have problems with erections, most of the time it's a confidence issue. And so, there are different ways to deal with that. One way is to give medications to get the confidence back. Another way is to use specialists trained in behavioral techniques to get confidence back, so sexual counselors or therapists can really help with this problem.

Modern day, we have several new, exciting, experimental things, such as shockwave therapy of the penis or platelet-rich plasma or stem cell therapy. These are not ready for prime time, and so you should not, as a patient, have to spend your hard-earned money to see whether or not this works for you. It's better to be part of a clinical trial to see if that works or to go with more traditional therapies at this point.

If you want to be a great partner for your medical team to help solve problems with erections, the number one thing you can do is book an appointment. Just like anything else in life, you have to take the initiative, set up an appointment for your physician, say, "Doc, I have a problem with sex." Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time and we wish you well.

For many people, a physical exam and answering questions (medical history) are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

    This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.

    (Video) Erectile Dysfunction 101 | Caroline Wallner, MD | UCLAMDChat

  • Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

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More Information

  • Erectile dysfunction care at Mayo Clinic
  • Ultrasound
  • Urinalysis

Treatment

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)
  • Have heart disease or heart failure
  • Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

    Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.

    Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

  • Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.

    (Video) With Erectile Dysfunction, There are Many Options for Treatment

    The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

  • Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.

Penis pumps, surgery and implants

Battery-powered penis pump for erectile dysfunction

Erectile dysfunction - Diagnosis and treatment (1)

Battery-powered penis pump for erectile dysfunction

A penis pump is used to draw blood into the penis to create an erection. You then place a rubber ring around the base of the penis to maintain the erection.

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

    Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

    The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

    If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

    Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

(Video) Erectile Dysfunction - Causes, Symptoms and Treatment Options

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

More Information

  • Erectile dysfunction care at Mayo Clinic
  • Erectile dysfunction and diabetes
  • Erectile dysfunction medications
  • Erectile dysfunction: Nonoral treatments
  • Acupuncture
  • Penile implants
  • Penis pump
  • Erectile dysfunction FAQs

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(Video) Signs, Symptoms and Treatment Options for Erectile Dysfunction presented by Dr. Bryan Kansas

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:

  • If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.
  • Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
  • Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
  • Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.
  • Work through relationship issues. Consider couples counseling if you're having trouble improving communication with your partner or working through problems on your own.

Alternative medicine

Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

The Food and Drug Administration (FDA) has issued warnings about several types of "herbal viagra" because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.

More Information

  • Erectile dysfunction care at Mayo Clinic
  • Erectile dysfunction dietary supplements

Coping and support

Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:

  • Don't assume you have a long-term problem. Don't view occasional erection problems as a reflection on your health or masculinity, and don't automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.
  • Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn't the case can help. Communicate openly and honestly about your condition. Treatment can be more successful for you when you involve your partner.
  • Don't ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.

Preparing for your appointment

You're likely to start by seeing your family doctor. Depending on your particular health concerns, you might go directly to a specialist — such as a doctor who specializes in male genital problems (urologist) or a doctor who specializes in the hormonal systems (endocrinologist).

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

Take these steps to prepare for your appointment:

  • Ask what you need to do ahead of time. When you make the appointment, be sure to ask if there's anything you need to do in advance. For example, your doctor might ask you not to eat before having a blood test.
  • Write down any symptoms you've had, including any that might seem unrelated to erectile dysfunction.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbal remedies and supplements you take.
  • Take your partner along, if possible. Your partner can help you remember something that you missed or forgot during the appointment.
  • Write down questions to ask your doctor.

For erectile dysfunction, some basic questions to ask your doctor include:

  • What's the most likely cause of my erection problems?
  • What are other possible causes?
  • What kinds of tests do I need?
  • Is my erectile dysfunction most likely temporary or chronic?
  • What's the best treatment?
  • What are the alternatives to the primary approach that you're suggesting?
  • How can I best manage other health conditions with my erectile dysfunction?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? What will that cost, and will the visit be covered by my insurance?
  • If medication is prescribed, is there a generic alternative?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to your prepared questions, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared for questions such as these:

  • What other health concerns or chronic conditions do you have?
  • Have you had any other sexual problems?
  • Have you had any changes in sexual desire?
  • Do you get erections during masturbation, with a partner or while you sleep?
  • Are there any problems in your relationship with your sexual partner?
  • Does your partner have any sexual problems?
  • Are you anxious, depressed or under stress?
  • Have you ever been diagnosed with a mental health condition? If so, do you currently take any medications or get psychological counseling (psychotherapy) for it?
  • When did you first begin noticing sexual problems?
  • Do your erectile problems occur only sometimes, often or all of the time?
  • What medications do you take, including any herbal remedies or supplements?
  • Do you drink alcohol? If so, how much?
  • Do you use any illegal drugs?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started.

(Video) Erectile Dysfunction - Diagnosis & Treatment

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FAQs

Can erectile dysfunction be treated completely? ›

In summary. So erectile dysfunction can be cured, but it depends on the cause. Some causes of ED are easier to “cure” than others. But, with the right diagnosis, support, and treatment, it's possible for ED to go away without the need for ED medications like Viagra (sildenafil) or Cialis (Tadalafil).

What is the best way to solve erectile dysfunction? ›

Medication

The best-known are drugs, such as tadalafil (Cialis) and Viagra, which increase blood flow to the penis and help to achieve an erection. These can be effective when that cause of ED is physical, and they also work well when the cause is unknown or related to anxiety.

Is there a test to confirm erectile dysfunction? ›

Various forms of ED self tests can include: A nocturnal penile tumescence (NPT) stamp test that utilizes a roll of stamps around the penis to confirm erections at night. A newer type of NPT test that includes the use of a device to evaluate the quality of the man's night time erection.

Is erectile dysfunction mental? ›

Although most causes of erectile dysfunction are physical in nature, many cases of ED develop as a result of emotional or psychological issues. When erectile dysfunction is related to a psychological problem, it's referred to as psychological ED, or psychological impotence.

How long does erectile dysfunction last for? ›

Erectile dysfunction can often improve with proper treatment. A 2014 study following 810 men found that 29 percent of the men with erectile dysfunction had improved symptoms after 5 years. The following are potential treatment options for temporary ED: Taking medications.

How does a urologist examine you for erectile dysfunction? ›

Your doctor may use an overnight erection test to see whether you're able to get an erection. For this test, you will place a device around your penis before you go to sleep. It measures how many erections you have and how strong they are. A simpler version of this test uses a special plastic ring around your penis.

Is erectile dysfunction permanent? ›

Almost all cases of erectile dysfunction are treatable, and treatment can lead to better overall physical and emotional health for nearly every patient as well as improve intimacy for couples.

What is the most prescribed drug for erectile dysfunction? ›

Sildenafil (Viagra).

This medication is most effective when taken on an empty stomach one hour before sex. It's effective for four to five hours or more if you have mild to moderate erectile dysfunction.

How can I help my husband with erectile dysfunction? ›

7 strategies for partnering up with ED
  1. Discuss the issue. ...
  2. Find the right time to talk. ...
  3. Reassure your partner that he is not alone. ...
  4. Learn about the condition and treatment options. ...
  5. Offer to go with your partner to his doctor's appointment. ...
  6. Help your partner help himself. ...
  7. Express your love in many ways.
19 Nov 2020

What is the main cause of erectile dysfunction? ›

Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction. On the other hand, depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual feelings.

Is erectile dysfunction reversible? ›

ED medications, like sildenafil (Viagra), can often help men with ED caused by medical conditions, but you won't be able to reverse or cure the ED.

Can overthinking cause erectile dysfunction? ›

Long-term stress and anxiety can increase certain hormone levels in your body and interfere with your body's processes. This can also lead to other health conditions that may cause ED.

How do I know if my erectile dysfunction is psychological? ›

If a guy easily gets an erection during sleep, but not in other situations, the cause is likely psychological. If however, he can't tell or an erection isn't happening, the reason is likely physical.

What exercise helps erectile dysfunction? ›

Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection.

Is ED temporary or permanent? ›

Summary. Erectile dysfunction may only be temporary, and the ability to achieve an erection can be restored. It may occur depending on the situation or be ongoing but reversible. A healthcare professional can diagnose erectile dysfunction, determine the cause, and direct treatment.

What pills help erectile dysfunction? ›

In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

What happens if sildenafil doesn't work? ›

Before you give up on Viagra, try using it at least a few times. If it doesn't work, consider talking to your doctor about switching to a higher dose. Often, Viagra will become more effective after a few tries as you become more comfortable with the medication and confident in its effects.

Can you take 2 Viagra pills at once? ›

Because 100mg is the highest dose available, you should never 'double up' on tablets or take more than one in 24 hours. Sildenafil 100mg is the highest safe dosage you can take – if it is ineffective, you should try another ED treatment.

How can I satisfy my wife with ED? ›

Mutual masturbation can help you and your partner learn what you both enjoy. You can also use sex toys, such as vibrators, to stimulate each other. Both manual and oral stimulation can be very fun and satisfying.

How does a wife deal with erectile dysfunction? ›

In most cases, erectile dysfunction help is both readily available and successful. Treatment options include oral and injectable medications, sex therapy, sexual help devices, and surgery. Women also have sexual issues. Up to 70 percent of couples have sexual health issues from time to time.

How do you stimulate a man with ED? ›

Mr Tilley says kissing, caressing, genital play and oral stimulation can all be experienced as pleasurable whether there is an erection or not. In relation to partnered sex, Dr Fox stresses it is something for both parties to work on together. "The partner may not be the cause, but they may be part of the solution."

Can Viagra Cure ED permanently? ›

Viagra is used to treat erectile dysfunction (ED). While it helps you temporarily maintain an erection so you can have sex, it does not cure ED. It does not affect sexual desire either. You still need mental or physical stimulation to get an erection.

Is erectile dysfunction reversible? ›

ED medications, like sildenafil (Viagra), can often help men with ED caused by medical conditions, but you won't be able to reverse or cure the ED.

How does erectile dysfunction make a man feel? ›

In fact, close to 70% of the men with ED in the survey said they felt that they are letting their partner down, and more than 40% said their partners feel they can no longer initiate sex. Those feelings of self-consciousness and embarrassment often lead men to hide their condition from their partners.

What is the safest drug for erectile dysfunction? ›

Sildenafil (Viagra) and tadalafil (Cialis) are the most commonly prescribed medications for ED, and are equally safe and effective.

At what age do men need Viagra? ›

About a quarter of men said that erection problems started between age 50 and 59, and 40% said they started between age 60 and 69. Having chronic diseases and other risk factors matter with respect to ED, too.

Who should not use Viagra? ›

Additionally, Viagra is not advised to be taken by patients who: Are also taking medicines called nitrates (such as nitroglycerin), which are used to treat high blood pressure during surgery and certain heart conditions. Use street drugs called “poppers” (such as amyl nitrate or amyl nitrite, and butyl nitrate)

What exercises fix erectile dysfunction? ›

Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection.

What is the main cause of erectile dysfunction? ›

Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction. On the other hand, depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual feelings.

Is erectile dysfunction permanent? ›

Almost all cases of erectile dysfunction are treatable, and treatment can lead to better overall physical and emotional health for nearly every patient as well as improve intimacy for couples.

How does a wife deal with erectile dysfunction? ›

In most cases, erectile dysfunction help is both readily available and successful. Treatment options include oral and injectable medications, sex therapy, sexual help devices, and surgery. Women also have sexual issues. Up to 70 percent of couples have sexual health issues from time to time.

Can a marriage survive erectile dysfunction? ›

In many cases, ED is treatable. A range of effective treatments can restore sexual function, thereby improving satisfaction in a relationship. A doctor can help couples understand their options, and they will often encourage both partners to attend appointments.

Videos

1. Understanding Erectile Dysfunction: Causes, Symptoms & Treatment Options
(Chesapeake Urology)
2. Erectile Dysfunction Treatment | 5 simple things to Reverse Erectile Dysfunction | ED | ED Treatment
(Medinaz)
3. Erectile Dysfunction | Evidence Based Causes and Treatments Webinar
(Johns Hopkins Medicine)
4. How is Erectile Dysfunction Diagnosed - How is ED Diagnosed
(Rehealthify)
5. Do YOU have Erectile Dysfunction ? | Why it Happens and How to Fix it
(JHP Medical UK)
6. ERECTILE DYSFUNCTION: CAUSES, DIAGNOSIS AND TREATMENT - GG Hospital - Dr Deepu RajKamal Selvaraj
(Dr KAMALA)

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