Erectile dysfunction (ED) can be caused by physical problems, psychological factors, or a combination of both.
The most noticeable symptoms of ED include:
- the inability to get or keep an erection
- low sex drive
- anxiety about sexual performance
Many men find it difficult to discuss a sexual health problem such as ED. However, it’s important to discuss your ED openly and honestly with your doctor. Various treatment options exist. With help, most men will find a treatment that works for them.
Even when ED doesn’t start with psychological problems, it can cause them. If you have ED, you may want to talk to a mental health professional. A sex therapist can also help you deal with any emotional and relationship problems that may have occurred because of ED. But the best place to start is always your primary care doctor.
Your doctor should be your first stop for ED diagnosis. ED has many potential causes, so you may need a comprehensive physical examination to diagnose it.
The first steps to diagnosing ED are usually straightforward. Then your doctor may refer you to a specialist if more information is needed.
Urologists specialize in urinary and reproductive health. They can help diagnose any abnormalities in your reproductive system.
Your doctor may refer you to a urologist if you don’t have any underlying health or mental conditions, such as cardiovascular disease, high blood pressure, or anxiety, but you still have symptoms of ED.
Issues with your prostate gland can cause erectile dysfunction. Your urologist may examine your prostate for conditions that can cause erectile dysfunction, including:
- polyuria, or excessive urine volume
- prostate cancer or treatment for prostate cancer
- enlarged prostate or treatment for enlarged prostate
- nerve damage resulting from radical prostatectomy
Your urologist may perform a physical exam by taking your blood pressure and examining your penis and testicles. A rectal exam, in which your doctor uses a finger to feel your prostate gland, may be necessary to check the health of your prostate. This test shouldn’t cause you more than minimal discomfort.
Your urologist may also ask about any diuretics you’re taking or about your caffeine and alcohol consumption. These can all cause or contribute to ED. Your urologist may recommend changing a medication that acts as a diuretic (increases urine production) or drinking fewer diuretic liquids (such as coffee) if they may be causing your ED.
Endocrinologists are hormone specialists. Blood tests can help determine whether your hormone levels are abnormal. Low testosterone levels can cause or contribute to ED.
Some hormonal conditions can cause ED, including:
- andropause (sometimes inaccurately called “male menopause”), in which your body doesn’t produce enough growth hormones or androgen; it may lead to weight gain, lower bone density, and body hair loss
- high levels of prolactin, a hormone that controls the production of sperm; when too much is produced, it can cause symptoms in men such as a decreased sex drive, infertility, and galactorrhea (the production of breast milk)
- irregular thyroid hormones, such as when too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone is produced
Your doctor may refer you to an endocrinologist if any of the symptoms of these conditions appear alongside symptoms of ED.
Your endocrinologist may give you several additional tests, including:
- a fertility test to make sure you’re still producing healthy sperm
- a prolactin level test to make sure your body isn’t producing too much prolactin
- the sex hormone binding globulin (SHBG) test to see how your testosterone is binding to blood proteins
- the dehydroepiandrosterone sulfate (DHEAS) test to make sure you’re not producing too much testosterone or androgen
A mental health professional can help determine if psychological issues are causing or contributing to your ED. A therapist can also help you work through psychological issues during ED treatment.
Your doctor may refer you to a mental health professional if you’re experiencing any of the following symptoms in addition to ED symptoms:
- symptoms of depression, such as loss of interest in activities, noticeable lack of energy, and suicidal thoughts
- symptoms of anxiety, such as feeling restless, insomnia, and uncontrollable worry
- high levels of stress or fatigue
- symptoms of schizophrenia
- an eating disorder
- relationship problems that are caused by stress or communication issues
- a personality disorder that affects your ability to have healthy relationships
- increased worry that you won’t be able to get an erection (sometimes called performance anxiety)
Your doctor may also recommend that you see a mental health specialist or therapist if your inability to get an erection is causing tension or stress between you and your partner.
A mental health professional may give you questionnaires to fill out if they believe anxiety, depression, or another mental health condition is causing your ED. These questionnaires allow them to discern whether or not you have all of the indications of a mental disorder. If you have a mental health condition, you may be prescribed medication to control the symptoms. This can also help you to get your ED under control.
A therapist will ask about your personal life and relationships. These questions can help uncover issues in your life that may be causing you stress or interpersonal problems that could be contributing to your ED. They may recommend lifestyle or personal changes that will help address your ED and the mental health issues that may be at the root of it.
Questions your doctor may ask
To help determine the cause of ED, your doctor may ask about your medical and sexual history. Be prepared to answer these questions honestly. Details about your past may provide important clues to the cause of your ED.
According to the Mayo Clinic, your doctor may ask about:
- other health problems and chronic conditions
- other sexual problems
- changes in sexual desire
- whether you get erections during masturbation
- whether you get erections while you sleep
- problems in your sexual relationship
- when your sexual problems started
- how often your ED symptoms occur
- what improves or worsens your ED symptoms
- whether you have anxiety, depression, or stress in your life
- whether you’ve been diagnosed with any mental health problems
- all the medications you take
- any herbal medications or supplements you use
- whether you consume alcohol, cigarettes, or illicit drugs
Questions to ask your doctor
Be prepared to ask your doctor questions about your ED and its treatment, including:
- What do you think is causing my erection problems?
- What tests do I need?
- Do you think my ED is temporary, or will it last a long time?
- How do you think I should treat my ED?
- What are the other options for treatment if one or more treatment doesn’t work?
- How will ED treatment affect my other health conditions, and vice versa?
- Are there any foods, medications, or behaviors I need to avoid? Can I make lifestyle changes to prevent ED?
- Do you think I need to see a specialist? How much will that cost? Will my insurance cover a visit to a specialist?
- Do you have any brochures or recommendations for websites to educate myself about ED?
- If I need medications for ED, are cheap, generic versions available?
You can ask both your primary care doctor and a specialist many of these questions. Depending on the cause of your ED, a specialist may be able to give you more specific answers, including how best to treat your ED and how ED is related to any other health conditions you have.
Many effective treatments exist for ED. The first step toward recovery is talking openly with your doctor about your ED to help you pinpoint its root cause.
Some possible treatments include:
- oral medications, such as sildenafil (Viagra) or tadalafil (Cialis)
- penis injections, such as alprostadil or phentolamine
- testosterone replacement using injections, gum, or medication
- penis pumps, which use a vacuum tube to give you an erection
- penis implants, which use inflatable or partially rigid rods to allow you to control the time and duration of your erection
Whether it is physical, mental, or both, knowing the issues underlying your ED can allow a specialist to treat the specific cause and symptoms. This may finally end your ED symptoms and allow you to continue living a healthy life, both sexually and personally.