Physical Causes of ED
ED happens when:
- There is not enough blood flows into the penis
Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking. - The penis cannot trap blood during an erection
If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age. - Nerve signals from the brain or spinal cord do not reach the penis
Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis. - Diabetes can cause small vessel disease or nerve damage to the penis
- Cancer treatments near the pelvis can affect the penis' functionality
Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns. - Drugs used to treat other health problems can negatively impact erections
Patients should talk about drug side effects with their primary care doctors.
Emotional Causes of ED
Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.
Some emotional issues that can cause ED are:
- Depression
- Anxiety
- Relationship conflicts
- Stress at home or work
- Stress from social, cultural or religious conflicts
- Worry about sex performance
Updated June 2018
Finding the cause of your ED will help direct your treatment options.
Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.
Health and ED History
Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment
What Questions Will the Health Care Provider Ask?
Questions about your health:
- What prescription drugs, over-the-counter drugs or supplements do you take?
- Do you use recreational drugs?
- Do you smoke?
- How much alcohol do you drink?
- Have you had surgery or radiation therapy in the pelvic area?
- Do you have any urinary problems?
- Do you have other health problems (treated or untreated)?
Questions About ED
Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.
Questions about your ED symptoms:
- How long have you had these symptoms? Did they start slowly or all at once?
- Do you wake up in the morning or during the night with an erection?
- If you do have erections, how firm are they? Is penetration difficult?
- Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
- Do you have problems with sex drive or arousal?
- Do you have problems with ejaculation or orgasm (climax)?
- How is this problem changing the way you enjoy sex?
- Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage.
Questions About Stress and Emotional Health
Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.
- Are you often under a lot of stress, or has something recently upset you?
- Do you have any anxiety, depression or other mental health issues?
- Are you taking any drugs for your mental health?
- How satisfied are you with your sex life? Has there been any changes lately?
- How is your relationship with your partner? Has there been any changes lately?
Physical Exam
A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.
Lab Tests
Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.
Other Tests
Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.
Advanced Erectile Function Tests
For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.
- Blood work to check Testosterone and other male hormones
- Blood work to measure blood sugar (Diabetes)
- Ultrasonography (penile Doppler) to check blood flow
- A shot into the penis with a vascular stimulant to cause an erection
- Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
- Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection