Key takeaways

Diagnosing erectile dysfunction (ED) typically involves a physical examination and discussion of medical history, with additional tests like blood tests, urinalysis, or ultrasound required if an underlying condition is suspected.
Erectile dysfunction, affecting over three million people in the U.S. annually, can be caused by a variety of factors including lifestyle choices, psychological issues, and underlying medical conditions.
Early signs of ED include inconsistent ability to achieve or maintain an erection, and diagnosing ED may involve self-assessment tools like the NPT Stamp Test followed by professional evaluation by a doctor or urologist.
Most cases of ED are treatable through a combination of lifestyle changes, medication, natural therapies, or other treatments, with the specific approach depending on the underlying cause of the ED.

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:

age
alcohol use
inactivity or lack of exercise
obesity or being overweight
smoking

Psychological and emotional causes of erectile dysfunction:

stress
general anxiety
performance anxiety
depression
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)
diabetes
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
stroke
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.

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.

Medical history

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?

Physical exam

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.

Blood tests

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.

Ultrasound

Generally performed by a specialist, an ultrasound is a simple procedure that can help identify any blood flow issues to your penis.

Psychological exam

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

sildenafil (Viagra)
tadalafil (Adcirca, Cialis)
vardenafil (Levitra, Staxyn)
avanafil (Stendra)

Lifestyle changes

reducing illicit drug and alcohol intake
quitting smoking
losing weight
increasing exercise
meditating
working through relationship issues
reducing stress

Natural treatments

emotional therapy
acupuncture
vitamins and supplements

Other options

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.