If you think you have erectile dysfunction, or ED, a good first step is to talk with your doctor. The treatment you need will depend on what’s causing it.
What Tests Will a Urologist Do if I Have ED?
Medical and sexual history
This one’s not actually a test, but your doctor will likely ask you questions about your medical and sexual history. The reason is simple: They want to better understand how ED affects you and see whether there might be a clear cause for it.
When you talk about past surgeries, medicine you take, injuries, and lifestyle choices, your doctor can learn about diseases or other issues you might have that could lead to ED.
By asking about your sexual history – your relationships, sex drive, if you ever get erections – they can begin to figure out whether the issue is more likely to be physical or mental. Be honest with your doctor. They can’t help you if you withhold information.
Your doctor will check your penis and testicles to make sure they seem normal and their nerves work as expected. They may also look for hair loss and larger-than-normal breasts. Both of these can be signs that you have a hormone problem.
They may also:
- Check your pulse at your wrists and ankles to see whether your blood flow is normal
- Listen to your heartbeat
- Take your blood pressure
Blood and urine tests
Based on your physical exam as well as your medical and sexual history, your doctor may want to order certain blood or urine tests. They’ll use these to check for problems that can lead to ED, such as:
- Heart disease
- Kidney disease
- Hormonal problems such as low testosterone
One type of blood test can check your thyroid function. Your thyroid helps with the flow of sex hormones. This test can check whether it’s working right.
Overnight erection test
Usually, men have three to five erections during the night as they sleep. 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. If you get an erection, the ring breaks.
If the test shows that you can get erections, it’s more likely that the ED is caused by something mental or emotional.
An injection test is also called an intracavernosal test. Your doctor injects a medicine into the base of your penis that should give you an erection. If you don’t get one, you may have a problem with blood flow to your penis.
Sometimes called Doppler ultrasound, this is another way to check blood flow to the penis. It may be used along with the injection test.
Your doctor takes a device that looks like a wand and holds it over your penis. It uses sound waves to create a video of your blood vessels so your doctor can look at blood flow.
Mental health exam
If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. These questions help them check for depression, anxiety, and other common causes of erectile dysfunction.
If you have a regular sexual partner, your doctor may ask to talk to the two of you together.
Your doctor may tell you to make some day-to-day adjustments. Expect to hear things like:
- Stop any tobacco or illegal drug use.
- Cut back on alcohol.
- Lower stress.
- Eat a healthy diet.
- Exercise regularly.
- Lose weight if you're overweight or obese.
- Lower your cholesterol and blood pressure levels.
If a medication is causing your ED, your doctor may lower your dose or try a different drug.
Other treatments include:
If anxiety or stress is causing your ED, it may help to talk to a professional therapist.
Life-changing problems or even everyday stress can trigger erectile dysfunction. Talking about these things with a licensed therapist can ease sexual anxiety and help you feel more confident in your relationship.
You may want to include your partner in these sessions as well.
ED medicines can be pills, drugs inserted into the tip of the penis, or shots into the penis.
The first things doctors usually prescribe to people with erectile dysfunction are pills like:
- Avanafil (Stendra)
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
They are taken anywhere from 15 minutes to 36 hours before having sex, depending on the drug. You shouldn’t use these more than once a day.
Staxyn dissolves in the mouth. The other medications are swallowed.
These pills work for about 80% of those who take them. But if your erection lasts more than 4 hours, seek emergency medical help. Side effects include:
- Stuffy nose
- Muscle ache
- In rare cases, a temporary blue-green shading of your vision
You shouldn’t take these pills if you take nitrate drugs for heart disease. Doing so can cause a dangerous drop in blood pressure.
Also use caution if you’re taking alpha-blockers for prostate problems or blood pressure.
Tell your doctor about all medications you’re taking, including any over-the-counter drugs, herbs, and supplements.
Injections and Suppositories
If the pills don’t work or aren’t safe for you to take, your doctor may prescribe a drug called alprostadil. It helps boost blood flow to the penis, triggering an erection within minutes.
It can be given in two ways:
Injection: The medication is put into the side of the penis by a needle. This raises your risk for dangerously prolonged erections and scarring.
Suppositories. Pellets are placed inside the urethra. You may hear this procedure called MUSE (medicated urethral system for erections). This may be less successful than shots.
A vacuum device improves firmness by boosting blood flow to the penis. About 80% of people who use the device correctly get an erection hard enough for sex.
They’re often used for penis rehabilitation, usually after prostate surgery. Your doctor will put you on a program designed to restore normal blood flow to the penis. This will allow you to get a spontaneous erection.
It may take several months to see results.
Vacuum erection devices, also called vacuum constriction devices, are made of three parts:
- A clear plastic tube that slides over the penis
- A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis
- An elastic ring that is placed around the base of the penis after an erection is obtained. It’s like a rubber band. It helps maintain firmness by preventing blood from draining out of the penis. If you have venous leak syndrome, this may help you.
A vacuum device can be cumbersome. It also will make sex less spontaneous. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
Vacuum devices are available with or without a prescription. Talk to your doctor before getting one.
If all other ED treatments have failed, your doctor may recommend surgery.
The operations are:
- Placement of an implant (prosthesis) in the penis
- Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures. This procedure works in very few cases and is currently not recommended.
Implants, or prostheses, help restore firmness for many people with ED. There are two types:
Malleable implants are a pair of bendable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for sex. Such implants do not affect penis size.
Inflatable implants are a pair of tubes placed in the penis and connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.
Once you have a penile implant, you must always use it to get an erection.
Implants may cause infection. If you have a urinary tract infection, skin infection, or body-wide infection, you shouldn’t get one.
The following may also happen:
- It may inflate on its own.
- The device may break down.
- The pump may shift.
Implants also make it more difficult to do surgery for an enlarged prostate, bladder cancer, or other urological conditions.
Vascular reconstruction surgery can:
- Repair blocked blood vessels to improve blood flow to the penis
- Block veins to prevent blood from leaking out of the penis
Blood vessel repair is best for younger people with a small blockage. It usually doesn’t work well for those who have more widespread blockages.
There are other treatments you can explore:
- Acupuncture. This traditional Chinese practice involves placing very fine needles at certain spots on your body. It’s thought to boost your body's ability to heal itself. It has helped some people. But more research is needed to prove that it works.
- Aromatherapy. Some scents, like lemon, may improve your mood. And that may put you in the mood.
Not Recommended for ED
Testosterone. It’s a male hormone. If you have a normal testosterone level, you don’t need more.
Trazodone. This is an antidepressant. It’s still uncertain whether it helps with ED. It’s not recommended.
Supplements. A lot of over-the-counter products have been hailed as all-natural ways to treat ED. But it’s not clear if they’re effective or safe.
The FDA warns that some products may contain harmful substances or the active ingredients found in some prescription medications.
Some of these products have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to vardenafil (the active ingredient in Levitra and Staxyn). These products can be dangerous for people who take nitrates to treat chest pain or heart disease.
In recent years, the FDA has seized many over-the-counter products for male sex issues because they contain dangerous or undeclared ingredients. Lab tests have discovered these risky ingredients in nearly 300 products.
The FDA says you should beware of products that:
- Promise quick results (in 30 to 40 minutes)
- Are advertised as alternatives to FDA-approved prescription drugs
- Are sold in single servings
- Advertise via spam or unsolicited emails
- Have labels written mostly in a foreign language
- Have directions and warnings that mimic FDA-approved products
Cell therapy. Doctors transfer cells from a pig's gonads into humans. More research is needed to prove if this therapy works, and it’s very costly.
Magnetic field therapy. Early small studies hint that there could be some benefit to this treatment, but more research is needed.
Low-intensity extracorporeal shock wave therapy. This treatment is considered investigational. The benefits do not outweigh the risks. There is only a small amount of evidence that it works in the short term and little evidence that normal erectile function returns after treatment.
Stem cell intracavernosal therapy and platelet‐rich plasma (PRP) therapy. Both of these supposed therapies are considered investigational.
Can I Use Insurance?
Some insurance policies cover ED treatment if it’s medically necessary. Check with your insurance provider.