Your doctor will perform a physical exam, which may include:
- Checking your blood flow (circulation)
- An exam of your penis and rectum
- An exam of your nervous system
To help find the cause of the problem, your doctor will ask medical history questions such as:
- Have you been able to get and keep erections in the past?
- Are you having trouble getting an erection, or keeping erections?
- Do you have erections during sleep?
- How long have you had trouble with erections?
- What medications are you taking (including prescription medications, over-the-counter medications, and recreational drugs)?
- Do you smoke? How much each day?
- Do you use alcohol? How much?
- Have you recently had surgery?
- Have you ever had surgery or other treatments for your blood vessels?
- Are you depressed?
- Are you afraid or worried about something?
- Are you experiencing a lot of stress?
- Has your energy level decreased?
- Are you sleeping well each night?
- Are you afraid of sexual activity because of physical problems?
- Have there been any recent changes in your life?
- What other symptoms do you have?
- Have you noticed changes in feeling to your penis?
- Do you have any problems with urination?
Tests that may be done include:
- Blood tests, including:
- Nerve testing
- Nocturnal penile tumescence (NPT) to check for normal nighttime erections
- Penile ultrasound to check for blood vessel or blood flow problems
- Psychometric testing
- Rigidity monitoring
- Urine analysis
The treatment may depend on the cause of the problem. Talk to your health care provider about the best way to treat your erection problem.
There are many treatment options today, including:
- Injections into the penis
- Medicines inserted into the urethra
- Medicines taken by mouth
- Vacuum devices
Ask your health care provider about the possible side effects and complications of each treatment.
Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines called phosphodiesterase-5 (PDE5) inhibitors. They work only when you are sexually aroused. They usually start to work in 15 to 45 minutes.
These drugs can have side effects, which can range from muscle pain and flushing to heart attack. Do not use these drugs with medications such as nitroglycerin. The combination can cause your blood pressure to drop. Some men have died after taking these drugs with nitroglycerin.
Use PDE5 inhibitors with caution if you have any of the following conditions:
- Recent stroke or heart attack
- Severe heart disease, such as unstable angina or irregular heartbeat (arrhythmia)
- Severe heart failure
- Uncontrolled high blood pressure
- Uncontrolled diabetes
- Very low blood pressure
If pills do not work, other treatment options include:
- Testosterone replacement using skin patches, gel, or injections into the muscle -- if your testosterone level is low.
- A medicine called alprostadil, injected into the penis or inserted into the urethra, improves blood flow to the penis. This usually works better than medications taken by mouth.
- A vacuum device can be used to pull blood into the penis. A special rubber band is then used to keep the erection during intercourse.
- Some men may need a penis implant (prosthesis).
Many herbs and dietary supplements are marketed to help sexual performance or desire. However, none of these supplements have been proven effective for treating erectile dysfunction, and they may not always be safe.