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Do I Have ED (Erectile Dysfunction) or Not? How Do I Know?


Dear Doctor K,

I’ve experienced an inability to get an erection a few times now, but it’s not consistent. Sometimes I’m fine. How do I know when I should be concerned?

My response:

There’s a joke about the difference between fear and panic. “Fear is the first time you can’t get it up twice. Panic is the second time you can’t get it up once.”

So the question is – when should you panic?

Many men have an occasional problem with the inability to become erect with sexual stimulation. Most of these instances are situational. Illness, stress, lack of sleep and other physically or emotionally draining circumstances can short-circuit the pathway to arousal.


Alcohol in small to moderate amounts can be a great inhibition remover. In more significant amounts, however, alcohol may prevent you from getting erect and/or maintaining your erection throughout intercourse. Alcohol dilates the blood vessels; the alcoholic flush some people have after a few drinks is a good example of this. An erection counts on the blood vessels in the penis to expand and contract in response to chemicals and nerve stimulation. If the blood vessels are already in a wide open state due to alcohol, they will not respond in the proper way.


These periodic episodes do not constitute true erectile dysfunction (ED). ED is the persistent inability to either achieve and/or maintain an erection satisfactory enough for intercourse.

Normally ED has a gradual onset, usually starting in the 40’s or 50’s. You may notice a decrease in the firmness of your erection. Initially this may be insignificant and you may only notice it in hindsight. When I ask when they first noted problems, most of my patients said it began recently. When I probe further, they realize the problem really originated quite a bit earlier. I always ask about the frequency and quality of their morning erections. If the “little soldier” does not come to attention early in the morning, you likely are in the early stages of ED.


Age, health and habits all influence the onset and severity of ED. Though usually thought of as an older man’s issue, ED is usually associated with declining levels of testosterone in the blood.  Good health, as with most issues in life, provides a strong defense against problems. Chronic illnesses, on the other hand, are definite weak spots in your defense. High blood pressure, high cholesterol and diabetes, along with their medications, can worsen the course of ED. Some psychiatric medications have sexual side effects including decreased sex drive and inability to climax. Poor diet, lack of exercise, excessive alcohol, smoking and illegal drugs are also bad habits that can cause damage to blood vessels throughout the body. Diseases of the heart and blood vessels obviously have a direct relationship to ED. In fact, erectile dysfunction may be the first indication of generalized cardiovascular disease.

Pelvic injury, prostate surgery, spinal cord trauma, radiation therapy can be associated with the acute onset of ED.

So, what should you do for peace of mind?

Don’t stew about it. Be proactive.

Talk to your doctor or see a urologist. New advanced tests, many of which are non-invasive and can be done in the office, are available to diagnose and treat ED. Numerous treatment options are also available. You don’t have to accept erectile dysfunction as a part of growing old.


Do you have questions? Send a confidential email to Dr. Kline and he will address your topic in an upcoming post.



dr ron klineDr. Ronald Kline graduated with his M.D. from the University of Texas Medical Branch, then completed both his general surgery residency and a colon and rectal surgery fellowship at Baylor University Medical Center in Dallas. He is certified by the American Board of Colon and Rectal Surgery.  Additionally, he is a Fellow of both the American College of Surgeons and the American Society of Colon and Rectal Surgeons.

Dr. Kline received his certification in age management medicine from the Cenegenics Institute. This training led him to incorporate hormone replacement therapy into his practice. He saw the effects hormone replacement provided in all aspects of the patient’s life, especially sexual health. From there, he looked for additional methods to improve and enhance sexual performance, which in turn brought him to Renewal Medical Centers and the innovative therapy for improving men’s sexual health.

renewal medical centers of north dallas

originally posted 2/2/2021
Updated 1/3/2022

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