How Do I Know if I Have Erectile Dysfuntion (ED) and What Should I Do?

By Dr. Ron Kline, M.D.
Medical Director, Renewal Medical Centers of North Texas

You don’t need to accept ED simply as part of living longer. For a long time, men considered erectile dysfunction a normal consequence of aging. Supposedly, once a man reached a “certain age” sex was no longer as important as in earlier years.

Do you believe that? I don’t. I think that’s just an excuse; a lot of men were embarrassed and didn’t want to deal with the issue. Many men, and their significant others, now realize the connection between a healthy body and mind and a healthy sex life. ED is no longer considered a problem with which you have to live the rest of your life.

Until recently, ED was a topic discussed almost exclusively in the privacy of a doctor’s office. Nowadays, advertisements for treatments are common on radio, TV, and online. It’s much more acceptable to talk about ED in public now. This change helps men to know they are not alone; many others have similar concerns.

What is Erectile Dysfunction?

Clinically, we define erectile dysfunction or ED as the inability to achieve and/or maintain an erection firm enough and long enough for sexual intercourse.  If you have an occasional difficulty that occurs with stress, anxiety, illness, or too much alcohol, do not immediately assume you have a problem. I often tell patients that panic is the first time you can’t get it up twice and fear is the second time you can’t get it up once.

You may have ED if you are consistently unable to get and keep an erection, and it seems to worsen over time. Communicate with your partner if your sexual experience is not satisfying for both of you and decide on the next step together.

“How do I know if I have ED?”

Ask yourself these 5 questions. Truthful answers help determine whether you suffer from ED.

Grade each response from 1 (lowest) to 5 (highest), based on the context of the question “1” indicates “very low,” “rarely,” or “very difficult,” and “5” equals “very high,” “always,” or “not difficult”.

1. How confident you are that you can get and maintain an erection?
2. How often are your erections firm enough for penetration?
3. How often are you able to maintain your erection during intercourse after penetration?
4. How difficult is it to maintain your erection to the completion of intercourse?
5. How often is intercourse satisfying for you?

The lower your score, the more severe your degree of ED. A score of 16 or below indicates moderate to severe ED.

Treatment Options

Okay, so you answered the questions above and decided you may have erectile dysfunction. What’s next? Numerous treatment options are available to deal with the physical symptoms such as weak or non-existent erections.

Penis vacuum pumps and penis rings

Penis vacuum pumps help with erections by creating a vacuum around the penis to cause the chambers of it to engorge with blood.  A ring placed around the base of the penis traps blood in it to maintain the erection. Sounds good, right? However, if you keep the ring on too long more problems may result.

Intercavernous injections

The intercavernous injection treatment involves injecting a formulated mixture of two or three chemicals into the shaft of the penis. These chemicals cause the vessels to dilate, filling the penile shaft with blood to cause an erection. Sounds like loads of fun.

Natural Treatment Options

Natural treatment options are centuries old. Some of these options include horny goat weed, Yohimbe, maca root, and ginkgo to name a few. Others involve certain foods, such as oysters.

The amino acid L-arginine is a naturally occurring amino acid available in over-the-counter powders or tablets. You may be familiar with this amino acid because bodybuilders and weightlifters often use it to encourage the muscular “pump” at the end of a workout. It is also used to help achieve erections. Here’s how it works: Once ingested, L-arginine is metabolized to nitric oxide, which is a vasodilator. This process causes the small blood vessels throughout the body to open up to allow better blood flow.

Medications

Sildenafil (the generic name for Viagra) and tadalafil (the generic name for Cialis) are probably the most well-known and touted of the medications used to treat ED.  They block the enzyme in the body that breaks down the nitric oxide. Originally developed to treat baldness, when given to trial subjects the men noticed a surprising side effect. And a new billion-dollar industry was born.

Surgical procedures

For EDs that do not respond to any of these methods, surgical procedures are available to correct the problem. These involve the implantation of a prosthesis -either rigid or inflatable- in the penis. The results are usually very satisfactory to the man and his partner. But, as with any surgery, there are risks of complications.

Low Intensity Shock Wave Therapy (LISWT)

All of the above treatment options address the possible physical symptoms of ED, but unfortunately not the cause.  A newer option now available is called Low Intensity Shock Wave Therapy (LISWT). This procedure works to stimulate the growth and regeneration of blood vessels, nerves, and elastic tissue within the penis. (A later article will explore this in more depth.)

The Bottom Line

Your ED might be caused by physical issues, or it might be the result of unhealthy lifestyle choices, poor self-esteem, and/or communication or intimacy challenges with your partner. Don’t be embarrassed – know you are in good company and that whatever the problem, chances are there’s a solution. You just need to find the one that works best for you. It’s important to have what might be a difficult conversation with your significant other, therapist, and/or doctor to get to the root of the problem.

FAQs About Erectile Dysfunction

Below are some commonly asked questions about Erectile Dysfunction and Erectile Dysfunction Treatments.

What causes erectile dysfunction?

ED can have various causes, including physical, psychological, and lifestyle factors. Common physical causes include cardiovascular issues, diabetes, hormonal imbalances, neurological disorders, and certain medications. Psychological factors like stress, anxiety, depression, and relationship problems can also contribute.

Who is at risk for developing ED?

ED becomes more common as men age, but it’s not solely an age-related issue. Factors such as obesity, smoking, excessive alcohol consumption, lack of physical activity, and certain medical conditions can increase the risk of developing ED.

How is ED diagnosed?

A doctor typically diagnoses ED through a combination of medical history review, physical examination, and possibly additional tests. These tests might include blood tests to check hormone levels, ultrasound to evaluate blood flow in the penis, and other specialized assessments.

How can psychological factors contribute to ED?

Psychological factors like stress, anxiety, and depression can interfere with the brain’s ability to send signals that initiate the process of achieving an erection. Performance anxiety and relationship issues can also lead to ED by creating a cycle of worry and reduced sexual confidence.

Can ED be a sign of other health problems?

Yes, ED can sometimes be an early warning sign of underlying health issues. Since ED can be linked to blood vessels and cardiovascular problems, it’s important for individuals experiencing ED to undergo a thorough medical evaluation to identify any potential underlying causes.

Is ED a permanent condition?

ED doesn’t have to be a permanent condition. Depending on the underlying cause, treatment can often improve, or even reverse ED. Lifestyle changes, medications, and other therapies can help many men regain their ability to achieve and maintain erections.

How can ED affect a relationship?

ED can have significant psychological impacts on both partners in a relationship. It can lead to feelings of frustration, disappointment, and inadequacy. Communication breakdowns, emotional distance, and reduced intimacy might also arise.

Is ED a common cause of relationship problems?

Yes, ED can contribute to relationship problems. The stress and emotional strain caused by ED can lead to misunderstandings, decreased emotional connection, and a decrease in overall relationship satisfaction.

How can partners support each other when dealing with ED?

Open and empathetic communication is key. Partners should discuss their feelings, concerns, and expectations related to ED. Supporting each other emotionally, seeking medical advice together, and exploring alternative forms of intimacy can help maintain a strong bond.

How can couples address the emotional impact of ED?

Couples should focus on understanding that ED is a medical condition and not a reflection of their worth as individuals or the strength of their relationship. Seeking professional counseling or therapy can provide a safe space to address emotional concerns and learn coping strategies.

What are some ways to maintain intimacy while dealing with ED?

Couples can explore various forms of intimacy beyond sexual intercourse. Emotional intimacy, cuddling, holding hands, and open conversations about desires and boundaries can help maintain a strong connection.

Remember, the information provided here is for general understanding and should not replace professional medical advice. If you or someone you know is dealing with ED, it’s always best to consult a qualified healthcare professional for personalized guidance and treatment.

About the Author: Dr. Ron Kline

Dr. Ronald Kline graduated from the University of Texas Medical Branch in 1973 and completed both his general surgery residency and a colon and rectal surgery fellowship at Baylor University Medical Center in Dallas and began private practice in 1979. Dr. Kline is certified by the American Board of Colon and Rectal Surgery. He is a Fellow of the American College of Surgeons as well as a Fellow of 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. Dr. Kline saw the effects that hormone replacement provided in all aspects of the patient’s life, especially sexual health. This experience led him to look for other methods to improve and enhance sexual performance, which in turn brought him to Renewal Medical Centers and innovative therapy for improving men’s sexual health.