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Men’s Health: How Do I Know if I Have ED and What Should I Do?

erectile dysfunction ED

By Dr. Ron Kline, M.D.


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 preferred not 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 exactly is ED?

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 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,” “almost never,” 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

This 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 goatweed, yohimbe, maca root, ginko 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.


Sildenafil (generic name for Viagra) and tadalafil (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 ED that does 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 stimulates 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

Physical issues might cause your ED, or the situation 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 erectile dysfunction treatment option 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 root of the problem.

Stay tuned for more information about this important topic. This is the first in a series where I plan to discuss causes and treatments of ED, the relationship between testosterone and ED, ED and lifestyle issues and more.  Please email me at the Renewal Medical Centers of North Texas if you have specific questions you want me to answer – I’m here to help!


About the author:

Dr. 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.


Disclosure: The information contained in this article is not intended as a substitute for medical advice. Please consult your doctor if you experience medical issues related to erectile dysfunction.


originally posted 11.2.2022
updated 3.20.2022

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