Here's Exactly What To Say To Your Doctor About Erection Issues
- By Emily Shiffer
- Medically reviewed by Joshua Calvert, M.D.
- April 8, 2022
Fast Facts
- Around 30 million men in the US experience erectile dysfunction.
- Several types of medical professionals can treat ED, including urologists, endocrinologists, psychologists, and family medicine physicians.
- Erectile dysfunction doctors may suggest medication, talk therapy, or injections to treat ED, depending on the cause.
If you’re struggling with erectile dysfunction (ED), you’re probably dealing with a lot of feelings: confusion, worry, and possibly embarrassment. Those emotions are understandable but don’t let them stop you from finding a doctor or specialist who can help. ED is common—about 30 million men in the US experience penis problems—and there’s nothing you can say to an erectile dysfunction doctor that he or she hasn’t heard before.
If you’ve been dealing with ED and are ready to seek help, you may feel overwhelmed with where to start. But finding an erectile dysfunction expert who you feel comfortable with, and who is qualified to treat you, is easier than you think.
Here’s what to know about ED, how to find the right doctor, and what to say at the appointment.
What is Erectile Dysfunction?
Every guy’s penis will occasionally fail to get or stay hard enough for sex. But if it happens regularly, you might be experiencing ED. Ongoing difficulty keeping an erection can lead to stress and relationship woes and can tank your confidence. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment.
Related: Why You Can’t Get And Keep an Erection
“Erectile dysfunction is complex,” says urologist Joshua Calvert, M.D. “There are numerous neurologic, psychologic, vascular, and interpersonal components at play.”
ED Symptoms
By the time a man is in his 40’s, he has about a 40 percent chance (1) of having some form of ED, and the risk increases about 10 percent per decade thereafter.
Erectile dysfunction symptoms can include ongoing:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced libido
Related: Erectile Dysfunction and Age
What Causes Erectile Dysfunction?
Physical and medical conditions are often to blame for ED. Chronic conditions that impair blood flow or nerve impulses can make it difficult for blood to flow easily into your penis (which is what causes it to expand and stiffen). The cause of your erectile dysfunction could be one of many things, including:
- Clogged blood vessels
- Diabetes
- Enlarged prostate
- Heart disease
- High cholesterol
- Hypertension
- Low testosterone
- Metabolic syndrome
- Multiple sclerosis
- Obesity
- Parkinson’s disease
- Peyronie’s disease
- Prostate cancer treatment
- Sleep disorders
Other culprits, including drugs (prescription and non-prescription), excessive alcohol consumption, smoking, and not exercising enough can also prevent your penis from rising to the occasion.
Another major contributor to ED is psychological factors. Psychological factors (e.g., depression, anxiety, relationship conflict) and psychosexual issues (such as trauma, body image issues, and guilt) can cause or contribute to ED. So can relationship issues, performance anxiety, or other stressors.
Hone’s test, which you can take from the privacy of your home, can analyze your testosterone levels.
Erectile Dysfunction Doctors: Specialists That Treat ED
Several different doctors can treat ED. The one that’s right for you will largely depend on what’s causing your erection struggles in the first place. But a great first visit is with the primary care physician you see for checkups and run-of-the-mill illnesses.
Related: Getting ED Medications Online—What Are Your Options?
Primary Care Physicians
Most PCPs are well versed in basic ED management, says Calvert, so they’re a great place to start. If you tell your doctor that you’re having problems with your erections, he or she will do a physical exam (more on that below). They also might run tests to suss out any underlying health conditions that could be contributing.
If your PCP diagnoses you with erectile dysfunction, he or she can prescribe a medication that you can take before sex to help you get and stay hard.
According to a comprehensive 2015 review (2), oral ED meds are effective for up to 80% of men. The other 20 % may not be taking the pills as prescribed, or they may have an underlying condition, such as uncontrolled diabetes or peripheral neuropathy, and may need something more aggressive than pills. Chances are good if you are relatively healthy, oral meds may do the trick for you.
Oral ED medications are effective for up to 80% of men
Urologist
If oral medications don’t work for you, your primary care doctor will likely refer you to a urologist, a physician who specializes in conditions that affect the urinary tract and reproductive system.
“The urologist will do a history and physical, and likely will check your testosterone,” explains Calvert. Armed with this information, he or she can suggest treatment options. “There are lots of other options for treatment should oral medications fail to give you satisfactory results,” says Calvert. Among them:
- Penile injections
- Urethral suppositories
- Penis pumps
- Penis implants
Endocrinologist
If your PCP diagnoses or suspects that you have diabetes or another hormonal cause for your ED, he or she might refer you to an endocrinologist, a specially trained doctor who is qualified to diagnose and treat hormone-related diseases and conditions. The endocrinologist will run labs to check for conditions including diabetes and low testosterone.
ED is common in men who have diabetes, especially those with type 2 diabetes. One study (3) found that men with diabetes have a 50% higher chance of developing ED than men without diabetes. And while many men may develop ED as they age, those who have diabetes may develop the condition up to 10 years earlier than other men their age. The issue can stem from damage to nerves and blood vessels caused by poor long-term blood sugar control.
Low testosterone can also cause ED. If your testosterone levels are below the normal range for your age, you may struggle to get and keep an erection. “Studies have shown that men with higher T tend to have better erections, and men with T deficiency have worse ones,” says Calvert.
Psychotherapist
If there isn’t a medical cause for your ED, a counselor or psychotherapist can often help. “I recommend most men that I see, especially young men for whom I can’t make a clear diagnosis, see a sex therapist,” says Calvert. “They can work wonders for ED related to thoughts, feelings, or relationship stressors.”
Sex and erectile difficulties can be taboo topics, but talking about relationship problems or performance anxiety with a trained pro can be a game-changer for men with ED. A therapist can help you identify areas in your relationship that might be causing a rough patch— like navigating a relationship with a new baby, overcoming your changing and aging body, or societal standards of men shaped by advertising and the porn industry—and give you pointers on how to work through them with your partner.
Some proof it works: One recent study (4) published in Sexual Medicine found that talk therapy helped guys suffering from ED that stemmed from issues like anxiety and depression to have better erections. In fact, men who participated in talk therapy showed just as much improvement in ED symptoms as men who were treated with sildenafil (Viagra). Plus, their anxiety levels diminished.
Questions Your Doctor Might Ask
Regardless of what kind of erection professional you see, the doctor will ask questions to fully understand your experience. They’ll want to know how common the problem is, whether you can get fully hard and if you can ejaculate and orgasm.
But there’s a good reason they’re interrogating: these questions establish a baseline that your doctor can use to monitor your treatment, says Calvert.
Your doctor will probably have you fill out a questionnaire which poses questions like:
- How long has this been an issue?
- Is the difficulty attaining or maintaining an erection or both?
- Do you get erections at night, or ever wake up with them?
- Does your penis curve?
- Do you have low libido?
- What have you tried for treatment?
- Do you take nitroglycerin for chest pain?
- What other medical conditions do you have?
How to Prepare for Your Visit With An Erectile Dysfunction Doctor
If you’re a little anxious about your appointment, knowing what’s coming might help you feel prepared. For starters, you’ll probably have a physical exam.
“While it may feel embarrassing, your doctor has literally seen thousands of penises, and in the case of most urologists, hundreds of thousands. And unless you are also being screened for prostate cancer, there won’t be a rectal exam as a component to the physical,” says Calvert.
You also should be proud you made the appointment.
“Give yourself some credit. In Western society, men are severely undertreated for medical conditions, so be proud of yourself that you’re willing to get some help,” says Calvert. “Keep an open mind, and remember that ED can be caused by a lot of things or a combination of a lot of things. There are solutions for ED no matter how bad it is.”
Questions to Ask Your Erectile Dysfunction Doctor
It is easy to blank or forget what you want to ask your doctor during your appointment. Write a few questions down in advance (or save them on your phone) to make sure you don’t forget to ask them during your appointment. A few to put on the list:
- What side effects should I expect from this medication/treatment?
- What is the next step if this medication doesn’t work?
- Are there any other lab tests we should do (like assessing testosterone levels), to help diagnose this problem?
Treatment Options for ED
Depending on the cause of your ED, here’s what your doctor may suggest:
Testosterone Replacement Therapy
If your testosterone levels are low and thought to contribute to erection difficulties, your doctor may suggest testosterone replacement therapy (TRT). TRT involves supplementing the testosterone your body isn’t producing, via injections, topical treatments, dissolvable lozenges, or other methods.
Oral Medication
One of the most common treatments for ED is oral drugs called phosphodiesterase type 5 (PDE5) inhibitors, like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These meds block the action of an enzyme that binds to and breaks down a chemical that helps blood vessels relax and dilate so that blood can flow into your penis. These medications have to be taken up to a few hours before sex, and usually on an empty stomach.
Related: How Do Erectile Dysfunction Meds Work?
Penile Injection Therapy
Medications that relax smooth muscle and open the blood vessels in your penis can also help you get and maintain an erection. The medication is injected directly into the penis.
“Men do them at home, and we usually recommend that they don’t inject themselves more than once in a 48 hour period,” says Calvert. “The needle is tiny, the size of an insulin needle, and most men are worried about the pain until they get a great erection. Trust me, if they work for you, the last thing you will worry about is the pain.”
Inflatable Penile Prosthesis
For men in whom nothing else works—commonly in men who have had their prostate removed for cancer—their urologist may recommend an inflatable penile prosthesis. Most urologists recommend this when everything else has failed. The prosthesis is a three piece system that is placed under the skin, with a pump in the scrotum that is used to inflate cylinders in the penis. It gives the patient a rock-hard erection whenever they want for as long as they want. No wonder the satisfaction rate in patients and their partners are in the high 90s. “The prosthesis should be considered the end of the line, and should only be implanted in someone who has been extensively counseled, says Calvert.
Hone’s test, which you can take from the privacy of your home, can analyze your testosterone levels.
The Bottom Line
References:
1. Ferrini, Monica G et al. “Aging related erectile dysfunction-potential mechanism to halt or delay its onset.” Translational andrology and urology vol. 6,1 (2017): 20-27. doi:10.21037/tau.2016.11.18
2. Chen, Liang et al. Phosphodiesterase 5 Inhibitors for the Treatment of Erectile Dysfunction: A Trade-off Network Meta-analysis, European Urology, Volume 68, Issue 4, 674 – 680
3. Maiorino, Maria Ida et al. “Diabetes, and sexual dysfunction: current perspectives.” Diabetes, metabolic syndrome, and obesity : targets and therapy vol. 7 95-105. 6 Mar. 2014, doi:10.2147/DMSO.S36455
4. Bilal, Ahmad, and Najam Ul Hasan Abbasi. “Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study.” Sexual medicine vol. 8,3 (2020): 396-407. doi:10.1016/j.esxm.2020.05.005
