“Erectile dysfunction treatment“: what it is and what your next step should be

Disclaimer: This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. If you are experiencing symptoms of erectile dysfunction (ED), consult a qualified healthcare professional for personalized evaluation and care.

Erectile dysfunction treatment begins with understanding what is happening in your body and why. ED—sometimes called impotence—is the persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual performance. Occasional problems are common. Ongoing symptoms, however, may signal an underlying physical or psychological condition that deserves medical attention.

Below, you’ll find a practical, step-by-step guide—from recognizing symptoms to deciding what to do next.

3 typical scenarios

Scenario 1: “It started gradually, and now it happens most of the time.”

What this might mean:
A gradual onset of erectile problems, especially in men over 40, may be linked to physical causes such as reduced blood flow, high blood pressure, diabetes, high cholesterol, hormonal imbalance (e.g., low testosterone), or medication side effects. Cardiovascular disease is a common underlying factor because erections depend on healthy blood vessels.

What a doctor usually does:
A physician will ask about your medical history, medications, smoking or alcohol use, and lifestyle habits. They may check blood pressure and order blood tests (glucose, lipid profile, testosterone levels). In some cases, additional cardiovascular assessment is recommended. You may also be referred to a specialist if needed.

For a broader understanding of related men’s health concerns, see our general men’s health overview.

Scenario 2: “I can get an erection sometimes, but not during sex.”

What this might mean:
If erections occur during sleep or masturbation but not during intercourse, psychological factors such as stress, anxiety, performance pressure, or relationship difficulties may be contributing. Depression and chronic stress can also affect libido and sexual performance.

What a doctor usually does:
Your clinician may explore mental health, recent life stressors, and relationship dynamics. Screening tools for anxiety or depression might be used. In some cases, counseling or sex therapy is suggested alongside medical treatment options.

Scenario 3: “The problem appeared suddenly.”

What this might mean:
A sudden onset of erectile dysfunction can sometimes be linked to acute stress, a new medication, hormonal shifts, or, less commonly, nerve or vascular injury. If ED is accompanied by other symptoms—such as chest pain or neurological changes—it requires urgent evaluation.

What a doctor usually does:
The doctor will review recent changes in medications (including antidepressants or blood pressure drugs), ask about injuries, and assess for systemic conditions. Further testing depends on associated symptoms and overall health status.

Decision tree: what should you do next?

1. If the issue happens rarely and during stressful periods, then consider stress reduction, sleep optimization, and monitoring for a few weeks.
2. If ED persists for more than 3 months, then schedule a primary care appointment for evaluation.
3. If you have diabetes, heart disease, or high blood pressure, then seek medical advice promptly—ED may be an early warning sign of vascular disease.
4. If you recently started a new medication and symptoms began soon after, then consult your prescribing doctor before stopping any medication.
5. If ED is affecting your relationship or mental well-being, then consider counseling or sex therapy in addition to medical assessment.
6. If you experience pain, penile curvature, or trauma, then seek urological evaluation.

When to seek help urgently (red flags)

• Chest pain or shortness of breath: May indicate a cardiovascular emergency.
• Sudden neurological symptoms (weakness, numbness, speech difficulty): Could suggest stroke or nerve involvement.
• Severe penile pain or prolonged erection lasting more than 4 hours (priapism): Requires emergency care.
• ED following pelvic trauma: Needs prompt evaluation for vascular or nerve damage.

Approaches to treatment/management (overview)

Erectile dysfunction treatment depends on the underlying cause. In many cases, a combination of approaches works best.

Lifestyle modification

Improving cardiovascular health can improve erectile function. This includes regular physical activity, a balanced diet, smoking cessation, moderating alcohol intake, and maintaining a healthy weight. Learn more in our preventive health basics guide.

Oral medications (PDE5 inhibitors)

Drugs such as sildenafil, tadalafil, vardenafil, and avanafil enhance blood flow to the penis. They are taken as prescribed by a doctor and require sexual stimulation to work. These medications are not suitable for everyone, particularly those taking nitrates for heart conditions.

Hormonal therapy

If low testosterone is confirmed through laboratory testing and symptoms are consistent, testosterone replacement therapy may be considered under medical supervision.

Psychological counseling

For stress-related or psychogenic ED, cognitive behavioral therapy (CBT), couples therapy, or sex therapy can be beneficial.

Vacuum erection devices

These mechanical devices create negative pressure to draw blood into the penis. They may be recommended when medications are ineffective or contraindicated.

Injection therapy or urethral suppositories

In some cases, medications are administered directly to improve penile blood flow. These are used strictly under medical guidance.

Surgical options

Penile implants may be considered when other treatments fail. Surgery carries risks and requires specialist consultation.

For more on how treatment plans are tailored, visit our erectile dysfunction treatment options overview.

Prevention: reducing your risk of erectile dysfunction

• Control blood pressure, cholesterol, and blood sugar.
• Exercise at least 150 minutes per week (moderate intensity).
• Stop smoking—tobacco damages blood vessels.
• Limit alcohol intake.
• Manage stress through relaxation techniques or therapy.
• Get adequate sleep (7–9 hours per night).
• Have regular medical check-ups, especially after age 40.

Method	Who it suits	Limitations / Risks
Lifestyle changes	Most men, especially with cardiovascular risk factors	Requires consistency; gradual results
PDE5 inhibitors (as prescribed by a doctor)	Men with vascular ED and no nitrate therapy	Headache, flushing; contraindicated with nitrates
Testosterone therapy	Men with confirmed low testosterone	Requires monitoring; not for prostate cancer patients
Vacuum devices	Men who cannot take oral medication	Possible discomfort or bruising
Penile implants	Severe ED unresponsive to other treatments	Surgical risks; irreversible procedure

Questions to ask your doctor

1. What is the most likely cause of my erectile dysfunction?
2. Do I need blood tests or cardiovascular screening?
3. Could my current medications be contributing?
4. Which treatment options are appropriate for me?
5. What are the risks and side effects of these treatments?
6. Are there lifestyle changes that could improve my condition?
7. How soon should I expect results?
8. Is this condition reversible?
9. Should I see a urologist or another specialist?
10. How does ED relate to my overall heart health?
11. Are there psychological factors I should address?

Sources (authoritative)

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – Erectile Dysfunction
• American Urological Association (AUA) Guidelines on Erectile Dysfunction
• European Association of Urology (EAU) Guidelines on Sexual and Reproductive Health
• Mayo Clinic – Erectile Dysfunction Overview
• National Institutes of Health (NIH) – Erectile Dysfunction

Bottom line: Erectile dysfunction treatment starts with identifying the cause. In many cases, ED is treatable—and sometimes reversible—especially when addressed early. If symptoms persist, your next best step is to schedule a medical evaluation and discuss a personalized plan.