Erectile Dysfunction

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Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the most common sexual problem that men report to their doctor and affects around 30 million men in the united states. ED, also known as impotence, is the condition in which men cannot get or keep an erection that is firm enough for sexual intercourse. Having a problem with ED from time to time is not a cause for concern; however, it is not normal if it becomes an ongoing issue and should be treated by US-licensed healthcare professionals like those at Roman. ED can be a sign of a more serious condition, so it is important to speak with your doctor if you have any signs of ED. Medications like ED pills can help prevent erectile dysfunction. 

Common Causes of Erectile Dysfunction

Sexual arousal in men is a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. Because of these complexities, ED can be caused by problems in any of these areas. ED can be caused by physical and psychological issues or a combination of both.

Physical Underlying Causes of ED

Some medical conditions can cause ED by reducing blood flow into the penis or when the penis can not trap blood during an erection. The most common physical causes of ED include:

  • Heart disease
  • Atherosclerosis
  • High cholesterol
  • High blood pressure
  • High blood sugar (diabetes)
  • Obesity
  • Metabolic syndrome - a condition involving high blood pressure, high insulin levels, body fat around the waist, and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Some prescription medications
  • Tobacco use
  • Peyronies disease - the development of scar tissue inside the penis
  • Drug use
  • Alcoholism
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Emotional Causes of ED

The brain plays a vital role in causing the physical events that lead to an erection. Many psychological and emotional factors can interfere with sexual desires causing or worsening ED. These could include:

Signs and Symptoms of Erectile Dysfunction

ED is often a symptom of an underlying health problem. Symptoms could include:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Other erection problems
  • Reduced sexual desire

How Do Doctors Diagnose Erectile Dysfunction?

A doctor can diagnose ED after reviewing your medical and sexual history, a mental health exam, and sometimes a physical exam is necessary. Some men may find it hard to talk with their doctor about ED, but keep in mind that your doctor is trained to talk about and treat these issues, and the more your doctor knows about you and your health history, the better he/she can treat your condition. Your doctor may also need to order lab or imaging tests to look for underlying health conditions that could be causing your ED.

Common questions your doctor may ask include:

  • How long have you had these symptoms?
  • Do you wake up in the morning or during the night with an erection?
  • How would you rate your confidence that you can get and keep an erection?
  • How often is your penis firm enough for intercourse when you have erections from sexual stimulation?
  • How often are you able to maintain an erection during sexual intercourse?
  • How often do you find sexual intercourse satisfying?
  • How would you rate your level of sexual desire?
  • How often are you able to climax, orgasm, or ejaculate?
  • Have you had any surgeries or medical treatments that may have damaged any nerves or blood vessels near the penis?
  • Do you have painful erections, feel any lumps or bumps in the penis?
  • Are you taking any prescription or over the counter medication?
  • Do you smoke? Drink alcohol? Or use illegal drugs?
  • Are you under a lot of stress?
  • Do you have anxiety?
  • Are you taking medication for your mental health?
  • How is your relationship with your partner?

This information will help your doctor better understand your ED and can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation. Some of these questions also address any psychological or emotional issues that may be causing your ED.

Some men affected with ED may require specialized testing that could include:

  • Blood work to check testosterone and other hormones
  • Blood work to measure blood sugar, to check for diabetes
  • Ultrasound, to check for irregular blood flow in the penis
  • A shot into the penis with a vascular stimulant to cause an erection to evaluate how full your penis becomes and how long your erection lasts
  • Pelvic x-rays, MRI, or CT scan to check for trauma or cancer
  • Nocturnal penile tumescence, which is an overnight test to check for sleep erection that may monitor how firm the erections are, the number of erections, and how long the erections last

Where to Get Treatment Online for Erectile Dysfunction

Erectile Dysfunction Treatments

There are various treatment options for ED, including ED pills, creams, and wipes, and even gummies. The treatment that is right for you will depend on the cause and severity of your ED and any underlying health conditions you may have. It is important to work with a health care professional to choose the ED treatment that is best for you; it may be helpful to talk with your partner about which treatment is best for you as a couple as well. ED treatment options could include lifestyle changes, medications, testosterone therapy, injections, erection devices, implants, or surgery.

Lifestyle Changes

Your doctor may recommend any of the following lifestyle changes to help improve your ED. If you have trouble making these changes on your own, seek help from your doctor.

  • Quit smoking
  • Limit alcohol consumption
  • Increase physical activity
  • Stop drug use

Oral ED Medications/ED Pills

There are four oral medications (including ED pills) approved by the FDA for the treatment of ED; these medications are known as PDE type-5 inhibitors and work to increase penile blood flow. These ED pills are taken by mouth and will help you to get and maintain an erection.

These medications all work by relaxing muscles in the penis and increasing blood flow in the penis during sexual stimulation allowing you to get an erection. Taking this medication will not automatically produce an erection; sexual stimulation is required first to work. These medications come in varying dosages, so it may take time to find the right medication and dose right. These medications do come with possible side effects, including:

  • Facial flushing
  • Back pain
  • Nasal congestion
  • Headache
  • Visual changes
  • Muscle aches
  • Stomach upset
  • Stuffy nose

Always check health information with your doctor before taking these medications. You SHOULD NOT take any of these medications if you take nitrates for your heart, have heart disease or heart failure, or have very low blood pressure. Don't take these medications on an empty stomach.

Testosterone Therapy

If the cause of your ED is related to low blood levels of testosterone, and you are experiencing low sex drive, testosterone therapy may help fix normal erections. Testosterone therapy may also work well combined with PDE type 5 inhibitors. Possible common side effects of testosterone treatment could include a high red blood cell count and problems urinating.

Penile Injection and Suppository Medicines

If ED pills do not treat your ED, the ED drug Alprostadil is an approved injectable or suppository drug to treat ED. 

When injected into the penis, Alprostadil works to cause it to become filled with blood, causing an erection. It may be beneficial to have your first injection done at the doctor’s office before doing this independently. Self-injection lessons will be given at your doctor’s office so you can learn to do this from the comfort of your own home. Each injection is dosed to create an erection to last no longer than an hour. Side effects could include mild bleeding from the injection, prolonged erection, and very rarely fibrous tissue formation at the injection site.

Alprostadil also comes in the form of a suppository, and this treatment is called Alprostadil intraurethral therapy. This method involves placing a small alprostadil suppository inside your penile urethra. To insert, you use a special applicator. The erection typically starters within 10 minutes of insertion and may last 30 minutes to an hour. Side effects of this method could include a burning feeling in the penis, minor bleeding in the urethra, and fibrous tissue formation inside your penis.

Vacuum Erection Device/Penis Pump

If medications do not successfully treat your ED, your doctor may recommend a vacuum erection device. This device is made of a plastic tube that slides over the penis and makes a seal with the body's skin. There is a pump at the other end of the tube, creating a low-pressure vacuum around the penis. The pump sucks out the air inside the tube, creating a vacuum that pulls blood into your penis and causes an erection. Once an erection is attained, an elastic ring is then slipped onto the base of the penis to hold the blood in the penis to maintain the erection. The erection typically lasts for up to 30 minutes, and the ring should be removed after sexual intercourse. Possible side effects of this device are bruising and restricted ejaculation.


If your ED is severe and other treatment methods have failed, your doctor may recommend surgery. This treatment involves surgically placing devices into both sides of the penis. These implants are either inflatable or bendable rods. The semi-rigid/bendable implants are made from two easy to bend rods made of silicone to give the penis firmness required for sexual penetration. Two fluid-filled cylinders are placed in the penis and tubing for the inflatable implant. It joins these cylinders to a pump placed inside the scrotum. When the pump is engaged, the cylinders inflate, making the penis stiff, creating an erection. As these implants do require surgery, there are risks of complications like infection.


If psychological or emotional issues cause your ED, your doctor may recommend seeing a counselor or online therapist. A counselor can help teach you coping strategies for anxiety and stress.  Your counselor may also recommend that you bring your partner along to a session so your partner can better support you.

Whether the cause of your ED is physical, psychological, or a combination of both, erectile dysfunction can be the cause of mental and emotional stress for you and/or your partner. It is important to seek help from a health care professional before your ED starts to affect your life, health, and relationship drastically. With the use of telemedicine technology, you can receive convenient, discreet, and affordable ED treatment, all from the comfort of your own home. There are many digital companies where you can complete an online doctor's consultation, and they can even ship your treatment in discreet packaging directly to your home, saving you a trip to your pharmacy. Check out our top list of digital clinics to start receiving treatment for your ED today.