June 24, 2024
“It happens to everyone.”
It’s what people say when someone can’t get an erection. But there’s no hard evidence proving that fact.
The truth is that erectile dysfunction, or ED, does happen to a lot of people. It’s the most common sex concern men relay to their doctors. Experts estimate it affects up to 30 million men in the United States alone. But for many men, it’s still difficult to talk about.
“It may be uncomfortable to talk about your sex life, but it’s important,” says Dr. Jack Campbell, an MU Health Care urologist. “Your health and happiness may depend on it.”
In this third installment in our series on how to have difficult conversations with your doctor, we asked Dr. Campbell to help us understand how — and why — you should discuss ED with your doctor.
Why You Should Talk to Your Doctor About ED
Many factors influence erections. If getting erections is challenging, several things could be to blame, including:
- Decreased arousal or libido
- Physical challenges
- Psychological distress
“Knowing the cause of your problem is half the battle,” Dr. Campbell says. “A doctor can look at your erection issue from all angles to manage any underlying conditions and get you the most effective treatment.”
Issues associated with erection concerns include:
Low Testosterone
Your difficulty getting an erection may be caused by your libido, which directly relates to the amount of testosterone in your body.
“National guidelines recommend that we check testosterone levels in anyone concerned about ED,” Dr. Campbell says. “Low testosterone is often an ignored piece of the puzzle, but easy to fix.”
Heart Disease
Erectile dysfunction is typically a physical issue related to getting or maintaining an erection — or both:
- If you can’t get an erection, blood isn’t getting into your penis. It could be a blood vessel problem and possibly related to underlying issues such as high blood pressure, diabetes or heart disease.
- If you can’t hold onto your erection, blood isn’t staying in the penis, which indicates a venous leak (blood is leaking back out of your penis).
No matter which erection issue you face, it’s a marker for heart disease, Dr. Campbell says. Research shows that ED precedes coronary artery disease (CAD) in two out of three cases. Once ED sets in, CAD symptoms often arise within three years and a major cardiovascular event may occur within five years.
“ED can signal something more serious going on with your body,” Dr. Campbell says. “For many men, it can motivate them to make changes before they have a heart attack.”
Mental Health Issues
The association between mental health and ED is complicated. Poor mental health can affect your ability to achieve erection, and unresolved ED can lead to mental health issues.
“We don’t have great research that says we improve mental health by fixing ED because it can be tough to measure,” Dr. Campbell says. “But we see men all the time who are much happier once their ED is improved or resolved.”
When to See a Doctor for Erectile Dysfunction
There are no hard and fast guidelines for when to see your primary care doctor or a urologist about erection problems. But it’s always better to tackle the issue sooner rather than later.
“If you can’t have an erection suitable for intercourse on a repeated basis, it’s worth talking to your doctor,” Dr. Campbell says. He also notes that if you’re already being treated for ED but aren’t seeing the same results you once were, it might be time for a new evaluation.
“Some men go a decade without telling anyone about their issue, or they’ve been on Cialis or Viagra for years, but it’s not working,” Dr. Campbell says. “If that’s you, see your doctor because you have other options for treatment.”
How to Talk to Your Doctor About ED
Most doctors will know what you want to discuss as soon as you mention you’ve been having problems in the bedroom. But Dr. Campbell shares these tips for having that conversation:
Don’t Be Embarrassed
This may be your first time talking about erections — at least in a sterile and brightly lit room. But it certainly isn’t your doctor’s first time discussing it with a patient.
“It may feel like a weird or taboo topic to discuss,” Dr. Campbell says. “But when patients are nervous about talking to me about their sex life, I reassure them that I have similar conversations at least five times a day.”
Be Prepared to Talk About Your Erections
A significant part of diagnosing ED is talking about your situation. Before your appointment, reflect on what’s happening and what you want to change.
Ask yourself questions such as:
- Does your penis get as hard as you want?
- Does your erection last long enough?
- Is there anything that triggers your erection challenges?
- Does it happen all the time?
- How long have you been struggling with achieving or holding erections?
“It helps when you have an idea of your goals,” Dr. Campbell says. “Be realistic about how much this issue bothers you because it can guide your treatment.”
Bring Your Partner
If you’re in a monogamous relationship and have shared your concerns with your partner, Dr. Campbell recommends bringing them to the appointment.
“I gain a deeper understanding of the situation when a partner offers their perspective about when and how it happens, what the issues are and what they hope to achieve with treatment.”
What Can Be Done for ED?
Most doctors can diagnose ED by discussing it and looking closely at your health history. If they aren’t convinced it’s a physical problem, there are ways to check:
- Injecting medicine into the penis stimulates an erection and allows the doctor to evaluate physical issues.
- Ultrasound provides a view of the blood flow and how quickly it leaves the penis.
If you’re diagnosed with ED, treatment options include:
- Drugs that vary by how long they remain in your system and how effective they are
- Injection therapy, which involves self-injection to reach an erection
- Vacuum device, which helps with mild ED by pulling blood into the penis and holding it there with a constriction band
- Surgery to put in a penile prosthesis
Treating an underlying heart issue rarely helps with ED, but improving your diet and increasing your exercise can. “If your ED is significant, lifestyle changes won’t take you back to where you once were,” Dr. Campbell says. “But it may improve your erections and help you sustain them.”
Dr. Campbell also recommends talking to your partner and tackling the issue as a team, especially if your issue is related to age, arousal or mental health.
Next Steps and Useful Resources
- Want to speak with a primary care doctor? Find one today.
- Have more sensitive topics to discuss with your doctor? Read the other installments in our difficult conversation starters series: Talking to Your Doctor About Sexual Health and Talking to Your Doctor About Urinary Incontinence.
