Erectile dysfunction: causes, tests, treatment and which doctor to see
What erectile dysfunction is, why it can be an early sign of heart disease or diabetes, the tests involved, safe treatments, and which doctor to see.
Also known as: ED; Impotence
What erectile dysfunction is
Erectile dysfunction (ED) means repeatedly being unable to get or keep an erection firm enough for satisfying sex. Most men have an occasional problem, often with tiredness, stress or alcohol; ED is when it happens regularly.
An erection depends on healthy blood vessels, nerves and hormones and on the mind. Because the arteries of the penis are narrow, they often show damage before the larger arteries of the heart do. ED can therefore be an early warning sign of heart disease or diabetes, sometimes appearing years before a heart problem. Seeing a doctor about it can protect more than your sex life.
ED is common, especially with age, and it is treatable. Many men delay seeking help out of embarrassment; doctors discuss it routinely.
Symptoms
- Difficulty getting an erection
- Difficulty keeping an erection long enough for sex
- Erections that are less firm than before
- Reduced sexual desire, which can point to a hormone problem or low mood
Normal erections in the morning or with masturbation, but not with a partner, suggest that anxiety or relationship factors play a large part. A gradual loss of all erections suggests a physical cause.
Causes and who is at higher risk in India
Most ED has a physical cause, often with a psychological part on top. Common causes include:
- Diabetes, which damages both blood vessels and nerves
- High blood pressure, high cholesterol and heart disease
- Smoking or chewing tobacco, and heavy alcohol use
- Obesity and physical inactivity
- Low testosterone and other hormone problems
- Medicines, including some for blood pressure, depression and prostate problems
- Surgery or radiotherapy to the pelvis or prostate, and spinal injury
- Stress, anxiety, depression and relationship problems
Diabetes and heart disease often start younger in South Asians, so ED in a man in his thirties or forties should prompt a check of sugar, blood pressure and cholesterol.
How it is diagnosed
Diagnosis starts with a confidential conversation about your symptoms, health, medicines and relationships, and an examination. Tests look for causes and for heart risk:
- Blood sugar or HbA1c, for diabetes
- Lipid profile, for cholesterol
- Blood pressure measurement
- Testosterone, usually a morning sample, and sometimes prolactin and thyroid tests
- Penile Doppler ultrasound, in some men, to look at blood flow
If you have chest pain on exertion or several heart risk factors, your doctor may recommend a heart assessment before treatment.
Bring a list of every medicine, supplement and herbal product you take, including anything bought without a prescription. Several common medicines affect erections, and some products interact dangerously with ED treatment.
Which doctor to see
A urologist assesses and treats ED, including procedures and implants. A qualified sexual medicine specialist can help with ED and with psychological and relationship aspects. Depending on the cause, a cardiologist or diabetologist is involved. Your general physician is a reasonable first step.
You can find urologists in Bengaluru or sexologists in Bengaluru on The Doctor Index, each with a registration you can check.
Treatment
Lifestyle changes
Lifestyle changes help both erections and heart health: stopping tobacco, cutting down on alcohol, losing weight if you carry extra, regular exercise, and good control of diabetes and blood pressure. Some men see real improvement from these alone.
Medicines
PDE5 inhibitors, such as sildenafil and tadalafil, improve blood flow to the penis and work with sexual stimulation. They suit many men but must never be taken with nitrate medicines for angina (tablets or sprays under the tongue), because the combination can cause a dangerous fall in blood pressure. Your doctor will check your heart and other medicines first. Testosterone is prescribed only if blood tests show it is truly low.
Other options
- Counselling or sex therapy, alone or with your partner, for anxiety, stress and relationship issues
- Vacuum devices, which draw blood into the penis
- Penile injections or medicines placed in the urethra, taught by a specialist
- Penile implant surgery, when other treatments do not work
Treatment works best when expectations are realistic. Tablets need sexual stimulation to work and may take a few attempts at the right dose to show their full effect, so do not give up after one try. Anxiety about performance can feed the problem, which is why talking with your partner, and sometimes a counsellor, matters as much as the medicine. Tell your doctor if a treatment is not working rather than buying stronger products elsewhere.
Living with it: follow-up
- Regular checks of sugar, blood pressure and cholesterol
- A review if a treatment is not working or causes side effects
- Involving your partner where possible
- Attention to mood and stress, which often improve when ED is treated
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, for:
- An erection lasting more than four hours, or a painful erection that will not go down
- Chest pain, breathlessness or fainting during or after sex
- Sudden loss of vision or hearing after taking an ED medicine
Questions to ask at your appointment
- What is the likely cause of my ED?
- Should my heart, sugar or hormones be checked?
- Is it safe for me to take ED medicines with my other medicines?
- Could any of my current medicines be contributing?
- What other treatments are there if tablets do not work?
- Would counselling help?
Common questions
Questions people ask
- Is erectile dysfunction linked to heart disease?
- Often, yes. The arteries of the penis are small and can show damage before the heart arteries do. ED, especially in younger men, can be an early warning of heart disease or diabetes, so a check of sugar, blood pressure and cholesterol is sensible.
- Are 'sex power' products safe?
- Many are unregulated, and some have been found to contain hidden prescription medicines in unknown amounts. They can be dangerous, especially for men with heart disease or those taking nitrates. Prescribed treatments, after a doctor's assessment, are safer.
- Can ED be cured?
- It depends on the cause. ED linked to anxiety, medicines, tobacco or weight often improves greatly once these are addressed. When it is caused by long-standing diabetes or artery disease, treatment usually controls it well rather than removing the cause.
- Is ED just a part of getting older?
- It becomes more common with age, but it is not inevitable, and it can be treated at any age. New ED is always worth mentioning to a doctor, because it may point to a health problem that needs attention.
This condition is usually assessed by a urologist. Every profile shows the doctor’s registration and what has been checked.
Urologists in Bangalore
A few urologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Erectile Dysfunction; ask the clinic whether the doctor sees it.
Related conditions
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Erectile Dysfunction
- NIDDK, US National Institutes of Health — Erectile Dysfunction (ED)
- MedlinePlus, National Library of Medicine — Erectile Dysfunction — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Erectile dysfunction: causes, tests, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-0850.