Erectile dysfunction (ED) is the ongoing difficulty in achieving or maintaining an erection firm enough for sex. It can be occasional, long-term, or vary in severity. Some people may only struggle to stay erect, while others cannot achieve an erection at all.

Although ED becomes more frequent with age, it is not a normal or unavoidable part of aging. Research shows around 5% of men at 40 have complete ED, with the rate rising up to 40% among those over 80. Because of its impact on quality of life, identifying ED early is crucial.

Medical and Sexual History

Your doctor will begin by reviewing your health and lifestyle. Many everyday factors—such as smoking, alcohol, drug use, or obesity—can contribute to ED. Underlying health conditions like diabetes, heart disease, or high blood pressure are also common triggers.

Other risk factors include:

  • Sedentary lifestyle

  • Atherosclerosis (hardened arteries)

  • Chronic kidney disease

  • Multiple sclerosis

  • Peyronie’s disease (penile curvature)

  • Complications from prostate or bladder cancer treatment

  • Nerve or pelvic injury

  • Certain medications, including blood pressure drugs, antidepressants, or tranquilizers

Providers may ask sensitive but important questions about confidence, sexual satisfaction, morning erections, and your overall sex drive to build a clear picture of your condition.

Physical Examination

A physical exam helps rule out physical causes of ED. Doctors may:

  • Check penile sensitivity for nerve issues

  • Look for curvature or visible signs of Peyronie’s disease

  • Measure blood pressure and heart rate for circulation health

  • Assess hormonal imbalances through signs like breast development or unusual body hair

This hands-on evaluation provides important clues before moving to lab testing.

Psychological Assessment

Mental health is often linked with ED. Stress, anxiety, and depression may trigger erectile issues, while ED itself can worsen these conditions.

Doctors often use questionnaires such as the International Index of Erectile Function (IIEF-5) to identify psychological contributors. Discussing your emotional health openly helps ensure treatment addresses both body and mind.

Laboratory Testing

Since ED can stem from underlying conditions, lab work is common. Tests may include:

  • Fasting glucose test – detects diabetes by measuring blood sugar levels.

  • Testosterone test – checks hormone balance, as low testosterone can reduce libido and erectile function.

  • Lipid profile – measures cholesterol and triglycerides to detect cardiovascular risks.

Blood work helps uncover silent health issues that may drive ED.

Imaging and Additional Tests

In some cases, imaging is necessary. A Doppler ultrasound of the penis can measure blood flow, often performed with medication to induce an erection.

Other tests include:

  • Nocturnal erection test – measures natural nighttime erections to distinguish physical from psychological causes.

  • Intracavernosal injection – medication is injected to create an erection while blood flow and duration are monitored.

These tools help doctors pinpoint whether ED is structural, vascular, or psychological.

A Quick Review

Erectile dysfunction is not simply an age-related issue—it is often a sign of underlying health problems. Diagnosis involves reviewing medical history, conducting physical and psychological assessments, and using lab or imaging tests when needed.

Talking openly with your doctor ensures early detection, proper treatment, and better overall health outcomes.