Condition
Erectile Dysfunction
ED is common and very treatable. We start with a full evaluation of vascular, hormonal, and medication causes, then build a plan that fits.
Common symptoms
- Difficulty achieving an erection
- Difficulty maintaining an erection
- Reduced sexual desire
Erectile dysfunction is common, often treatable, and almost always worth a conversation. ED can also be an early warning sign of cardiovascular or hormonal issues — so an evaluation is good for your sexual health and your overall health.
Common causes
- Vascular — diminished blood flow (often the same disease that affects the heart)
- Hormonal — low testosterone or thyroid issues
- Neurogenic — nerve injury (post-prostatectomy, diabetes, spinal injury)
- Medication side effects — common with antihypertensives, antidepressants, others
- Psychogenic — stress, performance anxiety, relationship factors
How we evaluate
A focused history and exam usually reveal the likely cause. We screen for cardiovascular risk factors and check labs that include testosterone. In some cases we use a duplex ultrasound to assess penile blood flow directly.
Treatment options
- Lifestyle — exercise, weight loss, smoking cessation, blood-sugar control
- Oral medications (sildenafil, tadalafil, vardenafil)
- Vacuum erection devices
- Penile injections (very effective, often used when pills do not work)
- Penile prosthesis (highly satisfying outcomes when other treatments fail)