What is erectile dysfunction?
Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough for intercourse. It affects about 40% of men by age 40 and 70% by age 70, but it's not just an "aging" issue — younger men experience it too.
ED is usually multifactorial: physical factors (vascular disease, diabetes, low testosterone, medications, smoking, alcohol), psychological factors (performance anxiety, depression, relationship issues), or both. Importantly, ED can be an early warning sign of cardiovascular disease — the small arteries of the penis often develop atherosclerosis before the coronary arteries.
Modern ED treatment is highly effective. PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra, avanafil/Stendra) work for the majority of men. Other options exist when PDE5 inhibitors don't work or are contraindicated.
Do I have erectile dysfunction? Common signs
If most of these describe what you're experiencing, telehealth is a reasonable next step:
What causes it
Vascular disease (poor blood flow to penis — often related to atherosclerosis, diabetes, hypertension, high cholesterol), neurological (diabetes neuropathy, spinal cord issues, surgery affecting pelvic nerves), hormonal (low testosterone), psychological (anxiety, depression, relationship issues), medications (antidepressants, blood pressure meds, antihistamines, prostate medications), lifestyle (smoking, excessive alcohol, illicit drugs, lack of exercise, poor sleep, obesity).
Is it contagious?
No.
ED is one of the most treatable conditions in medicine — and it can also signal early cardiovascular disease that's worth catching.
Can it be treated online?
ED is among the best-suited conditions for telehealth — the evaluation is largely history-based, and physical exam adds little for most cases. A clinician reviews medical history, current medications, cardiovascular risk factors (very important — ED can signal early cardiovascular disease), and prescribes appropriate therapy.
In-person evaluation may be warranted for unclear cases, sudden onset suggesting vascular event, suspected hormonal causes needing physical exam, or younger men with severe ED needing comprehensive workup.
How erectile dysfunction is treated
PDE5 inhibitors are first-line for most men: sildenafil (Viagra, 30–60 min onset, 4–6 hour duration), tadalafil (Cialis, 30 min onset, 24–36 hour duration — also daily lower-dose option), vardenafil (Levitra), avanafil (Stendra). All require sexual stimulation to work — they enhance the response, not create it.
Generic versions available for sildenafil and tadalafil — dramatically cheaper than brand.
Other options when PDE5 inhibitors don't work or are contraindicated: alprostadil (intraurethral or injection), vacuum devices, penile implants.
Lifestyle changes: weight loss, exercise, smoking cessation, alcohol moderation often improve erectile function.
Testosterone replacement: for confirmed hypogonadism (low T plus symptoms) — needs proper evaluation and monitoring.
Self-care while you wait
- Exercise regularly — both aerobic and resistance
- Lose weight if overweight
- Don't smoke
- Moderate alcohol use
- Manage diabetes, blood pressure, cholesterol aggressively
- Address sleep apnea
- Manage stress and anxiety
- Address relationship issues
- Don't use illicit drugs
- Get 7–9 hours of sleep
How long does it last?
ED is often chronic if underlying causes aren't addressed. With PDE5 inhibitors and lifestyle improvements, many men have substantial improvement. ED can sometimes resolve completely with weight loss, diabetes control, or stopping a contributing medication.
Frequently asked questions
Is ED a normal part of aging?
ED is more common with age but not "normal." It often reflects underlying treatable conditions. Don't accept it as inevitable — modern treatment works well.
Sildenafil vs tadalafil — which is better?
Both work well. Sildenafil acts within 30–60 minutes and lasts 4–6 hours — more "planned." Tadalafil lasts 24–36 hours, which feels more spontaneous, and has a daily low-dose option that maintains continuous effect. Personal preference and cost are the main factors.
Are these medications safe?
For most men without contraindications, yes. Main contraindications: taking nitrates (for chest pain or recreational poppers — combination can cause life-threatening drops in blood pressure), severe heart disease (recent heart attack, unstable angina), severe liver or kidney disease. We screen for these.
Will my insurance cover ED medications?
Often not for ED specifically, though generics are very affordable out of pocket. Daily tadalafil for benign prostatic hyperplasia (BPH) is often covered. Mail-order pharmacies can offer significant savings.
Could my ED signal something more serious?
Yes — ED can be an early sign of cardiovascular disease, diabetes, or low testosterone. The blood vessels of the penis are small and show vascular disease before the larger coronary arteries. A new ED diagnosis is a reason to optimize cardiovascular health.
