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How To Know If You Have ED – Essential Signs and Symptoms

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Is it erectile dysfunction or a temporary glitch in your ability to perform? Read our guide to discover whether your poor performance is due to ED or something else.

Last Updated: 05/22/2025

Written by

Kimberly Wilkes

It’s normal for men to have trouble in bed from time to time. It happens to every man. But how do you know if you’ve stepped over the line of normality into erectile dysfunction (ED) territory? How often do you have to be too soft for sex for it to be considered ED?

“A lot of my patients are experiencing the first signs that they’re at risk of ED,” says Dr. Paul Thompson, a urologist and surgeon who has spent several decades in clinical practice. “They’re experiencing intermittent episodes of being too soft for sex, and they visit me because they want to know if there’s anything they can do about it.”

In this blog post, we’ll dive into the signs and symptoms of erectile dysfunction, to answer the question: “How do I know if it’s really ED?”

What Is Erectile Dysfunction (ED)?

Erectile dysfunction is not being able to get and maintain an erection firm enough for sexual intercourse. According to the Cleveland Clinic, it affects over half of men between the ages of 40 and 70. Those numbers might be higher since many men are too embarrassed to ask their doctor for help even when they’re unable to maintain an erection.

Erectile Dysfunction Symptoms

You can suspect you have erectile dysfunction if you have the following symptoms:

Being too soft for sex at least some of the time.
Inability to maintain an erection firm enough for sex.
Needing a lot of stimulation to stay hard.
Unable to get an erection.

In general, if you’re too soft to have sexual intercourse more than 25% of the time, you can suspect you have erectile dysfunction. A doctor can confirm the diagnosis.

Physical Causes of Erectile Dysfunction

You may be more likely to develop erectile dysfunction if you’re also suffering from one of these physical causes of ED.

Poor Circulation

A strong erection is dependent upon blood flow to the penis. Without proper blood flow through penile blood vessels, it will be difficult to maintain an erection. When blood fills the penis during sexual stimulation, certain valves must close to hold the blood in the penis. If these valves don’t work properly, it can lead to sexual problems.

Research has found that 45% of men with slow coronary flow have erectile dysfunction compared with 35% of men with normal coronary flow.(1)

Underlying Health Condition

Many health conditions are linked to erectile dysfunction. For example, erectile dysfunction is considered an early marker of cardiovascular disease.(2)

Here are the most common conditions associated with ED:

Atherosclerosis
Diabetes
Digestive and kidney diseases
Epilepsy
High blood pressure
High cholesterol
Peyronie’s disease
Stroke
Vascular disease

If you’re not always able to get hard during sex, talk to your doctor about getting a full check-up to rule out these conditions as a possible cause of your erectile dysfunction.

Testosterone Deficiecy

Testosterone is a hormone involved in sex drive and sexual arousal. Levels tend to fall with age and due to health conditions like diabetes. Research shows that low levels are linked to erectile dysfunction while therapies that raise testosterone levels improve erectile function.(3)(4)

Injuries to the Penis

Penile fractures and injury to your pelvic bones can cause erectile dysfunction. Surgery to the pelvic area such as prostate cancer surgery or surgeries for colon or bladder cancer also can interfere with erectile function, as can radiation therapy.

Some Medications

Many prescription drugs can interfere with sexual response. These include:

Antidepressants
Anti-anxiety medications
Antihistamines
Anti-seizure medications
Blood pressure drugs
Chemotherapy medications
Heart rhythm drugs
Muscle relaxants
Parkinson’s disease medications
Prostate cancer drugs
Sedatives

If you’re taking any of these oral medications and you have erectile dysfunction, talk to your doctor to determine if the medications are a cause.

Illicit drugs like cocaine also can cause erectile dysfunction.

Mental Health Causes of ED

If you’re suffering from mental health concerns, you’re also at a greater risk for erectile dysfunction. Mental health concerns that cause erectile dysfunction include:

Anxiety
Depression
Genophobia (Being afraid of sexual intercourse or intimacy)
Poor self-esteem
Stress

Other mental health concerns that can cause erectile dysfunction include relationship problems, addictions to recreational drugs, alcohol, or porn, and post-traumatic stress disorder.

Temporary Erectile Dysfunction

In some cases, ED can be temporary. Maybe you’ve had an exhausting week at work and your sexual mojo takes a hit. Maybe you just got over the seasonal flu and your body isn’t ready yet for sexual activity. Or perhaps it’s really late at night and you’re too tired to perform at your best. Alcohol also can impact your sexual performance.

Before reaching the wrong conclusion about your sexual health, ask yourself if you’ve experienced anything exhausting over the short term that could be affecting your sexual function. If so, a good night’s rest or even having sex in the morning instead of late at night can do wonders for your erectile function.

If you’ve been drinking before intimate moments with your sexual partner, try cutting back on alcohol to see if your performance improves.

Risk Factors for Erectile Dysfunction

You’re more likely to get erectile dysfunction if you have one or more of these risk factors:

Are over the age of 40
Are overweight or obese, with a body mass index (BMI) more than 25
Have diabetes or other chronic health conditions like heart disease
Don’t exercise
Are depressed
Smoke

If you’re having problems in the bedroom and you have any of those risk factors, it warrants a visit with your doctor to confirm that you have erectile dysfunction and to pin down the cause.

Diagnosing Erectile Dysfunction

Your healthcare professional or urologist can determine whether you have erectile dysfunction. They’ll likely start by reviewing your medical history and conducting a physical exam.

Your doctor may ask you questions about what medications you’re taking, your stress level, whether you’ve been diagnosed with depression or anxiety, whether you have relationship problems, how often you have erections, and how long you can maintain them.

Your doctor also may order blood tests and other types of tests such as:

Complete blood count
Lipid panel
Liver function
Kidney function
Thyroid function
Testosterone levels
Penile Doppler ultrasound to check blood flow
Magnetic resonance angiogram (MRA)

Your doctor also may perform tests to find out if your penile nerves respond to vibrations or inject drugs that temporarily make your penis erect (vasoactive injection) to measure the quality of your erection.

“I perform a comprehensive workup on my patients to make sure their erectile dysfunction isn’t being caused by an underlying condition like diabetes,” says urologist Dr. Thompson. “I will also order tests like a Doppler ultrasound to determine blood flow to the penis.”

Your healthcare professional also may administer the International Index of Erectile Function questionnaire (IIEF), which is a measure of sexual response.

How To Fix Erectile Dysfunction

Once you know for sure you have ED, the next step is to talk to your doctor about treating erectile dysfunction. The treatment options will depend upon whether your erectile dysfunction has a physical cause or if it’s due to mental health conditions.

Treating Erectile Dysfunction That Has a Physical Cause

Urologist Dr. Paul Thompson recommends one or more treatment options for physical ED. Talk to your doctor to develop a treatment plan that works for you by incorporating any of these strategies

ED Medications – These are a good choice for some men. However, Dr. Thompson points out that the medical literature shows that ED meds stop working over a year or two. Dr. Thompson also has noticed this in his clinical practice. Erectile dysfunction medication also has side effects that some men can’t tolerate.
Li-ESWT – Low-intensity Extracorporeal Shockwave Therapy, otherwise known as acoustic soundwave therapy, is one of Dr. Thompson’s favorite ways to treat ED. It has a high success rate and it addresses the root cause of erectile dysfunction. He frequently uses in-clinic Li-ESWT to increase blood flow to erectile tissue. However, not all men can afford in-clinic Li-ESWT, which can cost $500 per treatment and most men need at least six treatments. Dr. Thompson recommends an at-home version of Li-ESWT that’s a fraction of the cost of in-clinic therapy. “Men report excellent results with the at-home version, similar to those achieved in the clinic,” Dr. Thompson says.
Penis Pump – Also known as a vacuum erection device, a penis pump can be used as a stand-alone treatment, but when combined with Li-ESWT it can be especially helpful to maintain an erection. Penis pumps create a vacuum around the penis, which boosts blood flow and stimulates an erection. Once you’re erect, place a constriction ring around the penile base to stop yourself from losing the erection.
Penile Implants – Inserting a penile implant device is done as a surgical procedure. The device makes the penis erect.
Lifestyle changes – Addressing lifestyle factors can prevent erectile dysfunction to begin with or stop it from becoming worse. Be sure to exercise regularly. Research shows that aerobic exercise of moderate to vigorous intensity is effective at improving erections, especially in men with mild erectile dysfunction.(5)
Diet – To prevent erectile dysfunction, eating healthy is important, too. Science shows that a Mediterranean diet consisting of fruits, vegetables, whole grains, nuts and seeds, legumes, fish, olive oil, and moderate amounts of lean meats and dairy, can improve erectile function.(6) It works by balancing cholesterol and blood sugar, increasing antioxidants, and boosting levels of the amino acid arginine, which can improve sexual health by increasing levels of nitric oxide, a molecule involved in erectile function.(6)
Treating underlying medical conditions – Work with your doctor to address any underlying medical conditions that could be causing your erectile dysfunction. High blood pressure, diabetes, and heart disease are all conditions that could get in the way of your sexual satisfaction. Your doctor can help you identify the best treatment, based on your health concerns.
Testosterone replacement therapy – Symptoms of testosterone deficiency include erectile dysfunction and decreased libido, while testosterone replacement therapy can help many men improve their erectile function.(7) Talk to your healthcare professional to determine if this is the right approach for you.
Pelvic floor muscle training – This type of exercise to strengthen the pelvic floor muscles may be effective for both erectile dysfunction and premature ejaculation.(8) These types of exercises are especially effective in men who have had their prostate gland removed.(9)

Treating Erectile Dysfunction Caused By Psychological Factors

Working with a professional therapist can resolve sexual problems caused by mental health issues like depression, anxiety, and stress. A marriage and family therapist can help with other mental health problems like relationship difficulties that are affecting your sex life. If you’re under a lot of stress, relaxation techniques such as meditation, yoga, and deep breathing exercises can improve erectile dysfunction.

Frequently Asked Questions About Diagnosing ED

How do I know if I have erectile dysfunction?

Common ED symptoms include:

Being too soft for sex at least some of the time.
Being unable to maintain an erection that’s firm enough for sex.
Needing a lot of stimulation to stay hard.
Unable to get an erection.

In general, if you’re too soft to have sexual intercourse more than 25% of the time, you can suspect you have erectile dysfunction.

How do I check myself for ED?

After determining whether you have any ED symptoms, visit your healthcare provider to confirm the diagnosis. They may order blood tests and other testing like Doppler ultrasound, as well as the IIEF questionnaire, which measures erectile dysfunction.

At what age does ED begin?

ED can happen at any age, but it’s more common after the age of 40. According to the Cleveland Clinic, it affects over half of men between the ages of 40 and 70.

Does ED go away?

Erectile dysfunction only goes away if you treat the underlying cause. Common physical causes of ED include heart disease, high blood pressure, and diabetes. Aging itself also can cause ED due to reduced circulation. Mental health concerns like depression, anxiety, stress, and relationship difficulties are other health problems that can contribute to ED and must be treated to fix the problem.

If you have temporary ED due to lack of sleep or late-night rendezvouses with your sexual partner, try getting more rest or having sex in the morning when you have more energy.