When to See a Doctor About ED
Warning Signs 2025
Quick Summary
See a doctor for ED if it persists for 3+ months, appears suddenly, or occurs with cardiovascular symptoms (chest pain, shortness of breath). ED can be an early warning sign of heart disease—men with ED have 50% higher risk of cardiovascular events within 3-5 years. Immediate medical attention is needed for sudden ED, painful erections lasting 4+ hours, or ED with chest pain.
- Persistent ED (occurring >50% of the time for 3+ months) warrants medical evaluation to screen for cardiovascular disease and diabetes
- Sudden ED onset requires prompt evaluation—may indicate cardiovascular event, medication side effect, or neurological problem
- ED with chest pain, shortness of breath, or neurological symptoms needs immediate emergency care
- Men with ED have 50% higher risk of major cardiovascular events within 3-5 years—ED often precedes heart disease by 2-3 years
When Erectile Dysfunction Requires Medical Attention
While occasional difficulty achieving or maintaining an erection is normal and happens to most men, persistent erectile dysfunction (ED) warrants a visit to your doctor. But how do you know when it’s time to seek medical help?
See a Doctor If ED Is:
1. Persistent or Worsening
Time to see a doctor when:
- Erectile difficulties occur more than 50% of the time over 3+ months
- ED is getting progressively worse
- You used to have no problems but now consistently struggle
- The problem is affecting your quality of life or relationship
Why it matters: Persistent ED often indicates an underlying physical or psychological condition that needs treatment. Early intervention leads to better outcomes.
2. Sudden in Onset
Immediate medical attention if:
- ED appeared suddenly rather than gradually
- You went from normal function to complete inability overnight or within days
- Sudden ED coincides with other symptoms (chest pain, shortness of breath, neurological symptoms)
Why it matters: Sudden ED can indicate a serious underlying condition like:
- Cardiovascular event
- Neurological problem
- Side effect of new medication
- Acute psychological trauma
Gradual ED is more common and usually less concerning, but sudden onset requires prompt evaluation.
3. Accompanied by Other Symptoms
Seek immediate medical attention (ER or urgent care) if you have:
- Chest pain or pressure during sexual activity
- Shortness of breath or difficulty breathing
- Severe headache with ED
- Vision changes (sudden vision loss, blurred vision)
- Painful erection (priapism - lasting more than 4 hours)
- Blood in urine or semen
- Pain in penis, testicles, or pelvis
- Difficulty urinating or urinary retention
See your doctor soon if ED comes with:
- Reduced libido (low sex drive)—may indicate hormonal issues
- Fatigue and low energy—possible low testosterone
- Mood changes (depression, anxiety)
- Weight changes (gain or loss)
- Increased thirst and urination—possible diabetes
- Numbness or tingling in extremities
- Leg pain when walking (claudication)—vascular disease warning
4. Affecting Your Mental Health or Relationship
Don’t wait if ED is causing:
- Significant stress or anxiety
- Depression or feelings of hopelessness
- Avoidance of intimacy
- Relationship strain or conflict
- Reduced self-esteem or confidence
- Social withdrawal
Why it matters: The psychological impact of ED can be as significant as the physical problem. Early intervention prevents the development of performance anxiety and relationship problems.
5. In Younger Men (Under 40)
Young men should see a doctor if:
- ED persists for more than a few weeks
- Occurs frequently (more than 25% of attempts)
- Is new and unexplained
Why it matters: While ED becomes more common with age, it’s not normal in younger men. In men under 40, ED often has treatable causes:
- Psychological factors (performance anxiety, stress, depression)
- Lifestyle factors (substance use, lack of exercise)
- Underlying medical conditions (diabetes, hormonal imbalances)
- Side effects of medications
ED as a Warning Sign: When It Indicates Serious Health Problems
Erectile dysfunction can be an early warning sign of cardiovascular disease. The blood vessels in the penis are smaller than those in the heart, so vascular problems often affect erectile function before causing heart symptoms.
ED May Be the First Sign Of:
Cardiovascular Disease
- Heart disease: ED often precedes heart disease by 3-5 years
- Atherosclerosis: Narrowed or blocked arteries
- High blood pressure: Often undiagnosed
- High cholesterol: Contributing to vascular damage
If you have ED, ask your doctor to check:
- Blood pressure
- Cholesterol levels
- Cardiovascular risk factors
Diabetes
- Up to 75% of men with diabetes develop ED
- ED may be the first symptom of undiagnosed diabetes
- High blood sugar damages nerves and blood vessels
If you have ED plus:
- Increased thirst and urination
- Unexplained weight loss
- Fatigue
- Blurred vision
Ask your doctor to check: Fasting glucose and HbA1c
Hormonal Disorders
- Low testosterone (hypogonadism)
- Thyroid disorders
- Pituitary problems
Symptoms that suggest hormonal issues:
- Low libido (not just erection problems)
- Fatigue and low energy
- Loss of muscle mass
- Increased body fat
- Mood changes
Ask your doctor to check: Testosterone, thyroid function
Neurological Conditions
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury or nerve damage
Red flags:
- ED plus weakness, numbness, or coordination problems
- Recent surgery or injury to pelvis or spine
Psychological Conditions
- Depression
- Anxiety disorders
- PTSD
- Stress
When psychological factors are likely:
- Sudden onset related to life stressor
- Normal morning/nighttime erections
- No physical symptoms
- Young age with no risk factors
What to Expect at Your Doctor’s Appointment
Many men feel embarrassed discussing ED, but remember: your doctor has heard it all before. ED is extremely common, and healthcare providers are trained to handle these conversations professionally and without judgment.
Before Your Appointment: Prepare This Information
1. ED History
- When did it start?
- How often does it occur?
- Is it getting worse?
- Can you achieve erections at all, or are they just not firm enough?
- Do you wake up with erections? (Indicates physical vs. psychological)
2. Medical History
- Current medical conditions (diabetes, heart disease, high blood pressure, etc.)
- Past surgeries (especially pelvic, prostate, or vascular)
- All medications (prescription, over-the-counter, supplements)
- Family history of heart disease, diabetes
3. Lifestyle Factors
- Smoking (how much, how long)
- Alcohol use
- Drug use (recreational)
- Exercise habits
- Diet
- Stress levels
4. Relationship & Psychological Factors
- Relationship status and satisfaction
- Recent life stressors
- Mood (depression, anxiety)
- Sexual history
5. Questions to Ask Write down your questions beforehand:
- What’s causing my ED?
- What tests do I need?
- What treatment options are available?
- Are there side effects?
- How quickly will treatment work?
- Is this covered by insurance?
During the Appointment
Step 1: Discussion
Your doctor will ask about:
- Your symptoms and sexual history
- Medical and psychological history
- Medications and lifestyle
- Relationship factors
Be honest and specific. Your doctor needs complete information to help you.
Step 2: Physical Examination
May include:
- Blood pressure and pulse
- Examination of penis and testicles
- Check for signs of hormonal problems
- Cardiovascular assessment
- Neurological exam (reflexes, sensation)
- Digital rectal exam (to check prostate) if indicated
Step 3: Laboratory Tests
Your doctor may order:
- Blood tests:
- Testosterone levels (morning sample)
- Blood sugar and HbA1c (diabetes screening)
- Cholesterol and lipid panel
- Thyroid function
- Complete blood count
- Urinalysis (if urinary symptoms present)
Step 4: Specialized Tests (If Needed)
- Nocturnal penile tumescence (NPT) test: Checks for nighttime erections—helps distinguish physical from psychological ED
- Penile Doppler ultrasound: Evaluates blood flow to penis
- Psychological evaluation: If psychological factors suspected
Step 5: Treatment Discussion
Based on findings, your doctor will:
- Explain the likely cause(s) of your ED
- Discuss treatment options
- Prescribe medication or refer to specialist
- Recommend lifestyle changes
- Schedule follow-up
Treatment Options Your Doctor May Recommend
First-Line Treatments
- PDE5 inhibitors: Sildenafil (Viagra), tadalafil (Cialis), vardenafil, avanafil
- Lifestyle modifications: Exercise, weight loss, smoking cessation
- Psychological counseling: If stress, anxiety, or relationship issues
Second-Line Treatments (If Pills Don’t Work)
- Testosterone replacement: If low testosterone confirmed
- Penile injections: Alprostadil injected into penis
- Urethral suppositories: Medication inserted into urethra
- Vacuum erection devices: Penis pump
Third-Line Treatments
- Penile implants: Surgical option for severe cases
- Vascular surgery: Rarely used, for specific vascular problems
How to Talk to Your Doctor About ED
Opening the Conversation
Direct approach:
- “I’ve been having difficulty achieving and maintaining erections, and I’d like to discuss treatment options.”
- “I’m experiencing erectile dysfunction and think it might be related to [my medication/diabetes/stress].”
If you’re embarrassed:
- Remember: Doctors hear this constantly
- ED is a medical condition, not a personal failing
- Your doctor wants to help
- Everything is confidential
Write it down if easier: Bring a written note explaining your symptoms if speaking about it is difficult.
What to Tell Your Doctor
Be specific:
- ❌ “Things aren’t working down there”
- ✅ “I’m having trouble achieving an erection about 75% of the time, and when I do get one, it’s not firm enough for intercourse.”
Include relevant details:
- When it started
- How often it happens
- Whether you have morning erections
- Medications you’re taking
- Lifestyle factors (smoking, alcohol, stress)
Don’t minimize:
- ED affects quality of life and relationships
- It can indicate serious health problems
- You deserve treatment
What If You’re Too Embarrassed to See Your Doctor In Person?
Telehealth Options
Modern telehealth services offer a discreet alternative:
Benefits:
- No face-to-face appointment
- Confidential online consultation
- Licensed physicians review your case
- Medications delivered to your door
- Often more affordable
Popular services:
- Hims, Ro, BlueChew (US)
- Manual, Numan (UK)
- healthyMale (Australia)
When telehealth is appropriate:
- Otherwise healthy men with uncomplicated ED
- No other concerning symptoms
- Just need medication prescription
When you should see a doctor in person:
- Sudden onset ED
- Other concerning symptoms
- Complex medical history
- Underlying conditions need evaluation
- First episode of ED and unsure of cause
Special Situations
If You’re on Medications
Many medications can cause ED:
- Antidepressants (SSRIs especially)
- Blood pressure medications
- Prostate medications
- Antihistamines
Don’t stop medications without consulting your doctor. Often:
- Dose can be adjusted
- Alternative medication can be prescribed
- ED medication can be added to counteract effect
If You Have Heart Disease
ED medications are generally safe for men with heart disease, except:
- If you take nitrate medications (nitroglycerin, isosorbide)
- Recent heart attack or stroke
- Uncontrolled blood pressure
- Severe heart failure
Your cardiologist and primary doctor can coordinate care.
If You Have Diabetes
ED is very common with diabetes but treatable:
- Blood sugar control can improve ED
- ED medications work well for diabetic men
- May need higher doses
- Address vascular and nerve health
If You’re Experiencing Depression
ED and depression often coexist:
- Depression can cause ED
- ED can cause depression
- Antidepressants can worsen ED
- Both conditions need treatment
Talk to your doctor about treating both simultaneously.
The Bottom Line
See a doctor if:
- ED persists for 3+ months
- ED is worsening
- Sudden onset
- Accompanied by other symptoms
- Affecting mental health or relationships
- You’re under 40 with persistent ED
Don’t delay because:
- ED can be an early warning sign of heart disease
- Early treatment is more effective
- Psychological impact worsens over time
- Many effective treatments available
- You deserve a satisfying sex life
Remember:
- ED is extremely common (30 million+ US men)
- It’s a medical condition, not a personal failure
- Doctors discuss this routinely—no embarrassment needed
- Treatment success rates are 70-90%
- Telehealth is an option if you prefer
Take action: Your health and quality of life are worth a potentially uncomfortable conversation.
Related Resources
ED Treatment Guides:
- Understanding Erectile Dysfunction: Complete Guide
- Sildenafil vs Tadalafil: Which ED Med Is Best?
- Premature Ejaculation Treatment Options
Telehealth Options:
- Hims Review - Convenient online ED treatment
- Ro Review - Comprehensive telehealth care
- BlueChew Review - Affordable chewable medications
Related Comparisons:
This guide is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for medical concerns.
Key Takeaways
- 1
See a doctor if ED occurs more than 50% of the time for 3+ months—persistent symptoms indicate underlying physical or psychological conditions requiring treatment.
- 2
Sudden ED onset (overnight or within days) requires prompt medical evaluation to rule out cardiovascular events, neurological problems, or medication reactions.
- 3
ED is an early warning sign of cardiovascular disease—men with ED have 50% higher risk of major cardiovascular events within 3-5 years, often preceding heart symptoms by 2-3 years.
- 4
Seek immediate emergency care if ED occurs with chest pain, shortness of breath, severe headache, neurological symptoms, or painful erections lasting 4+ hours (priapism).
- 5
Expect a comprehensive medical evaluation including sexual history, physical exam, blood tests (testosterone, glucose, cholesterol), and cardiovascular assessment at your ED appointment.
- 6
Most doctors are comfortable discussing ED—it's a common medical condition affecting 30 million US men, and telehealth options provide discreet alternatives to in-person visits.
Kai Nakano
Health Journalist & Men's Health Specialist
Medical review by Dr. Amara Okonkwo, PharmD, BCPS - Clinical Pharmacotherapy Specialist
View full profile →Common Questions About When to See a Doctor About ED
Common questions about ed medical guidance & warning signs answered by our research team.
Q How long should I wait before seeing a doctor for erectile dysfunction?
See a doctor if ED occurs more than 50% of the time for 3+ months, or immediately if ED appears suddenly or with other symptoms. Occasional difficulties (<50% of the time) are normal and don't require immediate medical attention. However, if ED is causing significant stress, relationship problems, or self-confidence issues, see a doctor sooner regardless of duration. Early intervention leads to better treatment outcomes.
Q Is erectile dysfunction always a sign of heart disease?
No, but ED is a cardiovascular risk marker. Studies show 50-75% of men with ED have underlying cardiovascular disease, even without heart symptoms. Men with ED have 50% higher risk of major cardiovascular events within 3-5 years. ED often precedes heart disease symptoms by 2-3 years, making it an early warning sign. However, ED can also result from psychological factors, diabetes, low testosterone, medications, or other causes unrelated to heart health.
Q Should I see my primary care doctor or a specialist for ED?
Start with your primary care doctor (PCP), who can evaluate 80-90% of ED cases, order necessary tests, and prescribe first-line treatments. PCPs refer to urologists only if initial treatments fail, anatomical abnormalities are suspected, or complex medical issues exist. Alternatively, online telehealth services (Hims, Ro, BlueChew) provide convenient consultations with licensed physicians who specialize in ED for $0-49 consultation fees.
Q What tests will my doctor order for erectile dysfunction?
Standard ED evaluation includes: blood tests for testosterone (normal: 300-1000 ng/dL), fasting glucose/HbA1c (diabetes screening), lipid panel (cholesterol, triglycerides), and sometimes thyroid function. Physical exam checks blood pressure, cardiovascular health, genital examination, and prostate (if over 50). Additional tests if needed: nocturnal erection test, penile ultrasound, or psychological evaluation. Most diagnoses are made through history and basic blood work.
Q Can I get ED medication without seeing a doctor in person?
Yes, through legitimate telehealth services that require online consultations with licensed physicians. Services like Hims, Ro, and BlueChew legally prescribe ED medications (sildenafil, tadalafil) after reviewing your medical history and screening for contraindications. This is legal telemedicine, not an illegal workaround—consultations are with board-certified doctors who evaluate medical appropriateness. Avoid overseas pharmacies or services that don't require prescriptions.
Q What should I tell my doctor about my erectile dysfunction?
Be honest about: frequency and duration of ED, whether you can achieve any erections (morning/spontaneous), firmness level (1-10 scale), relationship status, stress levels, medications, alcohol/drug use, and cardiovascular symptoms. Your doctor needs accurate information to diagnose properly—withholding details leads to misdiagnosis. Doctors discuss ED routinely with 20-30 patients weekly; it's a common medical condition, not an embarrassing topic.
Q Is sudden erectile dysfunction an emergency?
Sudden ED with cardiovascular symptoms (chest pain, shortness of breath, dizziness) is an emergency—call 911 or go to ER. Sudden ED without other symptoms requires prompt (within days) medical evaluation but isn't typically an emergency. However, painful erections lasting 4+ hours (priapism), ED with severe headache/neurological symptoms, or ED after genital trauma requires immediate emergency care. Gradual ED over weeks/months can be scheduled with your regular doctor.
Q Will my doctor perform a physical exam for erectile dysfunction?
Yes, most ED evaluations include a focused physical exam: blood pressure check, cardiovascular auscultation (listening to heart), abdominal palpation (checking for aortic aneurysm), genital examination (checking for Peyronie's disease, testicular abnormalities), and sometimes digital rectal exam for prostate (especially men 50+). The exam is brief (5-10 minutes) and medically necessary to identify physical causes. Telehealth consultations skip the physical exam but require detailed symptom reporting.
Q How much does an ED doctor visit cost?
With insurance: $20-75 copay for primary care visit. Without insurance: $100-300 for office visit, plus $50-150 for blood work. Telehealth ED services cost $0-49 for consultation (often free), with medications costing $4-49/dose through subscriptions. Many men prefer telehealth for cost savings and convenience. Specialist (urologist) visits cost $150-400 without insurance but are rarely needed for initial ED evaluation.
Q Can stress or anxiety alone cause erectile dysfunction that requires a doctor visit?
Yes, psychological ED from stress, anxiety, or depression is common, especially in men under 40. Even psychologically-caused ED warrants medical evaluation to: rule out physical causes, provide treatment options (therapy, medications, or both), and prevent the performance anxiety cycle from worsening. Combination therapy (medication + psychological counseling) is most effective for anxiety-related ED, with 70-80% success rates.
Have more questions? Our research is continuously updated. If you don't see your question answered here, check our complete guides or contact our team.
References
- 1. Erectile Dysfunction as a Harbinger of Cardiovascular Disease - PubMed Central
- 2. When to see a doctor for erectile dysfunction - Mayo Clinic