ED signs: how do I know if I have ED?

Erectile dysfunction (ED) is common, affecting an estimated 30–50 million men in the United States alone. ED describes persistent difficulty getting and keeping an erection. It’s normal to have trouble getting hard every once in a while, but, when exactly do you chalk it up to an off day and when is it right to question “do I have ED”? 

Erectile dysfunction can affect not only your sex life and relationship, but it can also be a sign of other health conditions, which is why it’s important to seek medical advice if you’re having signs of ED. If you’re wondering how to tell if you have ED, read on. We review four important telltale signs and go over when it’s time to seek treatment and when it may just be a bad night.

Erectile dysfunction (ED) is defined as difficulty getting or maintaining an erection hard enough for sex. There is no timeline stated in the official definition, but some experts have unofficially made six months the cut-off mark. That doesn’t mean that you have to wait 180 days to seek help if you are bothered by problems with getting hard.

Dealing with a half-hard-on now and then is not necessarily ED, but dealing with it regularly could be. The key is consistency. If you’re regularly experiencing any of the following big four symptoms on a consistent basis, it’s possible you have ED and you should seek further medical attention. Of course, this list isn’t all-inclusive, but it’s a good start as you think about common signs and symptoms.

Difficulty getting an erection

One way to tell if you have ED is if you consistently have trouble getting fully hard. While some may think that erectile dysfunction only means you can’t get hard at all, it can also mean that you only get partially hard. For example, you may get a sort-of erection, but it’s not hard enough for penetration.  

When you get an erection, blood vessels dilate in the penis, allowing blood to flow in, where it gets trapped and causes an erection. When blood flow is not sufficient for an erection (or if it flows out too quickly), you may get some blood flow to the penis, but not enough to get (or stay) hard enough for penetrative sex. 

Difficulty keeping an erection

If you get hard, but you have trouble staying hard, that could be another sign you have ED. This sign of ED can show up in specific situations as well. For example, you may have no problem staying hard while you masturbate, but your erection goes away before you can orgasm with a partner. 

Losing an erection in this way could suggest a psychological cause of ED, such as stress, depression, or even performance anxiety, though this may not always be the case.

Reduced libido

If you feel less interested in sex than you used to, that can contribute to developing ED. If you're experiencing any of the following, it may be a sign your sex drive has decreased:

• Fewer sexual fantasies

• Less interest in having sex

• Having sex less often

• Feeling less aroused by sight, words, or touch

Low libido can be a sign of other sexual dysfunction disorders, such as premature ejaculation or medical conditions like low T, so it can be helpful to sort out whether your low sex drive is contributing to ED, or if it’s something else. One helpful question to ask yourself is whether you are able to have erections long enough for satisfactory penetrative sex. Further complicating matters is the fact that some of the same things that can cause ED—such as getting older or smoking—can also cause a dip in your sex drive. 

Pain with erection

While less common, painful erections can also contribute to ED. Pain with an erection can occur due to a physical injury to the penis or genitals. It can also occur with a condition called Peyronie’s disease, where scar tissue develops and changes the shape of your erections. Pain is sometimes a very early part of the process of developing Peyronie’s.  Remember to get evaluated by a healthcare provider if you think you might be facing any of these issues. If you experience sudden pain or physical injury to the penis, you should seek immediate medical attention.

If you experience pain during sex, it can affect your ability to have sex and lower your desire to have it, both of which can be signs of ED. 

Yes, you can check yourself for ED. You can probably tell you have ED if you’re regularly having a hard time getting hard, but to get an official diagnosis—and get started with treatment—you’ll want to meet with a licensed healthcare professional. ED is extremely common, and in many cases, treatable, so you don’t need to feel nervous about talking to someone. Meeting with a provider can also help relieve any nerves you’re feeling, and if you’re feeling shy remember that you don’t necessarily need to physically meet with a doctor - there are virtual (telehealth) options. 

During your appointment, the health provider will review your medical history, ask about your symptoms, and review any medications you are taking. They may order blood tests if they suspect an underlying issue, such as low testosterone.

A healthcare provider can also prevent you from misdiagnosing ED. ED can be confused with other health issues, such as low sex drive or premature ejaculation.

Health providers may use a 15-item diagnostic tool called the International Index of Erectile Function to diagnose ED. There is a shorter, 5-question version you can answer at home if you’re wondering whether you have ED. It asks questions like:

1. How confident are you that you could get and keep an erection?

2. When you get an erection, how often is your erection hard enough for penetration?

3. During sexual intercourse, how often are you able to maintain your erection after penetrating your partner?

4. During sexual intercourse, how difficult is it to maintain your erection to completion of intercourse?

5. When you have sexual intercourse, how often is it satisfactory for you?

You then answer these questions on a 1 to 5 basis, with 1 being “very low,” “never,” or “extremely difficult,” (depending on the question) and 5 being “very high,” “always,” or “not difficult.” While it’s impossible to diagnose ED from a questionnaire alone, these questions can help you think about whether you are facing erectile dysfunction and might help you identify topics to discuss in your visit with a healthcare provider.

Just as there’s no single cause of ED, there’s no single thing you can do to prevent ED completely. Luckily, keeping yourself in good health is one of the best ways to prevent ED. Specifically, the following lifestyle changes have been proven to help prevent ED.

• Regularly exercising: Increased physical activity is recommended in both preventing and relieving ED. And, research shows that physically active men—e.g. those with a regular exercise routine—have a lower risk of getting ED. Plus, regular exercise can boost your sexual stamina in the bedroom by increasing your tolerance of aerobic activity. In particular, research suggests that 40 minutes of moderate- to high-intensity aerobic exercise, four times a week, can improve erectile function.

• Quitting smoking: Men who smoke are 1.5 times more likely to have ED than nonsmokers. Cigarette smoking is also linked to lower testosterone levels, according to some research. Other research shows that quitting smoking may help with erectile function, though data is mixed depending on how severe your ED is. Needless to say, quitting smoking comes with so many other benefits that it’s worth doing for the other health benefits alone.

• Improving your diet: Men who follow a healthier diet have a lower risk of developing ED, according to an analysis that observed men over the course of 10+ years. If you’re looking for a specific diet to follow, the study found that the Mediterranean diet was associated with the lowest risk of ED. If you’re interested in a more general approach, opt for erection-friendly foods like fruits, vegetables, whole grains, nuts, and legumes, and stay away from foods like red meat, sugar-sweetened beverages, and anything high in trans fats or sodium, like fried food.

• Managing your mental health: Depression often overlaps with ED. Men with depression are twice as likely to have ED as the general population. Taking care of yourself through therapy, behavioral changes, and stress reduction techniques can help, depending on what your symptoms are.

Typically, ED develops over time. But, it’s possible to experience it “suddenly” if you experienced a recent change in your life. For example, you might experience temporary ED after a long night of drinking or a stressful fight with your partner or boss. Or, the ED might feel sudden but be attributable to something new, such as the side effects of a new medication, or anxiety over a new relationship. Of course, if you experience an injury to your spinal cord or genital area, that could also cause “sudden” ED. 

“Sudden” causes of ED can also be related to something psychological, such as a major life-changing event like a breakup or loss of a job. A sign of psychological causes could be that you still experience morning wood or your usual hard-ons when you masturbate, but run into issues getting hard during partnered sex.

While ED can occur at any age, ED becomes more common as you age. About 40% of men age 40 have experienced ED, and the risk of experiencing ED goes up by 10% for each decade of life. It is estimated that about 11% of men in their thirties experience ED and about 8% of men in their twenties experience it.

Age is a big contributor to ED, in part because as you age, other health conditions that contribute to ED—such as high blood pressure or heart disease—can also develop. Besides age, other risk factors for ED include:

• Mental health issues, such as depression, stress, or anxiety

• Performance anxiety

• Other sexual disorders

• Health conditions, such as high blood pressure, high cholesterol, stroke, sleep apnea, glaucoma, heart disease, or diabetes

• Hormonal causes, such as hypogonadism or thyroid issues

• Injuries to the pelvis, nerves or the spinal cord

• Medications, such as antidepressants, opioids, antipsychotics, or blood pressure medications

• Nicotine, drug, or significant alcohol use

• Obesity or overweight

• Radiation therapy for cancer

In the vast majority of cases, ED is treatable. Having said that, it’s not likely to go away on its own unless you’ve addressed the underlying issues. How quickly ED goes away depends on how quickly you seek treatment, as well as address the underlying causes of ED. Furthermore, ED can be the first sign of something going on with your overall health so it can be a good indicator to check in with a healthcare provider.

Treating ED can involve oral medications like Viagra (sildenafil) or Cialis (tadalafil) in certain instances, but it also involves treating the underlying causes. For example, if stress is contributing to your ED, making changes to reduce stress in your life, as well as getting therapy and practicing stress relief techniques, may be required to treat ED. If a physical health condition such as obesity or diabetes is contributing to your ED, losing weight and managing blood sugar levels may be part of your ED treatment plan.

ED treatment varies by the individual, based on what’s contributing to your ED. ED treatment typically begins with lifestyle changes and ED medication. 

Lifestyle changes

Depending on your situation, lifestyle changes can help reduce symptoms of ED. Common approaches include:

• Losing weight if you have obesity or overweight

• Increasing your physical activity

• Quitting smoking and stopping heavy alcohol use

• Switching to a Mediterranean diet (people following a Mediterranean diet have been found to have a decreased risk of ED)

If an underlying condition is contributing to your ED, such as diabetes or high cholesterol, your healthcare provider will recommend treating that condition to see if that improves your erections over time.

Stress, anxiety, and depression can make life challenging enough, with or without ED. If you are dealing with any of these, you don’t have to face these challenges alone. Connecting with a therapist can help you feel better and more in control, which can help relieve your ED. You can also discuss these concerns and their potential impact on your sex life with your partner. 

ED medication

Several proven medical treatments for ED exist, starting with oral PDE5 inhibitors. This class of drugs includes Viagra (sildenafil), Cialis (tadalafil), vardenafil, and Stendra (avanafil). Oral ED medications are highly effective and only occasionally cause mild side effects such as headache, indigestion, muscle aches or stuffy nose. Serious side effects are possible but far less common. 

Several of these traditional ED meds are available as generics. You can also find the active ingredients in compounded formulations like Ro’s dissolvable ED lozenge, which combines tadalafil and sildenafil for a 2-in-1 rapidly acting treatment.

Bottom line: ED is treatable. Trouble getting or staying hard is normal now and then, but if it’s happening often, it’s possible you have ED. Make an appointment with your healthcare provider to know if you have ED, and to get started with treatment if it’s right for you.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

October 14, 2024

Written by

Amelia Willson

Fact checked by

Peter Schlegel, MD and Raagini Yedidi, MD

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About the medical reviewers

Peter Schlegel, MD

Peter Schlegel, MD, is a Ro Advisor, board-certified urologist, and internationally acclaimed expert in the treatment of male fertility. For nearly 20 years, Dr. Schlegel served as the chair of Urology at New York Presbyterian/Weill Cornell. He now focuses on providing the best patient care possible for urologic conditions through his private practice.

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.