Getting evaluated for erectile dysfunction starts with a conversation, either with your primary care doctor or through a telehealth platform. The process is straightforward: a medical provider reviews your symptoms, asks about your health history, and may order a blood test. If you qualify, you can often walk away with a diagnosis and treatment plan in a single visit.
What the Evaluation Looks Like
ED is defined as the consistent inability to get or maintain an erection firm enough for satisfactory sexual activity. A doctor diagnoses it primarily through your medical, sexual, and psychosocial history, a physical exam, and sometimes lab work. There’s no single test that confirms ED. Instead, the diagnosis comes from piecing together your symptoms, how long they’ve been happening, and whether an underlying condition might be driving them.
During the physical exam, your provider checks for blood vessel and nerve function, hormonal issues, and any structural problems with the penis. They’ll also likely order a morning blood draw to measure your testosterone level, since low testosterone can contribute to or mimic ED symptoms.
Questions Your Doctor Will Ask
Most providers use a short, validated questionnaire called the IIEF-5 (also known as the SHIM) to gauge how severe your symptoms are. It has five questions covering how often you can get an erection, how firm it is, whether you can maintain it during intercourse, and how difficult that feels. Each answer is scored from 1 to 5, and your total determines severity: 22 to 25 means no ED, 17 to 21 is mild, 12 to 16 is mild to moderate, 8 to 11 is moderate, and 5 to 7 is severe.
Beyond the questionnaire, your doctor will want to know whether the problem happens every time or only in certain situations. They’ll ask whether you still get erections in the morning or during sleep, and whether the issue changes with different partners or on your own. These details help distinguish between a physical cause and a psychological one. If you’re getting nighttime erections but struggling during sex, the plumbing likely works fine and stress, anxiety, or relationship factors may be playing a bigger role.
Why the Diagnosis Matters Beyond Sex
ED isn’t just a bedroom problem. It shares the same underlying risk factors as heart disease, including damaged blood vessels, high blood pressure, and poor circulation. Research published in JACC: Advances found that men with ED had a 23% higher risk of death from all causes even after accounting for other risk factors. When ED appeared alongside elevated cardiac biomarkers, the risk of cardiovascular death more than doubled.
ED often shows up years before a heart attack or stroke, making it one of the earliest warning signs of cardiovascular trouble. This is a big part of why getting formally evaluated matters. A diagnosis can prompt your doctor to screen for conditions you didn’t know you had.
How Common It Is by Age
If you feel too young for this, you’re probably not. Among men with no other health conditions at all, the prevalence of ED rises from about 10% at age 40 to 79% by age 80. Add in common conditions like diabetes, high blood pressure, or obesity and those numbers climb faster. The Massachusetts Male Aging Study found that at least some degree of ED affected roughly half of men between 50 and 54. You’re far from alone in dealing with this.
Getting a Prescription Online
Telehealth platforms like Hims, Roman, and BlueChew have made getting evaluated and treated significantly easier. The process typically starts with an online form where you answer questions about your health history and upload a photo ID. A licensed medical provider in your state reviews your information, then follows up with questions and an online or video visit. Some states require a live video chat; others allow the visit to happen through messaging alone.
If the provider determines a prescription is appropriate, they can prescribe medication directly. The prescription is then filled and shipped to you. Harvard Health recommends verifying that any online retailer requires an actual provider’s prescription, has a U.S. address and phone number, and is licensed with a state board of pharmacy. The provider doesn’t have to be a doctor specifically, but they do need to be licensed to prescribe in your state.
What Treatment Looks Like
The most common first-line treatment is a class of oral medications that improve blood flow to the penis. These come in several forms and dosages. The FDA recently approved an oral dissolving film version of sildenafil (the active ingredient in Viagra) in four strengths: 25, 50, 75, and 100 mg. Your provider will typically start you at a moderate dose and adjust based on how you respond.
These medications don’t create an erection on their own. They make it easier to get and keep one when you’re sexually stimulated. Most work within 30 to 60 minutes and last several hours, though the exact timing varies by medication. Your provider will walk you through what to expect and help you find the right fit.
Exercise as a Treatment
Medication isn’t the only option. A review of 11 randomized controlled trials involving more than 1,000 men with mild or moderate ED found that regular aerobic exercise, things like walking, running, and cycling, improved erectile function on par with what some men experience from medication. The effective dose was 30 to 60 minutes of aerobic activity, three to five times per week.
This makes sense given the vascular nature of most ED. Anything that improves cardiovascular health tends to improve erections. Losing excess weight, quitting smoking, and reducing alcohol intake all move the needle as well. For men with mild symptoms, lifestyle changes alone can sometimes resolve the problem. For more severe cases, combining exercise with medication tends to produce better results than either approach on its own.