How to Know If You Have Erectile Dysfunction: Symptoms, Diagnosis and Next Steps

The inability to achieve or maintain an erection strong enough for satisfactory sexual activity is known as erectile dysfunction (ED) — also called impotence. But how do you know if what you are experiencing is genuinely ED, or simply a normal, occasional variation in sexual performance? And if it is ED, what should you do next? This guide explains the signs and symptoms of erectile dysfunction, its causes, how it is diagnosed, and the full range of treatment options available.

What Is and Isn’t Erectile Dysfunction?

It is entirely normal for men to occasionally have difficulty achieving or maintaining an erection. Stress, fatigue, alcohol, and relationship tension can all cause temporary difficulties that resolve on their own. These isolated incidents are not erectile dysfunction.

ED becomes a clinical concern when:

• It occurs more than half the time when you attempt sexual activity
• It has been present for more than 2–4 weeks
• It is causing you significant distress or affecting your quality of life, relationships, or mental health
• It occurred alongside other symptoms that may suggest an underlying health condition

Signs and Symptoms of Erectile Dysfunction

• Inability to achieve an erection despite sexual stimulation
• Erections that are not firm enough for penetration
• Losing an erection before or during sex
• Reduced sexual desire (libido) — often associated with hormonal causes of ED
• Premature or delayed ejaculation — sometimes associated with ED
• Anxiety or avoidance around sexual activity

Physical and Psychological Causes

ED can arise from physical causes (cardiovascular disease, diabetes, hypertension, hormonal imbalance, nerve damage), psychological causes (anxiety, depression, stress, relationship issues), or most commonly, a combination of both. Certain medications also commonly cause ED. For a comprehensive breakdown, see our guide to what causes erectile dysfunction.

How Is Erectile Dysfunction Diagnosed?

Clinical History

A prescriber will ask about the nature of your ED symptoms, onset, frequency, and severity. They will also ask about your general health, cardiovascular risk factors, medications, and lifestyle factors (smoking, alcohol, drugs, exercise). They may use a validated questionnaire such as the International Index of Erectile Function (IIEF) to assess symptom severity.

Blood Tests

• Testosterone levels (morning sample preferred)
• Fasting blood glucose / HbA1c (diabetes screening)
• Lipid profile (cholesterol screening)
• Thyroid function tests
• Full blood count

Physical Examination

A physical examination may assess blood pressure, cardiovascular health, and genital anatomy. In men with risk factors for prostate disease, a rectal examination may be considered.

Treatment Options

Once diagnosed, treatment depends on the identified cause and its severity. Options range from lifestyle changes and psychological therapy to MHRA-approved oral medications (sildenafil, tadalafil, vardenafil, avanafil) and, in complex cases, other interventions. For a full overview, see our guide to is erectile dysfunction treatment guaranteed and our ED basics guide.