Understanding Erectile Dysfunction

Erectile dysfunction (ED) is far more common than most people realize, yet it’s still something many men hesitate to talk about. Whether from embarrassment or the misconception that it’s “just part of getting older,” concerns often go unmentioned. But bringing these symptoms to a trusted primary care provider can make a meaningful difference - not only in sexual health, but in overall health, too. In fact, ED is sometimes one of the earliest clues that something deeper, such as cardiovascular disease, may be developing.

While the internet is full of quick fixes and supplements, it’s important to approach ED with proper medical guidance. Online remedies may mask an underlying issue or introduce risks of their own. A thoughtful, in-person evaluation can uncover what’s really going on and help create a safe, effective plan forward.

What Is Erectile Dysfunction?

Erectile dysfunction refers to a persistent difficulty achieving or maintaining an erection that’s firm enough for satisfying sexual activity. Many men experience occasional challenges - this is normal. But when it becomes frequent or begins to affect quality of life, it deserves attention.

Common Signs and Symptoms

Men experiencing ED may notice:

Difficulty achieving an erection – Trouble becoming erect during sexual stimulation is often the first sign.

Trouble maintaining an erection – Being able to get an erection but not sustain it long enough for intercourse.

Reduced sexual desire – Low libido may accompany ED but isn’t always present.

Emotional or psychological effects – Stress, frustration, low self-esteem, or performance anxiety may develop over time.

What Causes Erectile Dysfunction?

ED is usually multifactorial - often a combination of physical, emotional, and lifestyle-related factors.

Physical Causes

These are among the most common and often relate to blood flow, nerve function, or hormones:

• Cardiovascular disease (such as hypertension or atherosclerosis)

• Diabetes

• High cholesterol

• Obesity or metabolic syndrome

• Low testosterone or other hormonal imbalances

• Neurological conditions, including Parkinson’s or MS

• Peyronie’s disease

• Pelvic trauma or surgeries, including prostate procedures

Lifestyle Factors

Certain habits can directly influence vascular and sexual health:

• Smoking

• Excessive alcohol use

• Recreational drug use

• Sedentary habits

• Ongoing stress or poor sleep

Emotional and Psychological Factors

Men often carry a heavy mental load - balancing work, family demands, and personal expectations. Stress and emotional health can significantly affect sexual performance:

• Anxiety, including performance anxiety

• Depression

• Relationship conflict

• Past trauma

These factors often overlap with physical contributors.

Medication-Related Causes

Some prescription medications may contribute to ED, including:

• Blood pressure medications

• Certain antidepressants

• Anti-anxiety medications

• Antihistamines

• Medications for prostate conditions

Never stop a medication without speaking with a clinician - sometimes a simple adjustment can help.

When to Talk With a Primary Care Provider

A conversation is warranted if you notice:

• Persistent difficulty with erections

• A decrease in sexual desire

• Symptoms of low testosterone (fatigue, reduced muscle mass)

• ED paired with new cardiovascular symptoms like chest pain or shortness of breath

Because ED can be an early sign of heart disease, diabetes, or hormonal imbalance, getting evaluated is an important part of protecting long-term health - not just sexual function.

The Bottom Line

Erectile dysfunction is common, treatable, and nothing to feel embarrassed about. More importantly, it’s often your body’s way of signaling that something deserves attention. Talking openly with a primary care clinician can lead to better sexual health, stronger relationships, and early detection of conditions that benefit from timely care.

At Laurie Birkholz MD & Associates, we care for women, men, and adolescents - and we offer unhurried, comprehensive visits where you can discuss all aspects of your health. If you’re looking for a primary care home where these conversations feel safe and supported, we invite you to schedule a meet & greet and learn more about what membership medicine can offer you.