You can’t diagnose erectile dysfunction (ED) at home, but you can gather useful clues. A validated questionnaire, the IIEF-5, gives a good guide to whether you have ED and how severe it is. Noticing whether you still get erections during sleep or on waking can hint at the cause. Home “tests” such as the stamp test aren’t reliable.

Whatever the result, it’s worth seeing a doctor, because ED can be an early sign of heart disease or diabetes.

What is erectile dysfunction?

Erectile dysfunction means regularly finding it hard to get or keep an erection firm enough for sex. Occasional problems are normal and aren’t ED.

It’s common and becomes more so with age. In a well-known US study of men aged 40 to 70, about half had some degree of ED, from mild to complete [1].

What causes it?

Most ED has a physical cause, often more than one, and stress or worry about performance can then make it worse.

  • Blood vessel problems, linked to high blood pressure, high cholesterol, diabetes, smoking and excess weight.
  • Nerve problems, from diabetes, multiple sclerosis, spinal problems or pelvic surgery.
  • Hormone problems, such as low testosterone or thyroid disease.
  • Medicines, including some antidepressants, blood pressure tablets and opioid painkillers. Don’t stop a prescribed medicine without speaking to your doctor.
  • Psychological factors, such as stress, anxiety, depression and relationship difficulties.
  • Alcohol and recreational drugs.

Why it’s worth taking seriously

The arteries in the penis are smaller than those in the heart, so narrowing can show up there first. In a large study, men who developed ED were more likely to have a heart attack or stroke in the following years. The researchers advised that ED should prompt a check of heart risk factors [2].

Self-test 1: the IIEF-5 questionnaire

The IIEF-5, also called the Sexual Health Inventory for Men, is a short questionnaire used by doctors worldwide. It asks five questions about your erections and sexual satisfaction over the last six months. Each answer is scored, giving a total between 5 and 25.

When it was developed, a score of 21 or less identified ED with high accuracy. Scores are also grouped into bands from mild to severe ED [3].

It’s a screening tool, not a diagnosis. It tells you how much of a problem there is, but not why. Read more about the IIEF-5 questionnaire.

Self-test 2: night-time and morning erections

Healthy men usually have several erections during sleep, mostly during dreaming (REM) sleep. You may notice one when you wake.

If you regularly wake with a firm erection, or can get a firm erection on your own but not with a partner, it suggests the blood vessels and nerves are working. Stress, anxiety or relationship factors may then be playing a larger part.

If night-time and morning erections have faded along with erections during sex, a physical cause is more likely. This is only a rough guide. Sleep quality, alcohol, age and medicines all affect night-time erections, and many men have more than one cause.

What about the stamp test?

The “stamp test” involves wrapping a ring of postage stamps around the penis before sleep and seeing whether it has torn by morning. It was an early attempt to detect night-time erections.

It isn’t a reliable test. A tear can happen from moving in your sleep, and an intact ring doesn’t prove you had no erections. It also tells you nothing about how firm an erection was. Doctors don’t use it, and we don’t recommend it.

In specialist clinics, night-time erections can be measured with a monitor worn overnight. This is only needed in a small number of cases.

Other questions to ask yourself

Thinking about these before an appointment helps your doctor find the likely cause:

  • Did the problem start suddenly or gradually?
  • Does it happen every time, or only in some situations?
  • Is it hard to get an erection, keep one, or both?
  • Has your interest in sex changed?
  • Have you started any new medicines?
  • How much alcohol do you drink, and do you smoke?

How a doctor diagnoses ED

A GP will usually ask about your symptoms, health and medicines, and check your blood pressure, weight and sometimes your genitals. Blood tests commonly check blood sugar, cholesterol and, in some men, hormone levels.

Most men don’t need specialist tests. A referral may be offered if you’re young, had a pelvic injury, have a curve in the penis, or if first treatments don’t work.

Treatment options

Treatment starts with the cause. Lifestyle changes, such as losing weight, being more active and stopping smoking, can improve erections. See our article on foods and lifestyle changes for healthy blood flow.

Your GP can prescribe tablets that help erections, which work for many men. Other options include vacuum devices, injections, and psychosexual therapy. Low-intensity shockwave therapy is also offered by some clinics. The research on it is mixed, so it suits some men better than others.

When to get urgent help

Call 999 if you have chest pain, particularly during sex or exercise. Go to A&E if an erection lasts more than 4 hours.

See your GP promptly if ED came on suddenly after an injury, or comes with back pain, numbness between the legs, or bladder or bowel problems.

Next steps

If self-testing suggests ED, book a GP appointment first to check your heart health and look for treatable causes. At Vale Health Clinic, our men’s health team offers a free consultation to talk through the options available at Vale, including what the evidence shows for each. Call 01892 543029.

References

  1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151(1):54–61. doi:10.1016/S0022-5347(17)34871-1
  2. Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294(23):2996–3002. doi:10.1001/jama.294.23.2996
  3. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11(6):319–326. doi:10.1038/sj.ijir.3900472

This article is general information, not personal medical advice. Please speak to a clinician about your own situation.

This article is general information and isn’t a substitute for advice about your own health. If you’re worried about a symptom, speak to your GP or book an assessment.