Understanding Erectile Dysfunction
Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is one of the most prevalent male health conditions in the United States, affecting an estimated 30 million men. Prevalence increases with age — approximately 40% of men at age 40 and 70% of men at age 70 experience some degree of ED — but ED is not an inevitable consequence of aging and is often treatable regardless of age. Many men experience ED and never seek care due to embarrassment or the mistaken belief that little can be done.
ED has multiple underlying causes that often co-exist. Vascular causes are the most common — atherosclerosis, hypertension, and diabetes impair blood flow to penile tissue and are responsible for the majority of organic ED cases. Because the penile arteries are small-diameter vessels, ED can be an early marker of systemic cardiovascular disease. Neurogenic causes include spinal cord injury, multiple sclerosis, pelvic surgery (prostatectomy), and diabetes-related peripheral neuropathy, all of which impair the nerve signals necessary for erection. Hormonal causes include hypogonadism (low testosterone), hyperprolactinemia, and thyroid dysfunction. Psychogenic causes — including performance anxiety, depression, relationship stress, and generalized anxiety — are particularly common in younger men and can exist alongside organic causes in any age group. Medication-induced ED is also recognized, with antihypertensives (especially beta-blockers and thiazides), SSRIs/SNRIs, antipsychotics, and 5-alpha reductase inhibitors among the common contributors.
your board-certified provider, provides thorough, evidence-based ED evaluations aligned with American Urological Association (AUA) guidelines at Innocre Telehealth — serving patients in Delaware, Maryland, and Washington. Every consultation is conducted with clinical professionalism and complete discretion.
Common Symptoms and Presentations
Difficulty achieving an erection with sexual stimulation
Inability to maintain an erection throughout intercourse
Reduced sexual desire or libido
Erections that are less firm than previously
Situational ED (present in some contexts but not others — suggests psychogenic component)
Associated fatigue, low mood, or reduced energy (possible hypogonadism)
ED developing after starting a new medication
ED in the context of poorly controlled diabetes or hypertension
How Innocre Treats Erectile Dysfunction Online
your provider will conduct a structured ED evaluation that includes a detailed sexual health history, relevant medical history (cardiovascular disease, diabetes, hypertension, neurological conditions, prior pelvic surgery), current medication review for potentially causative drugs, and a cardiovascular risk assessment. Because ED can be the first symptom of underlying cardiovascular disease, the AUA recommends that providers assess cardiovascular risk before prescribing PDE5 inhibitors. Patients with uncontrolled hypertension, recent MI or stroke, or high cardiovascular risk may require in-person cardiology evaluation before treatment can be safely initiated via telehealth.
First-line pharmacological treatment for ED consists of PDE5 inhibitors, which work by increasing blood flow to penile tissue in response to sexual stimulation. These are not aphrodisiacs — sexual arousal is required for them to work. Options include: Sildenafil (Viagra) — typically 50 mg taken 1 hour before sexual activity as needed (range: 25–100 mg); Tadalafil (Cialis) — available as 10 mg or 20 mg as-needed dosing, or 2.5–5 mg daily dosing for spontaneity; Vardenafil (Levitra) — typically 10 mg taken 1 hour before sexual activity (range: 5–20 mg). The most important contraindication to all PDE5 inhibitors is concurrent use of nitrate medications (nitroglycerin, isosorbide mononitrate/dinitrate) — the combination can cause severe, potentially fatal hypotension and is an absolute contraindication. Alpha-blockers used for prostate conditions also require caution and dosing guidance.
Beyond pharmacotherapy, your provider will discuss the significant impact of lifestyle factors on erectile function — including smoking cessation (smoking is a major independent risk factor), aerobic exercise, weight management, reduced alcohol consumption, and glycemic control in diabetic patients. Testosterone screening (total and free testosterone) may be recommended if symptoms suggest hypogonadism. For patients where psychogenic factors play a role, referral for sex therapy or psychological counseling may be discussed as a complementary approach. Prescriptions are sent electronically to your pharmacy in DE, MD, or WA.
⚠️ When to Go to the Emergency Room
Telehealth is appropriate for evaluation and ongoing management of ED. However, seek emergency care immediately for:
- • Priapism — a painful erection lasting more than 4 hours — is a medical emergency. Go to the ER immediately. Ischemic priapism causes permanent damage to erectile tissue if not treated within hours
- • Chest pain, severe headache, vision changes, or shortness of breath after taking a PDE5 inhibitor — call 911 immediately, especially if also using nitrates
- • Sudden significant drop in blood pressure after taking sildenafil or tadalafil — loss of consciousness or near-syncope requires emergency evaluation
- • Signs of heart attack or stroke — ED medications do not cause these, but cardiac events can occur in men with underlying cardiovascular disease