This is a checklist to help identify the cause of any erection problems you may be experiencing

If you’re having trouble getting an erection, this checklist may be helpful in sorting out the cause of the problems and resolving your thoughts and feelings.

Question 1: What bothers you about your sexual functioning?

1 Low sexual desire in general
2 Low sexual desire for my partner
3 Not feeling aroused (turned on)
4 Not getting an erection sufficient for intercourse
5 Not keeping an erection (erectile dysfunction)
6 Not having an orgasm, even though I feel aroused
7 Ejaculating too quickly (coming too fast)
8 Having an orgasm that lacks intensity
9 Having an orgasm but not being able to ejaculate (delayed ejaculation)
10 Pain during sex

Interpretation of Question 1

Answering the question should get to the heart of your problem. Some men are able to get an erect penis but cannot ejaculate or have an orgasm. Some men can erect and ejaculate but experience a decline in the intensity of the orgasm. Others are not  able to ejaculate and have orgasm, a condition which is called delayed ejaculation. 

Some men can attain an erection but not sustain it in order to penetrate and complete the sex act. Others can become erect and penetrate but ejaculate too quickly to satisfy themselves or their partner. (Read about erection problems here.) Some men will experience pain in the genitals with sexual activity. Having defined your problem, let’s determine the cause.

Question 2: When is the last time you had what you would consider a complete, normal erection followed by ejaculation?

Interpretation of Question 2

It is important to estimate the time of onset of your difficulty. Erectile problems (ED) of short duration is very often psychologically related to a specific event or has a physical cause such as beginning a new medication or having gone through a surgical procedure. ED that is of a longer duration and has come on slowly but progressively usually has a physical cause such as poor blood flow. Read about causes of erectile dysfunction here.

Question 3: Are you able to achieve an erection with masturbation? If so, what percent of a full erection do you get?

Interpretation of Question 3

Being able to achieve a fully hard penis with self-pleasuring or that provided by your partner indicates normal blood and nerve supply to your penis. Being able to become erect with masturbation but not for intercourse usually indicates a psychological problem.

Question 4: When you awaken during the night or in the morning, what percent of a full erection have you seen in the last few months?

Interpretation of Question 4

Erections that occur during the night are indicative of normal nerve and blood flow to the penis. Every man will have three to five erections at night, each lasting 20 to 25 minutes. These are not generally appreciated by the man (although they may be by his partner) because they only occur at a certain depth of sleep. The erection that is noted upon awakening, contrary to popular opinion, is not due to a full bladder. It is a reflection of one of the normal erections occurring during rapid-eye movement sleep. The presence of these erections is a very favorable sign and often points to a psychological cause for any erection difficulties during partnered sex.

Question 5: If you read erotic material or see an erotic movie, what percent of a full erection do you usually get?

Interpretation of Question 5

An erection brought about by an erotic thought or visual stimulus is initiated in the brain. This is a very favorable sign and again is indicative of normal function of the nerve and blood supply to the penis, suggesting a psychological cause.

Question 6: Are you able to get a good firm erection at some times and not at others?

Interpretation of Question 6

If you get a good-quality erection at any time that is sufficient to complete the act of intercourse, yet at other times you are impotent, it is quite likely that your difficulty is psychological.

Question 7: Does erectile difficulty occur only with a certain partner?

Interpretation of Question 7

If you are failing to become erect only with a certain partner but can perform successfully with someone else, there is not likely to be any physical problem causing impotence. (This is not a suggestion that you try multiple partners, particularly if you are married!) It does, however, suggest that sex therapy or marriage counseling should be considered.

RELATIONSHIP QUESTIONS

Question 8: Does your partner know that you are seeking help and have come for an evaluation?

Interpretation of Question 8

If a man with ED has discussed the problem with his partner, it indicates good communication. Treatment is more likely to be successful if his partner is aware of what is happening.

Question 9: Is your partner supportive of your seeking help?

Interpretation of Question 9

Men who have supportive partners are more likely to experience a quick recovery. Men whose partners are not supportive are generally angry and resentful, which does not help the healing process.

Question 10: Do you find your partner sexually attractive?

Interpretation of Question 10

Men who are no longer “turned on” by their partner are more likely to experience erection problems. Men who do not accept the normal changes in a partner’s body that occur with aging may have unrealistic expectations and desires. Read about ED from a woman’s point of view.

Question 11: Has your sexual problem caused any of the following difficulties in your relationship?

• 1. “Chilly” atmosphere in the house
• 2. Less overall communication
• 3. Avoidance of specific topics like sex
• 4. More arguing
• 5. Withdrawal from family members or friends
• 6. Less trust in my partner
• 7. Less trust in me by my partner
• 8. Doing fewer activities together

Interpretation of Question 11

Like a stone cast in the water, a sexual problem may have a ripple effect upon a couple’s entire relationship. Arguing, avoidance, distrust, frustration, and discouragement or depression are more likely to occur in either or both individuals.

Question 12: Do you or does your partner usually initiate sexual activity?

Interpretation of Question 12

If one partner always initiate sexual activity, it may be indicative of widely differing levels of interest in sex or reflect negative feelings about the relationship. In an ideal world, each partner may initiate sex at different times depending upon urge, interest level, and a desire to satisfy each other.

Question 13: Do you feel it is important that your female partner reaches orgasm during every episode of intercourse? Do you feel that all sexual encounters must include intercourse?

Interpretation of Question 13

If you feel that you must guarantee your female partner has an orgasm during every sexual encounter or that you must achieve sexual penetration and vigorous thrusting, you may be placing unrealistic demands on yourself, which may lead to sexual failure.

PAST MEDICAL HISTORY QUESTIONS

Question 14: Do you have or have you had in the past any of the following?

1. High blood pressure
2. Heart disease
3. Heart attack
4. Diabetes
5. Thyroid gland disease
6. Testicular disease
7. Multiple sclerosis
8. Parkinson’s disease
9. Other neurological disease
10. Stroke
11. Kidney disease
12. Cancer

Interpretation of Question 14

Any of these illnesses may indicate a general medical problem that can cause difficulties with sexual functioning. It is important that your physician, psychologist, or counselor be fully aware of such problems. All of these may indicate an underlying physical cause of ED.

Question 15: Have you had any of the following surgical procedures?

1. Removal of the prostate
2. Removal of the bladder
3. Rectal or colon surgery
4. Cardiac bypass
5. Disk surgery
6. Vascular surgery of the legs or major blood vessels

Interpretation of Question 15

Any of these operations may indicate a physical cause for your impotence because of an impairment of blood flow or nerve function.

Question 16: What medications do you take?

Interpretation of Question 16

Commonly prescribed medicines such as antidepressants, blood pressure pills, sedatives, hormones, drugs for peptic ulcer, and over-the-counter cold medications can contribute to erectile failure. 

Question 17: Did your sexual problem begin soon after taking a new drug?

Interpretation of Question 17

If you can document in your mind that your difficulty began soon after starting a new medication, this may be a very important point. It suggests that this drug may be causing or contributing to your problem.

Question 18: Have you ever had an erection that lasted several hours?

Interpretation of Question 18

A past history of an excessively prolonged erection (usually more
than four to six hours) may prevent future erections. This is due to damage caused to the erectile tissue, which is generally not reversible.

Question 19: Do you smoke, abuse alcohol, use recreational drugs, or have high cholesterol? Do you believe that you are not in good physical condition?

Interpretation of Question 19

Any of these factors, smoking, elevated cholesterol, abusing alcohol, or failing to exercise, may contribute to difficulties with sexual functioning.

Question 20: Do your legs ache when you walk more than a few blocks?

Interpretation of Question 20

Poor blood supply to the pelvis and the legs, which is usually caused by atherosclerosis, may indicate poor blood flow to the penis, which may cause impotence.

Question 21: If you have heart disease or have had a heart attack, are you fearful of dying during intercourse or is your partner fearful of having sex with you for this reason?

Interpretation of Question 21

Anxiety following a heart attack may keep you from resuming a normal sexual life. If your partner has major concerns, she may be unwilling to participate in sex for fear of precipitating a heart attack or stroke. Many men who have suffered from such an illness and whose partner refrains from sex out of concern for them often misinterpret her restraint as a lack of interest.

These questions and your answers are intended only as a framework to help you understand your problem and to aid a professional sex counselor or a physician in managing your case.

Many men who answer these questions will figure out for themselves whether the cause of their erectile dysfunction is likely to be psychological or physical, or both. Most are relieved once they have taken a step toward understanding their own diagnosis. Once you pinpoint your difficulty, you will have a better understanding of diagnostic tests or treatment that your doctor may recommend.