If you're having trouble getting an erection,
this checklist may be helpful in sorting out your thoughts and feelings, and
perhaps even pointing to the cause of the problem, before you see a doctor.
Question 1: What is your problem?
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 erect penis
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
10 Pain during sex
*Interpretation of Question 1
are many causes of low sexual desire and loss of erection, and they are not
all about erectile dysfunction. So before you assume that your problem is a
psychogenic or physical case of erection problems, cast an mental eye over
your relationship to check what might be going on there.
We know, for example, that men may quickly
become bored with sex with the same partner. So is that a factor in your lack
of sexual response?
Or is it simply that your partner is not
showing any enthusiasm for sex? Has she perhaps gone off sex and her lack of
enthusiasm about bedroom pleasure is having a knock-on impact on your desire
and ability to become erect?
If so, it might be necessary for you both to get some better
sexual techniques, so that you can introduce an element of novelty into the
bedroom. For women, knowing how to
please a man in bed is essential because without specific information on
this delicate subject, women tend to assume that men like what women like -
e.g. a gentle touch to the genitals. This is a mistake.
And of course, that said, you may really have erectile
dysfunction rather than some kind of desire deficit. In which case, read on...
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. Impotence 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.
Erectile dysfunction of a longer duration and which has come on slowly but
progressively usually has a physical cause such as poor blood flow.
assessment for ED by clicking on the link.
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-stimulation 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. As previously noted, every normal male will have three to
five erections at night, each lasting 20 to 25 minutes. These are not
generally appreciated by the male (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.
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
Question 6: Are you able to get a good firm erection at some times and not at
others? In other words,
erectile dysfunction is intermitent.
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 impotent 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.
Question 8: Does your partner know that you are seeking help and have come for
Interpretation of Question 8
If an impotent male has discussed the problem with his partner, it indicates
good communication. Treatment is more likely to be successful if his partner
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 impotence. Men who do not accept the normal changes in a partner's
body that occur with aging may have unrealistic expectations and desires.
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
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 climax
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
5. Thyroid gland disease
6. Testicular disease
7. Multiple sclerosis
8. Parkinson's disease
9. Other neurological disease
11. Kidney disease
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 impotence.
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. You should review your
medications with your physician. However, keep in mind that most men who take
these medications do not experience impotence.
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 illicit 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
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 impotence 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
physician may recommend.