Condition guide
Evidence status: EstablishedErectile Dysfunction: Causes, Types and Specialist Assessment
What is erectile dysfunction?
Erectile dysfunction (ED) is the repeated difficulty getting or keeping an erection firm enough for satisfactory sexual activity. It is common. It often has a physical cause, such as reduced blood flow, nerve damage or a hormonal problem, and it can sometimes be an early sign of heart or metabolic disease. The right treatment depends on the cause.
Key fact: Major guidelines support a diagnosis-first pathway, cardiovascular risk assessment and lifestyle measures alongside established ED therapies such as PDE5 inhibitors. (European Association of Urology, 2026; page updated )
Many men wait years before asking for help. A confidential specialist assessment can show which type of ED you may have and which options are worth considering.
Private & confidential enquiry. You do not need to call.
Key takeaways
- ED is a symptom with several possible causes, not a single condition.
- Blood-flow problems are one of the most common physical causes.
- New or worsening ED can be linked to heart disease, diabetes or hormone problems, so assessment matters.
- You do not need to know which treatment you need before contacting the clinic.
What kind of erection problem do you have?
These patterns can point towards different causes. Only an assessment can confirm which one applies to you.
Difficulty getting an erection
Often linked to reduced blood inflow, nerve problems, hormones or anxiety. Morning or night erections can help show whether the cause is more physical or psychological.
Difficulty keeping an erection
An erection that starts but fades quickly can be related to the penis not holding blood effectively (venous leak) or to other blood-flow problems.
Learn more →Reduced hardness
Less firm erections are often a blood-flow (vasculogenic) pattern, especially with diabetes, high blood pressure, smoking or high cholesterol.
Learn more →Reduced penile sensitivity
Reduced feeling can point to nerve involvement, for example after pelvic surgery or with diabetic neuropathy. It deserves a proper medical review.
Sudden-onset ED
ED that starts suddenly can follow a new medicine, stress, injury, a hormone problem or a health event. See a doctor promptly, particularly if you also have chest symptoms or neurological symptoms.
ED despite Viagra or Cialis
Tablets may not work well if the dose, timing or contraindications are wrong, or if the underlying cause needs a different approach.
Learn more →Not all erectile dysfunction has the same cause
Many men have more than one contributing factor. Identifying the main one helps the doctor choose which options may be relevant.
Vasculogenic ED
Reduced blood flow into or retention of blood in the penis. This is the most common physical group.
Learn more →Arterial insufficiency
Narrowed or stiff arteries limit the blood that can enter the penis. It often shares risk factors with heart disease.
Cavernosal insufficiency (venous leak)
The penile tissue cannot trap blood effectively, so the erection fades.
Learn more →Neurogenic ED
Nerve signals are affected, for example by diabetes, spinal problems or pelvic surgery.
Hormonal ED
Low testosterone or other hormonal problems can reduce desire and erections.
Learn more →Drug-related ED
Some medicines can affect erections, including some antidepressants, blood-pressure medicines and 5-alpha-reductase inhibitors.
Post-surgical (iatrogenic) ED
Surgery or radiotherapy in the pelvis, especially for prostate cancer, can affect nerves and blood vessels.
Learn more →Psychogenic ED
Anxiety, depression, stress and relationship factors. They can occur alone or alongside a physical cause.
How a specialist ED assessment works
History
Your symptoms, medical conditions, medicines, surgeries, lifestyle and previous treatments.
Examination
A focused physical examination, including blood pressure and genital examination where appropriate.
Tests when useful
Blood tests such as glucose or HbA1c, lipids and morning testosterone. Penile Doppler ultrasound can assess blood flow in selected men.
Cause-based plan
The doctor explains which options may be relevant to the likely cause, including established treatments and any emerging therapies.
ED treatment options at a glance
The most appropriate treatment depends on the underlying cause of ED. This table is a guide for discussion, not a recommendation.
| Treatment | Typical candidate | Invasiveness | Number of sessions | Recovery | Primary treatment concept | Clinical assessment required |
|---|---|---|---|---|---|---|
| P-Shot (PRP) | Selected men with organic ED after assessment | Minimally invasive (injection) | Protocol varies; confirmed at assessment | Usually short; instructions given by the clinician | Injected platelet-rich plasma, proposed to support tissue repair | Yes |
| Shockwave / EdSWT | Vasculogenic ED; some partial responders to tablets | Non-invasive (no injection) | Clinic protocol: 12 sessions over about 2 to 3 months | No downtime expected for most men; confirmed by the clinic | Low-intensity shockwaves, proposed to support blood-flow pathways | Yes |
| Stem Cell | Selected men when established options were unsuitable or ineffective | Minimally invasive; may involve cell collection | Individualised; explained at assessment | Depends on the procedure; confirmed by the clinic | Cell-based preparation, proposed to support tissue repair | Yes |
| Exosome | Men asking about an investigational option | Minimally invasive if offered | Not established; confirmed only if offered | Confirmed if offered | Cell-derived vesicles, proposed to support repair signalling | Yes |
| PDE5 medication (e.g. sildenafil, tadalafil) | Many men with ED, unless contraindicated (for example with nitrates) | Non-invasive (tablet) | Ongoing, as needed or daily depending on the medicine | None | Increases the blood-flow response to sexual stimulation | Yes (prescription, with a health check) |
| Penile injections (e.g. alprostadil) | Men for whom tablets are unsuitable or ineffective | Self-injection after training | As needed before sex | None | Medicine injected into the penis to produce an erection | Yes (training and dose setting) |
| Penile implant | Severe or refractory ED after other options | Surgical | One operation | Surgical recovery; instructions given by the surgeon | A device placed in the penis that allows an erection | Yes (surgical assessment) |
A guide for discussion with your urologist, not a ranking or recommendation. Regenerative therapies are experimental or investigational for ED.
Your physician
Dr. Niyazi Umut Özdemir
Urological Surgeon, UZ Clinic Antalya
Responsible for assessment and treatment planning at the clinic, with a clinical focus on male sexual health and penile rehabilitation.
Rated 4.5 on Google (47 reviews, as of 2 Oct 2026)Qualifications
- • Medical education at Ege University
- • Specialisation in urology
- • Turkish Association of Urology board certification
- • Clinical practice in Antalya, Turkey
Clinical focus
- • Erectile dysfunction assessment and treatment planning
- • Penile rehabilitation
- • Vasculogenic (blood-flow related) erectile dysfunction
- • Shockwave therapy, PRP and regenerative approaches
Education and roles
- • Ege University Faculty of Medicine (2000); urology specialisation, Ege University (2005)
- • Head of the Antalya branch, CİSED
Professional memberships
- • Turkish Urological Association
- • Society of Urological Surgery (Ürolojik Cerrahi Derneği)
- • European Association of Urology (EAU)
- • Turkish Andrology Association
- • Aegean Urological Association (Ege Üroloji Derneği)
- • Ankara Urologists Association
Ask the urologist about your case
Send your history and the clinic will advise which options may be relevant. Suitability is decided after medical assessment.
Frequently asked questions
What causes erectile dysfunction?
Common causes are reduced blood flow, nerve damage, hormonal problems, medicines, psychological factors and surgery in the pelvic area. Many men have more than one cause.
Can ED be a sign of another health problem?
Yes. ED shares risk factors with heart disease and diabetes and can be an early warning sign, so a health review is sensible, particularly if ED is new or getting worse.
Do I need tests for ED?
Not always. The doctor decides after your history and examination. Blood tests are common, and penile Doppler ultrasound is used in selected men to assess blood flow.
Is ED permanent?
It depends on the cause. Some causes can be treated or improved, while others need long-term management. A specialist assessment gives a more realistic picture for your case.
Do I need to know which treatment I want before contacting the clinic?
No. Send your case and the clinic can advise which options may be relevant to you.
Sources
- EAU Guidelines on Sexual and Reproductive Health: Management of Erectile DysfunctionEuropean Association of Urology, 2026 · Guideline
- Erectile Dysfunction: AUA GuidelineAmerican Urological Association, 2018 · Guideline
Related guides
Send your case for confidential review
You do not need to know which treatment you need. Share a few details and the clinic can advise which options may be relevant to your case.
- 1. Send your caseAbout 2 minutes, private.
- 2. Coordinator contacts youBy WhatsApp, phone or email.
- 3. Doctor assessmentThe urologist decides suitability.
Private & confidential enquiry. You do not need to call.
This page provides general information and does not diagnose ED or decide whether a treatment is suitable for you. Suitability and expected benefit vary between patients and are decided after medical assessment. Treatments described as experimental or investigational are discussed with full informed consent. Seek urgent care for chest pain, new neurological symptoms, penile injury or an erection lasting more than four hours.