6 ways to help you know if it’s ED or erectile dissatisfaction

If things have hit a speed bump in the bedroom because of erectile problems, you may be wondering: Am I experiencing erectile dysfunction (ED)? Or is it just that my erections aren’t what they used to be? It’s not always easy to know if you’re dealing with actual ED or something called erectile dissatisfaction, which is erectile difficulty that’s mostly due to natural changes as you age.

It’s easy to confuse the 2 issues. Even doctors may have a tricky time figuring it out until they investigate more. But there are questions you can ask yourself to get closer to an answer, along with some important things your doctor may want to assess. Here’s what you need to know about the range of erectile problems.

What is ED?

Erectile dysfunction is the inability to get or keep an erection firm enough for penetrative sex. In other words, you can’t complete the act. You can have ED occasionally, frequently or every time you have sex. It’s more common in older men than in younger men: More than 50% of men ages 40 to 70 experience ED at some point, according to the Massachusetts Male Aging Study. (Read Erectile dysfunction: The Optum Guide to learn more about ED.)

Get ED help today

Fill out an assessment and have low-cost medication delivered discreetly to your door. We’re open 24/7. 

Start now

What is erectile dissatisfaction?

Erectile dissatisfaction might be mistaken for ED, but it’s not the same. With erectile dissatisfaction, it’s possible to get and keep an erection — though it becomes much more difficult to do, especially as you age. As men get older, it’s typical for erections to become less firm and take more time to develop.

How is erectile dissatisfaction different from sexual dissatisfaction?

Sexual dissatisfaction is what it sounds like: You’re becoming unhappy with your sexual life. While this may be related to a lower libido, sexual dissatisfaction is often easily resolved, depending on what’s going on in your personal life.

Talking with your partner about your mutual sexual needs and theirs can get you both on the same page. And switching up activities in the bedroom (or elsewhere) can spice things up.

Stress can also play a role by sapping libido. So tackling sources of anxiety (such as work) or speaking to a therapist about how to handle pressures can help. 

If you think you may have ED or erectile dissatisfaction, making an appointment with a doctor is a good first step, especially if symptoms are new, says clinical psychologist Zoë Peterson, PhD. She’s a senior scientist at the Kinsey Institute in Bloomington, Indiana.

A preliminary visit to a urologist can be a great opportunity to air your concerns and rule out health-related issues. There can be serious physical causes of ED, so the earlier treatment begins, the better you can head off complications. You may discover that occasional problems are erectile dissatisfaction. Either way, you can breathe easier once you understand what’s going on.

Here are 6 questions to ask yourself to help determine if you’re experiencing erectile dissatisfaction or erectile dysfunction, and when it’s time to connect with a doctor for an assessment.

1. Do you have nighttime erections?

Healthy males have an average of 3 to 5 nightly spontaneous erections from as young as age 3 to as old as 79. If you’re still experiencing erections while sleeping or you have one upon waking, then your erectile issues probably aren’t ED. That said, if you notice a reduction in your normal number, you may want to talk to a doctor just to rule out anything.

2. Do you have relationship issues?

Relationship problems could cause or worsen a performance issue. If you work on your relationship and your erectile issues improve, you may be dealing with erectile dissatisfaction or sexual dissatisfaction, rather than ED. Likewise, if you’re having problems only during sex with your partner but not while masturbating, then the issue is more likely in your heart (romantically speaking).

Relationship problems are so vital to figuring out the cause of erectile issues that many urologists include this question in their initial assessment. “I ask whether problems are occurring with one partner or all your partners. Or whether there are strains in the relationship,” says Richard R. Augspurger, MD. He’s a urologist and a medical director at Optum. The answers help him narrow down the cause.

Read about how to talk to your partner about ED.

3. Have your erections been changing gradually as you age?

You may be used to getting strong erections simply from fantasies or visual stimulation. But you might be surprised or even troubled that over time this isn’t enough to produce an erection firm enough for sex.

Some men mistake the need for fondling or other manual stimulation to get a firm erection as a sign of ED. But this is a normal part of aging and doesn’t mean you have ED. It’s true that older men experience ED more commonly than younger men, and a big reason is that older men have more health issues that could be causing ED.

If you’re concerned, visit your doctor to rule out any health conditions that might be related to ED. Speaking of ...

4. Have you recently developed or been diagnosed with a serious health condition?

In some men, ED can be caused by health conditions such as heart disease, diabetes, high blood pressure or high cholesterol. These conditions can affect blood flow to the penis, resulting in ED. After all, ED is essentially a blood flow problem (though it can also involve psychological factors).

If you’ve been diagnosed with such a condition and are having erection problems, talk to your doctor about whether the 2 are connected. Treating the underlying health condition can often improve ED.

These conditions can also play a role in erectile dissatisfaction. So getting annual checkups to assess your risk factors can have a positive domino effect on your sex life.

An important reason not to wait to make an appointment: Erectile problems can be an early — and sometimes the only — obvious sign of heart disease. Erection issues tip off your doctor to look more carefully at your heart health and head off serious problems down the road. (For further reading: What ED Reveals About Your Health.)

Mental health conditions can also factor into both ED and erectile dissatisfaction. If you’ve been diagnosed with or have depression or anxiety, talk to your doctor about getting treatment.

The Optum Store makes affording mental health care easier. You can choose from 3 subscription plans designed to meet your needs. Learn more.

5. Have your erections changed since you started viewing more pornography?

As pornography has become more available online, researchers are examining whether it’s at the root of the increase in sexual dissatisfaction, especially among younger men. Several studies show that using pornography can reduce sexual desire and the ability to orgasm. It can also lead to other erectile problems. There’s even a term for it: PIED, or pornography-induced erectile dysfunction.

If you worry that your use of porn might be affecting your enjoyment of sex or causing erectile dissatisfaction, the fix may be as simple as sharply reducing your consumption, experts say.

That’s not to say that watching porn always has a negative effect on a person’s sex life: A study in the journal Sexual Medicine showed that porn could help increase desire for sex with a partner and was not related to ED. Bottom line: It’s all about each person’s individual habits and responses.

6. Could depression or depression medication be a factor?

Depression and anxiety can sap the joy out of a lot of things, including sex. When you’re depressed, the chemical neurotransmitters in your brain are out of balance. That can lead to low or no sex drive. It can also result in ED, erectile dissatisfaction or even sexual dissatisfaction.

And in what might seem like a cruel joke, some popular medications for anxiety and depression, such as Prozac^® (fluoxetine), Zoloft^® (sertraline) and Lexapro^® (escitalopram), can lower libido and even delay orgasm.

Doctors can prescribe alternative medications with a lower risk of sexual side effects. Those medications include Wellbutrin^® (bupropion), Remeron^® (mirtazapine) and Viibryd^® (vilazodone).

If you’re on depression medication, talk to your doctor about whether it’s among those known to contribute to ED. You might be able to counteract this effect with ED medications such as Viagra^® (sildenafil) or Cialis^® (tadalafil). Learn more about your medication options here.

The bottom line? You don’t have to live with sexual dissatisfaction. Once you begin to understand what’s behind your feelings, you can take steps that can help you find more happiness inside the bedroom and out.

Treat ED on your terms

Get discreet care from the comfort of home and medication delivered to your door, starting at $1 per dose.

Get started

Additional sources
Nighttime erections: Asian Journal of Andrology (2020). “Consecutive Nightly Measurements Are Needed for Accurate Evaluation of Nocturnal Erectile Capacity When the First-Night Laboratory Recording Is Abnormal”
Porn enhances sex life: Sexual Medicine (2015). “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction”
Porn and erectile problems: Behavorial Sciences (2106). “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports”
Porn and low libido: Mayo Clinic (2020). “Let’s Talk About Low Libido”
Depression and sexual problems: Cleveland Clinic (2020). “Depression and Sex”