Erectile Dysfunction versus Premature Ejaculation

These conditions are both extremely common and affect almost all men at some point - so it is important to understand both erectile dysfunction (ED) and premature ejaculation (PE) and how they are different and what to do about each. 

Erectile Dysfunction

Erectile dysfunction (ED) is when it is hard for you to get an erection or keep an erection that is hard enough for satisfying sex. It can be caused by either mental or physical problems. 

If you smoke for example - your body might have a harder time supplying enough blood to the penis to fill it up for a strong erection. This is what we mean by a physical or physiologic cause of ED and ED medicines can help drive more blood flow to the penis to fix this problem. 

If you are very stressed by work and not getting enough sleep, or if you are nervous in a new relationship - sometimes it can be hard to relax and not worry about having an erection. This is what we mean by a mental or psychologic cause of ED. Often times ED medicines can also help in these cases - but in the long term it is better to focus on lowering stress, getting more sleep, reducing anxiety, and other mental strategies so you are less likely to need medicine in the long term. 

Premature Ejaculation

Premature ejaculation (PE) is a different problem than ED, but sometimes they can happen together. PE means that you have trouble not ejaculating (coming) quickly. This can often be caused by stress or anxiety. 

Sometimes this problem is linked to ED, so that when you feel the erection getting weaker your body wants to ejaculate quickly. Some people have less PE when the ED is treated. 

However, for other men PE is not related to ED. It can be caused by things like stress, depression, or just a penis that is too sensitive. This is best treated with other medicines and non-medical therapies and you should talk to your doctor in person about it. 

Accurate Information

In order for us to assess your visit and determine if ED medicines make sense for you - it is very important that you provide full and accurate health information. If you have any questions about what something means, or how to get certain information just message us in the secure chat or call us and we can help. We need real data, such as a blood pressure reading within 6 months, and it is important that you provide accurate information for your own safety. 

Side Effects

With any medicine there are many potential side effects. Some of the most common side effects of ED medicines (PDE5I medicines like Viagra) include:

  • Flushing (10% to 19%)
  • Headache (16% to 46%)
  • Stomach ache (3% to 17%)
  • Visual disturbance (2% to 11%)
  • Nose bleeds (9% to 13%)

Some serious but less common side effects include:

  • Dizziness 
  • Priapism (an erection over 4 hours - that can cause penile damage)
  • Syncope or passing out
  • Heart attack or stroke
  • Vision loss
  • Liver damage

You can also read more about the risks and benefits from the manufacturers of Viagra (sildenafil), Cialis, or Levitra

Physical Exam

It is important that you've had a recent genital physical exam, within 3 years, before starting ED medicines. Some anatomic abnormalities of the penis, like Peyronie's disease, can increase the risk of side effects like penile damage with some ED medicines. 

Recreational Use

Obviously sex is fun and so all use is in some sense recreational. However using ED medicines if you don't have a problem with your erections (just to enhance sexual activity) can be dangerous and is not recommended. It can, for example, raise your risk of penile damage due to these medicines. 

Sex Drive or Libido and Testosterone Levels

You should have your testosterone level checked if you haven't already since low testosterone may be contributing to your ED or low libido (sex drive). 

High Blood Pressure,  High Cholesterol, and Diabetes

You should make sure you always follow up with your primary care doctor to make sure you are in good health. Erectile dysfunction (ED) can often be a warning sign that your blood vessels (arteries) are not in good health and so you should have your cardiovascular health checked. Commonly conditions like high blood pressure, high cholesterol, and diabetes are closely associated with ED - and if you improve those conditions often ED also improves. 


Smoking or nicotine use is another major risk factor for ED, and quitting those habits can often quickly reduce the symptoms of ED. If you are interesting in quitting - talk to your HeyDoctor team or your primary care doctor. There are a lot of medicines and strategies that can make quitting easier. 

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