Erectile dysfunction in men: when to worry and how to treat it

By Dr. Pablo Juárez del Dago - Urologist. GUA Urology and Andrology.

Table of Contents

1. What is erectile dysfunction in men?
2. When to worry
3. Main causes
4. How it is diagnosed
5. Effective treatments
6. How we address erectile dysfunction at GUA
7. Frequently asked questions
8. Request an appointment

What is erectile dysfunction in men?

Erectile dysfunction in men is the ongoing difficulty in achieving or maintaining an erection firm enough for sexual activity.
It does not define those who suffer from it: it is a health indicator that requires medical attention and can be treated with excellent results.

When to worry

• Persistence of the problem for more than 3-6 months.
• Progressive decrease in rigidity or duration of erection.
• Anxiety or impact on the partner.
• Risk factors: diabetes, hypertension, high cholesterol, smoking, obesity.
• Pain, curvature or associated hormonal changes.

Attention: Erectile dysfunction in men can be a vascular warning. Early detection also improves cardiovascular health.

Main causes

ED is usually multifactorial in origin:

• Vascular: arteriosclerosis, hypertension, endothelial damage.
• Neurological: neuropathies, pelvic injuries or prostate surgery.
• Hormonal: low testosterone or thyroid disorders.
• Pharmacological and toxic: some antihypertensives, alcohol and tobacco.
• Psychological: performance anxiety, stress, relationship problems.

More information about erectile dysfunction - GUA Urology and Andrology.

How it is diagnosed

• Clinical history and physical examination.
• Hormone analysis and metabolic profile.
• Penile Doppler ultrasound to assess arterial and venous flow.
• Psychological and sexual evaluation.

Effective treatments

Habits and lifestyle

• Regular exercise, balanced diet and adequate sleep.
• Smoking cessation and alcohol reduction.
• Stress management and improvement of sexual communication.

Sex therapy and psychological support

The emotional component is key. Sex therapy helps reduce performance anxiety and improves response to medical treatments.

3. Oral medication (iPDE5)

• Sildenafil, tadalafil, vardenafil or avanafil, always under medical supervision.
• They require sexual stimulation and control of interactions.

4. Local treatments and devices

• Intracavernous injections or urethral suppositories (alprostadil).
• Vacuum pump and constriction rings.

5. Penile implants

Definitive solution for refractory cases.
Visit our penile prosthesis page.

6. Innovative alternatives

• Low intensity shock waves.
• Regenerative therapies (under investigation).
• New oral/local formulations.

How we address erectile dysfunction at GUA

Our philosophy: science + human warmth.
At GUA Urology and Andrology, we offer comprehensive diagnosis and personalized plans with continuous follow-up.

Request an appointment

Take the first step toward a fulfilling sex life today.
At GUA, we evaluate your case with discretion and offer personalized solutions.

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Book your appointment online

"Erectile dysfunction in men can be treated. At GUA we help you regain your confidence and sexual well-being."

Frequently asked questions about erectile dysfunction

By Psychologist Jasmina García Velázquez - Specialist in Psychology and Sexuality.

For years, men's mental health has been a silenced topic. Social pressure to "be strong" and "solve problems alone" has led many men to delay seeking professional help. However, scientific evidence shows that untreated emotional disorders directly impact physical health, sexuality and the quality of relationships.

In urological and andrological consultations it is common to see patients who, in addition to a physical symptom, have anxiety, stress or emotional problems that aggravate their situation. Male sex therapy, combined with the medical approach, offers a complete path to wellness.

Table of Contents

1. Warning signs: when to ask for help?
2. Relationship between mind and male sexual health
3. Benefits of psychological therapy in intimate life
4. Interdisciplinary approach: medical and psychological work together
5. Debunking common myths
6. Clinical example: the failure spiral
7. Practical tips to improve your intimate life
8. How we accompany you in GUA
9. Make an appointment today

Warning signs: when to ask for help?

Going to therapy does not mean weakness, but responsibility and self-care. Here are some signs that you could benefit from psychological help:

• Anxiety or depression: insomnia, irritability, lack of concentration and persistent discouragement.
• Chronic stress: work or personal burden affecting sexual and urinary performance.
• Couple problems: frequent arguments, lack of communication or intimacy difficulties.
• Sexual dysfunctions: premature ejaculation, erectile dysfunction or low desire when not explained only by physical causes.
• Difficult medical processes: infertility, urological cancer or surgeries affecting body image.

Recognizing these signs early can make the difference between a problem that becomes chronic and a successful recovery.

Relationship between mind and male sexual health

Mind and body form an inseparable binomial. In male sexuality, emotional factors play a decisive role:

Erectile dysfunction and performance anxiety

Many men experience the so-called "failure spiral": after an episode of erectile difficulty, there is a fear of repeating it. This anxiety generates more tension and perpetuates the problem. The intervention of a psychologist for erectile dysfunction helps to break this vicious circle.

Premature ejaculation

Up to 30% of men suffer from it at some point in their lives. The psychological component - anxiety, hyperarousal, anticipatory thoughts - is usually decisive and responds very well to sex therapy.

Low sexual desire

It is not always hormonal. It is often related to depression, chronic fatigue or relationship conflicts. In therapy, both emotional causes and relationship patterns are addressed.

Male infertility

Receiving a diagnosis such as oligozoospermia or azoospermia generates a strong emotional impact. Feelings of guilt, low self-esteem and tension with the partner arise. Here, psychological help for men in sexuality is essential to sustain the process.

Benefits of psychological therapy in intimate life

The benefits of psychotherapy are not limited to emotional symptoms. Its effects reach sexual, couple and social life:

• Improved communication in couples: learning to express fears, desires and expectations.
• Anxiety and stress management: relaxation techniques and cognitive restructuring.
• Strengthening of self-esteem: regaining personal security and sexual confidence.
• Prevention of isolation: encourage the search for social and family support.
• Accompaniment in medical processes: emotional support in situations such as prostate surgery or vasectomy.

Interdisciplinary approach: medical and psychological work together

The integrated approach combines the vision of the urology/andrology specialist with that of the clinical psychologist:

• Urologist/andrologist: rules out organic causes (vascular, hormonal, neurological).
• Clinical psychologist/sexologist: works with emotional and relationship factors.
• Multidisciplinary team: the patient receives global care, without fragmenting his or her problem.

Debunking common myths

• "Therapy is for the weak" → False. Seeking help is a sign of maturity.
• "Sexual problems are only physical" → False. More than 50% have a strong psychological component.
• "Going to a psychologist involves years of sessions" → False. Many specific dysfunctions improve in a few weeks.

Clinical example: the failure spiral

A 45-year-old man comes to the clinic for erectile dysfunction. After ruling out organic causes, a great anticipatory anxiety is identified: "it will fail me again". This belief reinforces the problem. The combined treatment -medication and cognitive-behavioral therapy- achieves better results than those obtained separately.

Practical tips to improve your intimate life

• Take care of rest and nutrition: poor sleep and excess alcohol affect sexual function.
• Talk to your partner: sharing concerns reduces tension.
• Do not self-medicate: a specialist must assess each case.
• Integrate physical exercise: improves self-esteem and erectile function.
• Seek professional help: the sooner, the better the prognosis.

How we accompany you in GUA

At GUA Urology and Andrology we understand that sexual health is not only physical. Our medical and psychological team works in a coordinated way to offer you:

• Medical diagnosis of sexual dysfunctions.
• Psychological and sexological therapy specialized in men.
• Continuous follow-up to ensure lasting recovery.

Also explore our male dysfunctions section and our blog articles for more information.

Make an appointment today

If you notice that your intimate life is affected by stress, anxiety or sexual dysfunction, don't let it go. Take the first step toward a fulfilling life:

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Book your appointment online

"Taking care of your emotional and sexual health is investing in your well-being. We are here to help you."

By Dr. Maria Fernanda Peraza Godoy - Specialist in Urology, Andrology and Sexual Medicine. GUA Urology and Andrology.

Table of Contents

1. Why talk about this now?
2. What will you find in this guide?
3. Top 3 STIs we see the most in consultation
4. "What if I don't have symptoms?"
5. The 1-3-3 rule to test yourself without getting confused
6. Window periods: when to test after a risky practice
7. Practical prevention: what works
8. Quick "before-during-after" checklist
9. Why prevention messages don't get through (and how to make them get through)
10. How we accompany you in GUA
11. Make an appointment today

Why talk about this now?

Sexually transmitted infections (STIs) are on the rise in Spain and Europe. They especially affect young men, but no one is free. The good news: they can be prevented, detected in time and treated. Our aim with this article is to give you clear criteria, without scares or moralizing, so that you can make informed decisions about your sexual health.

Here you will find

• Which STIs are the most frequent in men today and how they manifest themselves.
• The 1-3-3 rule for deciding when to test yourself.
• Practical prevention tips for vaginal, anal and oral sex.
• What to do if you have a steady partner, if you have new partners or if you practice chemsex.
• Vaccines that do protect you.
• How we accompany you at GUA: confidentiality, testing, treatment and follow-up.

Top 3 STIs we see the most in consultation

1) Gonorrhea

What it is: a bacterium(Neisseria gonorrhoeae) that is transmitted by unprotected vaginal, anal or oral sex.

Typical symptoms in men: itching during urination, thick urethral discharge (yellow/greenish), testicular pain or swelling. Rectal pain or discharge and sore throat after oral sex may also occur. Sometimes, there are no symptoms.

Why it is a cause for concern: it progresses rapidly and is associated with antibiotic resistance. Requires proper diagnosis and choice of treatment.

Spread: by contact with infected secretions. Also during childbirth (from mother to baby). Not transmitted by towels, toilets or swimming pools.

More info: Gonorrhea - testing and treatment at GUA.

2) Chlamydia

What it is: Chlamydia trachomatis infection. Very common and often silent.

Symptoms in males: clear or thin discharge, burning during urination, pelvic discomfort or testicular pain. In the rectum: pain, tenesmus, discharge. In the throat: irritation.

Cause for concern: because it can go unnoticed and facilitate other infections. In men it can be complicated by epididymitis.

It is transmitted: by sex without a condom (vaginal, anal or oral) and by contact with secretions. There is perinatal transmission.

More info: Chlamydia - diagnosis and management.

3) Syphilis

What it is: Caused by the bacterium Treponema pallidum. It evolves in stages.

Guiding symptoms:

• Primary: a painless ulcer (chancre) on the genitals, anus or mouth.
• Secondary: rash on palms and soles, plaques on mucous membranes, fever, malaise.
• Latent: no symptoms.
• Tertiary (late): may affect heart, brain and other organs.

Spread: by direct contact with the ulcer during vaginal, anal or oral sex. It can also be transmitted during pregnancy.

More info: Syphilis - testing and treatment.

"What if I don't have symptoms?"

Most STIs can occur without clear signs, especially chlamydia and gonorrhea. Therefore, if you are sexually active, it is worth getting screened regularly and requesting tests in all areas of exposure (urethra/urine, rectum, and pharynx), not just urine.
To make it part of your routine, you can book your appointment online or write to us.

The 1-3-3 rule to test yourself without getting confused

• 1 → If you have a steady partner and do not change partners, once a year. Whenever you change partners, get tested.
• 3-6 → If you have new or multiple partners in parallel, every 3-6 months.
• 3 → If you are MSM (men who have sex with men), use PrEP, practice chemsex or have frequent condomless sex, every 3 months.

Request tests according to your practices: urethra (urine or exudate), rectum, and pharynx. Add serology (syphilis, HIV), and hepatitis tests as appropriate.
Reinforce your plan with our sexual health content and request your screening.

Window periods: when to test after a risky practice

• Chlamydia / Gonorrhea (PCR/NAAT): reliable detection from the first-second week after exposure. If you have symptoms, test earlier.
• Syphilis (serology): antibodies are usually detected after 3-6 weeks; a very early negative test may require repetition.
• HIV (4th generation): definitive result 6 weeks after the risk contact. If the negative result is earlier, control may be required.

Si hay síntomas compatibles, no esperes: consulta y valora tratamiento presuntivo. Después podrás repetir pruebas para confirmar curación.
En riesgo reciente (<72h), valora consulta urgente.

Practical prevention: what works

Non-negotiable

• Condom: use it from the beginning to the end in vaginal, anal and oral sex. Change condoms when changing practices.
• Lubricant: water or silicone based; avoid damaging the condom. Anal always with lubricant.
• Periodic tests: apply the 1-3-3. Integrate the tests into your health routine.
• Notify and treat partners if a test is positive.
• Vaccines: HPV, hepatitis A, and hepatitis B. See our pages on HPV and
  Hepatitis.

Negotiable (depending on your context)

• Partner agreements: monogamy, "negotiated monogamy", use of PrEP, or agreeing to testing before stopping condom use.
• Oral barriers: condom for oral penile-mouth sex; latex barriers for oral-vulva/anus sex.
• Self-exudates: some clinics allow pharyngeal/rectal self-tests (convenient and effective), ask for it.

For a complete approach to urogenital health, also check out our male pelvic floor section and other blog content.

Quick "before-during-after" checklist

• Before: carry kit (condoms, lubricant, wipes), check expiration date, discuss limits and prevention methods.
• During: if the condom breaks, change it immediately. Do not mix fat-based lubricants (oils, petroleum jelly) with latex condoms.
• Después: si hubo incidente, valora PEP VIH (profilaxis post-exposición) cuanto antes (ideal < 72 h). Agenda test según ventana.
  Pedir cita.

Why prevention messages don't get through (and how to make them get through)

What slows down

• Information ≠ awareness. Knowing facts does not always change behaviors.
• False reassurance about silent infections. Chlamydia and gonorrhea may not give symptoms.
• Inconsistent condom use. The risk of oral sex and practice changes without changing the condom is minimized.
• Normalization of casual sex without screening. Sexual networks increase, but testing is not integrated as routine.
• Low risk perception. "It's not going to happen to me."
• Psychological reactance. Moralistic or fear messages generate rejection ("they want to control me").
• Cognitive dissonance. To avoid guilt, we tend to minimize risk.
• Guilt and shame. They block consultation and conversation.
• Double social message. Pleasure is promoted but infection is stigmatized → confusion and silence.

How we change the script

• Non-judgmental language, with focus on care and pleasure: choose condoms, lubricant, vaccinations and periodic tests.
• Mnemonic rule 1-3-3 in all communications: annual / 3-6 months / 3 months.
• Normalize the test as sexual hygiene. Same as dental check-up.
• Explicit harm reduction (MSM and chemsex): partner agreements, PrEP, barriers to oral/anal sex, quarterly check-ups if high risk.
• Concrete and measurable calls to action: "order your test this month", "bring your partner", "get vaccinated if you are missing".
• Micro-messages that work: "No symptoms ≠ no STIs", "Test + condom = protection", "Safe sexual health = self-care + informed choices".

How we accompany you at GUA: confidentiality, testing, treatment and follow up

At GUA Urology and Andrology, we offer you a confidential and friendly environment. We perform STI tests tailored to your practices (urethra, rectum, pharynx, and serology), advise you on vaccination, initiate treatment when appropriate, and schedule follow-up appointments. Our approach is practical, without alarmism, focused on your well-being.
Meet our team: the GUA team and the author, Dr. Mafe Peraza Godoy.

Make an appointment today

Take the next step towards safe sexual health. Schedule your STI test or consultation with our team.

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Book your appointment online at
  (also available: Request an appointment)

"Taking care of your sexual health is taking care of you. We are here to help you."

By Dr. María Fernanda Peraza Godoy - Urologist and Andrologist specialized in Sexual Medicine. 

Male sexual health is not an isolated episode, but a journey that accompanies men at every stage of life. From puberty to old age, biological, emotional and social changes influence how men experience their sexuality, how they care for it and what challenges they face.

Throughout this journey, a central theme recurs: men also need permission to take care of their sexual health, express vulnerability and ask for help without fear of losing virility. In this article we explore men's sex lives at every stage and how to enhance sexual well-being with a holistic approach.

Table of Contents

1. Puberty: awakening of sexuality and first cares
2. Youth and early adulthood: prevention and healthy habits
3. Middle adulthood: sexuality as a health sentinel
4. Maturity: redefining masculinity and coping with andropause
5. Old age and longevity: active sexuality as a source of well-being.
6. Final reflection: vulnerability as a strength
7. Make an appointment today

Puberty: awakening of sexuality and first cares

Puberty marks the beginning of sexual maturation. Between the ages of 9 and 14, boys experience hormonal activation that triggers testosterone production, testicular growth, penile development, the appearance of pubic hair and a deeper voice.

Major challenges at puberty

• Genital hygiene and care of the foreskin: a simple explanation on how to properly wash the penis prevents balanitis and infections.
• STI education: condom use, consent and mutual respect in relationships.
• Healthy approach to sexuality: understanding that sexuality is not about performance, but about self-knowledge and healthy bonds.

Youth and early adulthood: prevention and healthy habits

In the second and third decades of life, men reach their maximum physical and sexual potential, but also consolidate habits that will impact their future.

Key care at this stage

• STI prevention: increase in cases of chlamydia, gonorrhea and syphilis. Recommendation: periodic testing and consistent use of condoms.
• Lifestyle construct: what a man does in his 20s and 30s (diet, exercise, sleep, tobacco or alcohol consumption) has a direct impact on his fertility and future sexual health.
• Stress and parenthood: anxiety and work pressure can affect erectile function.
• Male fertility: healthy habits today are the best investment for tomorrow.

Male fertility is not unlimited: start taking care of it from a young age.

Middle adulthood: sexuality as a health sentinel

Between the ages of 40 and 55, sexuality becomes an indicator of overall health. Erectile dysfunction may be the first symptom of cardiovascular disease.

Key aspects

• Erectile dysfunction as a warning sign: consulting a urologist can save your life, not just your sex life.
• Hormonal check-up: detect incipient hypogonadism and differentiate it from normal aging.
• Metabolic control: obesity, glucose and lipids influence testosterone and sexual function.
• Stress management: professional and family responsibilities impact libido.

Sexuality is a mirror of cardiovascular health.

Maturity: redefining masculinity and coping with andropause

From the age of 50 onwards, many men face the so-called andropause or late hypogonadism. Its most common symptoms include:

• Decreased sexual desire
• Erection problems
• Persistent fatigue
• Loss of muscle mass
• Emotional changes: apathy, irritability or sadness

Psychosocial challenges

• The male cultural script leaves little room for vulnerability.
• Many men consult late, delaying diagnosis and treatment.
• Mature masculinity coexists with the demand to continue to perform sexually.

The approach should be comprehensive: medical evaluation, psychological support, nutrition, exercise and, in indicated cases, supervised testosterone therapy.

Old age and longevity: active sexuality as a source of well-being.

Sexuality does not disappear in old age: it evolves and continues to be a source of physical and emotional well-being.

Relevant data

• Forty percent of men between 76 and 80 years of age are still sexually active.
• Seventy-six percent believe that sex is still important in the relationship.
• Masturbation is common and one in three uses sex toys.

Benefits of sexuality in old age

• Cardiovascular improvement
• Pelvic floor strengthening
• Improved sleep quality and stress reduction
• Reinforcement of self-esteem and partner connection

Intimacy in old age improves physical and emotional health.

Final reflection: vulnerability as a strength

The journey of male sexual health demonstrates that every stage of life has challenges and opportunities. Taking care of it does not detract from masculinity, it strengthens it. Consulting a specialist is an act of responsibility and courage that improves the quality of life and relationships.

Make an appointment today

In GUA Urology and Andrology, Gran Canaria, we are specialists in andrology and urology. We accompany you at every stage with a personalized approach.

• Phone: 928 264 695
• Email: info@urologiayandrologia.com
• Book your appointment online

"Your sexual health deserves attention at every stage of your life."