Answer 12 targeted questions about your erectile pattern, morning erection history, and cardiovascular risk factors. This tool classifies the most likely aetiology of your ED and identifies what blood tests your doctor should order.
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Step 1 — Basic Information
Step 2 — Morning Erections (The Most Important Question)
How would you describe your morning erections (erections on waking) currently?
Morning erections are driven purely by vascular and neurological mechanisms during REM sleep — completely independent of sexual desire or psychological state. Their presence or absence is the single most clinically useful discriminator between organic and psychological ED.
Normal — firm and regular (most mornings)
Reduced — less frequent or less firm than before
Rare — once a week or less
Absent — none in the past month
Step 3 — Erectile Pattern
Can you achieve an erection with masturbation or in other solo situations?
The ability to achieve a full erection alone but not with a partner strongly suggests a psychological or situational cause rather than a vascular or hormonal one.
Yes — full, normal erection
Yes — but weaker or shorter-lasting than before
No — difficulty in all situations
How would you describe the onset of the erection problem?
Sudden — started abruptly after a specific event
Gradual — slow progressive worsening over months or years
Situational — only with specific partners or circumstances
A gradual onset correlates strongly with organic (vascular, hormonal) causes. A sudden or situational onset is more consistent with psychological aetiology.
Step 4 — Cardiovascular Risk Factors
ED and cardiovascular disease share the same root cause — endothelial dysfunction. Penile arteries (1–2 mm) clog before coronary arteries (3–4 mm), making ED a 3–5 year early warning signal for cardiac events.
Do you have diagnosed high blood pressure (hypertension)?
Yes — diagnosed and/or on medication
Borderline — readings above 130/80 but not treated
No — blood pressure has never been flagged
Never had my blood pressure checked
Do you have diabetes or have you been told your blood sugar is high?
Yes — diagnosed type 2 diabetes
Prediabetes / borderline high glucose
No
Never tested
Diabetes is the single strongest independent risk factor for ED — up to 50% of diabetic men develop erectile dysfunction, typically through both vascular and neurological damage.
Do you smoke or have you smoked in the past?
Current smoker
Ex-smoker — quit within the last 5 years
Ex-smoker — quit more than 5 years ago
Never smoked
Have your cholesterol levels ever been tested? If so, were they elevated?
Yes — elevated / on a statin
Yes — normal
Never tested
Step 5 — Hormonal & Other Factors
Have you noticed a significant reduction in your sex drive (libido) alongside the erection difficulty?
Reduced libido alongside ED is a key hormonal flag — it suggests low testosterone rather than (or in addition to) vascular disease. Pure vascular ED typically preserves libido.
Yes — libido has dropped significantly
Yes — mildly reduced
No — libido is normal or unchanged
Are you currently taking any of the following medications?
Beta-blocker (atenolol, metoprolol, bisoprolol)
SSRI or SNRI antidepressant
Finasteride or dutasteride
Spironolactone
None of the above
Several commonly prescribed medications are significant causes of ED. If ED began after starting a new medication, this connection must be explored with your prescribing doctor before ED treatments are initiated.
Do you have any history of pelvic surgery, spinal cord injury, or neurological conditions (MS, Parkinson’s, diabetic neuropathy)?
Prostatectomy (prostate surgery)
Other pelvic or rectal surgery
Spinal, neurological, or neuropathy condition
None of the above
How would you rate your stress, anxiety, or relationship tension levels currently?
High — significant stress, anxiety, or relationship difficulties
Moderate — some background stress
Low — no significant psychological stressors
Most Likely Aetiology
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Cardiovascular Risk Factor Summary
⚠ Medication-Induced ED — This Must Be Investigated First
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Blood Tests Your Doctor Should Order
Recommended Management Pathway
Dr. Muhammad Khalid
MBBS · FCPS (Urology) · MCPS (Gen. Surgery) · IMC #539472 — Aetiology classification based on EAU Guidelines on Sexual and Reproductive Health 2024. Cardiovascular link: Vlachopoulos CV et al., Circ Cardiovasc Qual Outcomes 2013. Diabetes prevalence: Kouidrat Y et al., Diabet Med 2017.
This screener identifies the most likely aetiology and appropriate investigations — it does not constitute a diagnosis or treatment recommendation. Erectile dysfunction has multiple overlapping causes. Always consult a urologist or GP for a full clinical assessment before initiating any treatment.
Why are morning erections so clinically important?
Morning erections (nocturnal penile tumescence) occur during REM sleep through a purely physiological mechanism — they are completely independent of sexual arousal, performance anxiety, or psychological state. They test whether the vascular and neurological machinery for erection is intact. A man who has normal morning erections but cannot perform sexually almost certainly has a psychological or situational cause. A man who has lost morning erections has an organic problem that requires investigation. This single distinction changes the entire clinical approach. Read more about the ED–heart disease connection →
Can lifestyle changes genuinely improve erectile function?
Yes — and the evidence is strong. A meta-analysis of 11 trials found aerobic exercise improved erectile function with effects comparable to PDE5 inhibitors in mild-to-moderate ED. A randomised JAMA trial found one-third of obese men restored normal function through lifestyle changes alone. Smoking cessation improves function within 6–12 months. Weight loss reduces erectile dysfunction through multiple pathways — lowering blood pressure, improving insulin sensitivity, and modestly raising testosterone. These are not “soft” interventions — they address the underlying endothelial disease that causes ED.
If my GP prescribes Viagra without doing any blood tests, is that adequate?
No. Prescribing a PDE5 inhibitor (sildenafil, tadalafil) without checking blood pressure, fasting glucose, and a lipid profile is treating the symptom and missing the disease. ED in men over 40 is frequently the first symptom of undiagnosed cardiovascular disease. A man who receives Viagra without a cardiovascular assessment and subsequently has a cardiac event may have had that event prevented with timely risk factor management. Blood pressure, HbA1c, lipids, and morning testosterone should always be checked at first presentation of ED.
