Who this guide is for
This guide is for men who have booked, or are about to book, a first visit about erectile dysfunction. Many men put that visit off for months, then spend the appointment searching for words. A little preparation changes that. When you arrive with a severity score, a complete medicine list and a clear picture of how your erections have changed, the provider can spend the time on answers instead of questions.
There is nothing to be embarrassed about. ED is common, it is a medical issue, and the NIDDK points out that it is not a routine part of aging. Our page on whether ED treatment is confidential explains how your information is handled.
Four things to do before the visit
1. Score yourself on the IIEF-5
The IIEF-5 is a five-question version of the International Index of Erectile Function, a validated questionnaire used worldwide. The American Urological Association recommends validated questionnaires to assess how severe ED is and to track response to treatment. Filling it in beforehand gives you and your provider a baseline.
Think about the past six months and answer each question honestly. Each has five answer choices, scored from 1 (lowest function) to 5 (highest). The questions cover:
- Confidence. How confident you are that you can get and keep an erection.
- Firmness. With sexual stimulation, how often your erections were hard enough for penetration.
- Keeping it. During intercourse, how often you could maintain the erection after penetration.
- Difficulty. During intercourse, how hard it was to keep the erection until the end.
- Satisfaction. When you attempted intercourse, how often it was satisfying for you.
Add the five answers for a total between 5 and 25. In the study that developed the IIEF-5, a score of 21 or below was the cutoff that most accurately separated men with ED from men without it, and scores were grouped into five severity levels:
| Total score | Severity |
|---|---|
| 22 to 25 | No ED |
| 17 to 21 | Mild |
| 12 to 16 | Mild to moderate |
| 8 to 11 | Moderate |
| 5 to 7 | Severe |
The score does not diagnose the cause. It tells the provider how much ED is affecting you, and repeating it after treatment shows whether the plan is working. If you have not attempted sex during the period, note that instead of guessing.
2. List every medicine, and flag nitrates
Write down everything you take: medicines from every doctor, over-the-counter products, supplements and anything recreational. Bring the bottles or photos of the labels if that is easier.
Nitrates matter most. These include nitroglycerin tablets or spray for chest pain, isosorbide mononitrate or dinitrate, and recreational “poppers.” MedlinePlus tells men to tell their doctor about nitrates before taking sildenafil, and the combination can drop blood pressure dangerously. If you use any form of nitrate, even rarely, say so at the start of the visit. Our page on ED pills and nitrates explains why.
Use this checklist so nothing is missed:
- Nitrates of any kind, including poppers
- Blood pressure medicines and alpha-blockers for the prostate
- Antidepressants and anti-anxiety medicines
- Finasteride or dutasteride
- Testosterone, anabolic steroids or SARMs, past or present
- Opioid pain medicines
- Blood thinners
- Supplements, including “male enhancement” products
- Alcohol, cannabis and nicotine use, roughly how much
Some of these medicines can cause or worsen ED. Our page on ED from antidepressants covers one common example. Do not stop anything before the visit; bring the list and let the provider sort out what matters.
3. Note your morning erections and how ED started
Two details help the provider more than almost anything else: whether you still get erections during sleep or on waking, and how the problem began.
Morning erections happen without conscious arousal, so they say something about blood flow and nerve function. If they have faded over time, our page on loss of morning erections explains what that can mean. If they are still strong while erections with a partner are not, stress, anxiety or relationship factors may play a bigger part, as our page on whether ED is psychological explains.
Then describe the onset pattern:
| Pattern | What to note |
|---|---|
| Gradual over months or years | When you first noticed, and how it has progressed |
| Sudden | The date, and anything that changed around then: a new medicine, surgery, injury or stress |
| Situational | Whether it happens with a partner but not alone, or only in certain settings |
| Constant | Whether erections are weak in every situation, including morning |
Also note whether the problem is getting an erection, keeping it or both, and any change in desire, ejaculation or curvature. Our guide on tracking symptoms before a men’s health consult offers a simple log.
4. Gather your health history and any recent labs
The AUA guideline calls for a thorough medical, sexual and psychosocial history and counsels that ED is a risk marker for cardiovascular disease. Bring notes on heart disease, diabetes, high blood pressure, high cholesterol, smoking, sleep problems and past pelvic surgery or radiation. Bring recent lab results if you have them, and list any ED treatments you have already tried, how you took them and what happened.
What the visit looks like, and how it ends with a plan
The provider reviews your score, medicines, pattern and history, asks follow-up questions and may do a focused exam. If labs are needed, the AUA guideline recommends a morning total testosterone, and blood sugar or A1c and sometimes lipids are the other labs most likely to change treatment. Our page on what happens at an ED consultation walks through the visit.
With good preparation, you should leave with a plan: which labs are being drawn, what treatment fits, how to use it and when to follow up. Questions worth asking before you go:
- What do you think is causing my ED?
- Which treatment do you suggest first, and why?
- How should I take it, and how will we know if it is working?
- What should I do if it does not work, or causes side effects?
- When is my follow-up, and will we repeat the IIEF-5?
Our ED treatment roadmap shows the options in order. If talking to your partner is part of the worry, our guide on talking to your partner about ED may help.
When to call the clinic, and when to call 911
Call the clinic before your visit if:
- you develop a new curve, lump or pain in the penis
- ED started suddenly after an injury or a new medicine
Call 911 or go to the ER for:
- chest pain or pressure, especially during exertion or sex
- sudden weakness or numbness on one side, facial drooping or slurred speech
- an erection lasting more than four hours
Sudden new numbness in the groin or legs, or loss of bladder or bowel control, also needs emergency care.
How Ultimate Male runs your first ED visit
At our San Gabriel and Downey clinics, ED care starts with a free, confidential 10-minute phone call. From there you book a one-on-one consultation with a PA-C or MD, and labs can be drawn on site the same day, with results in 24 to 48 hours. The consultation is an evaluation; treatment is recommended only once the picture is clear.
Bring your score, list and notes, and the visit can move quickly from history to options. Payment is per visit, with itemized receipts for HSA or FSA claims and financing available. To see what treatment can look like, visit our page on erectile dysfunction treatment.
