Erectile dysfunction care, handled privately
ED is difficulty getting an erection, or keeping one, long enough for sex. Many men deal with it, there are good treatment choices, and it deserves a real workup: blood-vessel problems behind ED can also point to heart disease or diabetes.
What are common causes of ED?
Anything that affects blood vessels, nerves or hormones can play a part: heart disease, high cholesterol, diabetes, extra weight, smoking, heavy drinking, some medicines, low testosterone, and stress or anxiety. Often more than one factor is involved.
Options our urologists offer
- Health and habit changes that also protect your heart
- Prescription pills such as sildenafil and tadalafil
- A vacuum device
- Penile injections
- A penile implant, placed in an outpatient surgery center
- Hormone treatment when testing confirms low testosterone
A conversation that stays private
Your first appointment covers your health history, a physical exam and a few basic tests. Dr. Chirag Dave, who sees patients in Marietta, Canton and Jasper, explains the options in more detail in the article linked below.
More on this topic from Advanced Urology: erectile dysfunction
Educational information, not medical advice. Every treatment has risks, benefits and alternatives to discuss with your clinician.
When should you see a urologist about erectile dysfunction?
ED is worth a visit when it happens more often than not, when it is new, or when it worries you. Chest pain with exertion or sex needs emergency care, and so does an erection lasting more than four hours.
How do our urologists evaluate erectile dysfunction?
We talk through your health history and medicines, examine you, and order lab work that can include testosterone, blood sugar and cholesterol. That picture shows which treatments make sense.
What causes erectile dysfunction? A closer look
An erection depends on healthy blood flow, working nerves, enough testosterone and a mind that isn't under strain. Trouble at any of those points can show up as ED, and for many of the men we see, two or three of them overlap.
Blood flow
Narrowed arteries are the most frequent physical reason. The same process that stiffens heart vessels, pushed along by high blood pressure, high cholesterol, diabetes and smoking, limits how much blood can fill the penis.
Nerves
Long-standing diabetes, spine problems and pelvic surgery, including treatment for prostate, bladder or rectal cancer, can interrupt the signals that start an erection.
Hormones
Low testosterone more often lowers desire than blocks erections outright, but it can make other causes worse and blunt the response to tablets. A morning blood test, usually repeated, shows whether it is part of the picture; our low testosterone page explains the testing.
Medicines and habits
Some blood pressure medicines, antidepressants and prostate drugs list ED as a side effect, and heavy drinking, recreational drugs, poor sleep and little exercise add to it. Please don't stop a prescribed medicine on your own; we can work with the clinician who prescribed it.
Stress, mood and relationships
Performance worry, depression and relationship strain can cause ED by themselves or keep it going after a physical cause starts. Erections that still happen during sleep or on waking often point toward this side of things.
How the workup usually goes
- A private conversation about when the problem started, how often it happens and what you have tried
- A review of your medicines and of conditions such as diabetes, heart disease and sleep apnea
- A focused physical exam
- Blood work that can include morning testosterone, blood sugar and cholesterol
- A short questionnaire that lets us measure change at follow-up
When the results point to heart or blood-sugar risk, we share them with your primary care clinician, because treating those conditions helps erections and your long-term health.
Treatments we offer, from first steps to surgery
- Habit changes: more movement, less alcohol, stopping smoking and better sleep
- Tablets such as sildenafil and tadalafil, including low-dose daily tadalafil
- A vacuum erection device
- Penile injections, taught in the office
- Low-intensity shockwave therapy, given as a series of office sessions for selected men
- A penile implant, placed at our Marietta Clinic & Surgery Center
- Testosterone treatment when blood tests confirm it is low
Men from Marietta, Kennesaw, Canton, Woodstock, Dallas and Jasper can start this conversation at any of our four offices. The penile implant page on advancedurology.com has more on implants.
What is recovery usually like?
Pills and vacuum devices involve no procedure. Shockwave therapy is an office treatment. A penile implant is placed during surgery at our Marietta surgery center, with a recovery period before it is used.
More questions we hear
Can ED be an early warning sign of heart disease?
Yes. The small arteries in the penis can show narrowing before larger vessels do, so ED can be an early clue.
What if pills don't work?
Other options include penile injections, a vacuum device, shockwave therapy and, for some men, a penile implant. Before switching, we check the pill dose and timing, because many men who say pills failed haven't had a full trial.
What is a penile implant?
A device placed during surgery, often considered by men who haven't done well with pills, injections or vacuum devices. Dr. Chirag Dave lists penile implants among his focus areas.
Is the conversation private?
Yes. Every conversation is handled with discretion, and partners are welcome if you'd like.
Can low testosterone cause erectile dysfunction?
It can contribute, though it is seldom the whole story. Low testosterone mainly lowers desire, and treating it may help erections when the level is truly low. We confirm it with repeat morning blood tests before recommending treatment.
Is ED a normal part of getting older?
It becomes more common with age, but it is not something you simply have to accept. Treatment works for men in their 60s, 70s and beyond, and a new problem at any age deserves a look at your heart and blood sugar.
How do sildenafil and tadalafil differ?
Sildenafil is usually taken about an hour before sex and works for several hours; tadalafil lasts much longer and can also be taken as a small daily dose. Neither causes an erection without arousal, and neither can be combined with nitrate heart medicines. This Advanced Urology article compares them in more detail.
Which articles go deeper on erectile dysfunction?
These short reads answer questions patients often bring to us.
- How do I bring up ED at a urology visit?
- Low-Intensity Shockwave Therapy for ED: who is a good candidate?
- Vacuum Erection Device: how long does it take to get used to a VED?
- Who should consider a penile implant?
- Can ED be an early warning sign of heart disease?
- ED and high blood pressure: what is the link?
- Daily Cialis: who is it for?
- Will an implant affect my sensation or orgasm?
- Can high cholesterol cause ED?
- Erection problems: causes and treatment options
All 10 articles on erectile dysfunction
Clinicians whose Advanced Urology profiles list this area: Chirag Dave, MD, Andy Ostrowski, MD, Amanda Boulos, PA-C, Shane Bell, PA-C, Anna Flint Todd, PA-C, Ionela Turcin, PA-C, Britany Howard, FNP.
Common contributors
Heart disease, high cholesterol, diabetes, obesity, substance use and psychological stress can all affect erections. Because ED can reflect blood vessel health, it's a useful prompt to look at your overall health.
How the main treatments work
- PDE5 pills such as sildenafil and tadalafil increase blood flow with sexual stimulation; they need a prescription and don't mix with certain heart medicines
- Low-intensity shockwave therapy uses acoustic waves on the outside of the penis to encourage new blood vessels
- Penile implants, inflatable or malleable, are for men who haven't responded to or can't use other treatments
Moving through options
We start with what suits your health and preferences, review how it works at follow-up and move to the next option if needed. Implant operations take place in our own surgery center on Church Street Extension NW.
Common questions
Is shockwave therapy a single session?
No. It is given as a series of short office sessions over several weeks, and no anesthesia is needed.
Videos from Advanced Urology
Videos play here from Advanced Urology’s YouTube channel, using YouTube’s privacy-enhanced mode.
Let's sort this out together. Our offices in Marietta, Canton, Dallas and Jasper share one phone line and one caring team.