Erectile Dysfunction (ED) | Facts on Hardness & Health

(Estimated Reading Time: 11 minutes)

Let’s talk about something real. As a health journalist, I’ve seen few topics as loaded with stress, anxiety, and misinformation as our sexual health. And when it comes to Erectile Dysfunction (ED), the silence and the myths can be deafening. That silence often breeds Performance anxiety, which can spiral, turning a simple concern into a major crisis. But here’s the truth: you are not alone, and you are not broken.

Recently, I’ve been digging into the work of Dr. Rena Malik, a urologist who breaks down these complex topics with incredible clarity. That’s why I want to tackle two of the biggest questions I hear.

1. First, what does “hard enough” even mean when we talk about erections?
2. Second, what happens when the treatment for one health issue (like depression) starts to cause problems in the bedroom?

This isn’t just about a medical condition. It’s about your quality of life, your confidence, and your relationships. So, what if the anxiety itself is the biggest part of the problem? Let’s find out.

Rethinking Erection Hardness and Erectile Dysfunction (ED)

One of the biggest sources of anxiety is the “all-or-nothing” mentality. Many people believe that if an erection isn’t “rock hard,” it’s a failure. However, that’s not how health works, and it’s not how your body works.

How is Erection Hardness Professionally Measured?

When you talk to a Urologist, they don’t just guess. They often use a simple, 4-point scale called the Erectile Hardness Score (EHS). It’s a straightforward way for you and your doctor to get on the same page.

• Grade 1: The penis gets larger, but is not hard.
• Grade 2: The penis is hard, but not hard enough for penetration.
• Grade 3: The penis is hard enough for penetration, but not completely rigid.
• Grade 4: The penis is completely hard and fully rigid.

Instantly, you can see there’s a lot of room between “no erection” and “perfect erection.” Most of life, and most satisfactory sex, happens in Grades 3 and 4.

💡 Pro Tip: An isolated “off-night” is not a diagnosis. A Urologist looks for a persistent pattern. If you’re worried, start a private journal to track frequency, time, and circumstances. This gives your doctor valuable data, not just feelings.

How is Erectile Dysfunction (ED) Diagnosed?

Here’s the key: a diagnosis of Erectile Dysfunction (ED) doesn’t just come from that score. A doctor will also likely give you a formal questionnaire. This asks questions about your confidence, your ability to maintain an erection, and how often it’s firm enough for intercourse.

Your answers create a score. This score helps your doctor understand the severity (mild, moderate, or severe). Therefore, this process separates a single bad experience from a consistent medical pattern. It’s about the big picture, not one snapshot.

What Truly Matters? A Urologist’s Perspective

This is the part I really want you to hear. According to experts like Dr. Malik, the technical grade is far less important than the functional outcome.

The real goal is not to get a “Grade 4” every single time. The goal is to have an erection that is firm enough, and lasts long enough, for a satisfying sexual experience for you and (if you have one) your partner. That’s it. Ultimately, it’s about satisfaction and function, not a number.

For anyone, but especially for curious teenagers and young men worried about ED in young men, this is vital. Your body is not a machine. Don’t let a myth define your reality.

The Hidden Link: When Mental Health Treatment Affects Sexual Health

Now, let’s pivot to a situation that is incredibly common but rarely discussed. You’re doing the right thing by taking care of your mental health, perhaps with an anti-depressant. But suddenly, you notice other problems.

The Problem: SSRIs and Sexual Dysfunction

Many common anti-depressants, especially SSRIs (Selective Serotonin Reuptake Inhibitors), are life-savers. They are critical tools for managing depression and anxiety. However, these Anti-depressant Side Effects can, for some people, include a range of Sexual Dysfunction issues.

This can mean:

• Low libido (your sex drive just isn’t there)
• Difficulty with ejaculation
• Trouble achieving an orgasm
• New or worsening Erection problems

This can feel like a cruel trade-off. You’re finally feeling better mentally, but your physical relationship is suffering. This is also a form of Sexual Dysfunction that needs to be addressed.

It’s Not “All in Your Head” (But Part of it Is)

This is where the mind-body connection becomes so clear. Any sexual issue, whether it’s from a pill or a blood flow problem, almost always triggers a psychological response.

You have one bad experience, and the next time you’re intimate, a little voice in your head says, “What if it happens again?” That is Performance anxiety. That anxiety itself can then… cause the problem to happen again. This creates a negative feedback loop.

This loop is a huge part of Psychological ED and can make a mild case of Erectile Dysfunction (ED) feel much worse. It’s why so many urologists, including Dr. Malik, also recommend seeing a Sex Therapist. They can help you break that mental cycle while the urologist works on the physical side. How can we get better at talking about mental health and sexual health together, instead of as two separate things?

How to Take Control: Be Your Own Healthcare “Quarterback”

When you’re dealing with a urologist for your body and a psychiatrist for your mind, it’s easy for things to get lost in translation. This is where Patient Advocacy in Healthcare becomes your most powerful tool.

Your Key Role in Managing Erectile Dysfunction (ED)

You have to be the “quarterback” of your own health team. Only you are in the room with every doctor you see. Ultimately, you serve as the CEO of your own health.

When Managing Multiple Doctors, you are the one who ensures they are working from the same playbook. Don’t assume they are talking to each other.

Practical Steps for Managing Your Care

Here’s your action plan. It’s simple, but it’s not easy.

1. Ask Doctors to Communicate: At the end of your visit, say this: “I’m also seeing Dr. Smith for my medication. Would you be willing to send her a summary of this visit?”
2. Get Your Records: You have a legal right to your Patient Medical Records. Sign up for the patient portal. Read the visit summaries. Know what your doctor wrote.
3. Be the Messenger: Print your notes from one doctor and literally hand them to the other. Or, send a message through the portal, “FYI, this is what my other specialist said.”
4. Use Your Primary Care Doctor (PCP): Your PCP is your real quarterback. Make sure they are copied on all communications.
5. Stay “In-System”: If you can, try to get care within one large hospital system. It makes sharing records and sending messages between doctors much, much easier.

🗣️ Pro Tip: When you get your Patient Medical Records, use your patient portal. Send a message to your Urologist saying, “I just saw my psychiatrist, and we adjusted my medication. Can you see the note in my chart?” This actively connects the dots for them.

Speaking Up About Side Effects

If you think your SSRI is causing Sexual Dysfunction, do not just stop taking it. That can be very dangerous.

Instead, you must talk to the doctor who prescribed it. This is not new to them. They know all about SSRIs and Sexual Side Effects. Solutions exist.

• The side effects are often dose-dependent. They might just need to lower your dose slightly.
• There are alternative medications for depression that are well-known for having fewer sexual side effects.

Your doctor cannot help you with a problem they don’t know you have. What’s the best way to start this “embarrassing” conversation with a doctor? Just be direct. “I’ve been noticing some sexual side effects since I started this medication, and I’d like to talk about my options.”

Your Health Is a Whole Story, Not a Single Chapter

Let’s bring this all home. Your health is a complex, interconnected story. First, we’ve learned that erection quality is about function and satisfaction, not a “perfect” score. Second, Sexual Dysfunction from medications is a real, valid problem, and you have a right to seek solutions for it. And third, you must be your own best advocate.

The goal isn’t just to “fix” Erectile Dysfunction (ED). The goal is to improve your overall wellbeing. It’s to lower your anxiety, improve your confidence, and give you the tools to manage your complete health.

📈 Pro Tip: Your sexual health is a vital sign, just like your blood pressure. Male sexual health is a key indicator of overall cardiovascular health. Erection problems can be the very first sign of heart disease or diabetes. Never ignore it!

You have the right to a satisfying life, both mentally and physically. Your journey to wellbeing starts with being informed, asking questions, and demanding to be heard. What’s one step you’ll take this week to be a better “quarterback” for your own health?

Your Top Questions Answered

1. If I have trouble getting an erection sometimes, does that mean I have Erectile Dysfunction (ED)?

Not necessarily. Almost everyone will experience occasional Erection problems. This can be caused by stress, Performance anxiety, drinking too much alcohol, or just being tired. A diagnosis of Erectile Dysfunction (ED) is about a persistent, consistent pattern of not being able to get or keep an erection firm enough for sex. An “off-night” is just an off-night.

2. Is ED only something old men get, or can young people have it too?

This is a huge myth. While the chances increase with age, ED in young men is real and becoming more common. In younger men, the Causes of ED are often linked more to Psychological ED (like stress, depression, or anxiety) or lifestyle factors, rather than the physical issues like heart disease seen in older men.

3. Can lifestyle habits like watching porn or masturbating cause permanent ED?

Let’s clear this up. Masturbation does not cause ED. That is a myth. The relationship with porn is more debated. Some researchers are studying if excessive porn use can lead to a form of Psychological ED by creating unrealistic expectations or desensitizing the brain’s reward pathways, but this is not the same as physical Impotence or permanent damage.

4. Is ED “all in your head”?

No, but your head is a powerful part of the equation. Psychological ED is a real diagnosis. However, even when the Causes of ED are clearly physical (like poor blood flow), it almost always creates a psychological layer of anxiety. It’s almost always a mix of both mind and body.

5. Is ED a sign of a more serious disease?

This is the most important question. Yes, it can be. Because erections rely on healthy blood flow, Erection problems can be the first warning sign of more serious underlying conditions like heart disease, diabetes, high blood pressure, or high cholesterol. Think of it as an early warning system for your overall men sex health.