Six questions covering erection quality, consistency and change over time. It is a private self-check, not a diagnosis, and nothing is stored or sent anywhere.
The reason it exists is that erectile difficulty is common, treatable, and frequently a signal about something other than sex.
This is the part most men do not know, and it is the most important thing on this page.
An erection depends on healthy blood vessels. The arteries supplying the penis are considerably narrower than the coronary arteries, which means the same process affecting both shows up here years earlier.
Erectile dysfunction is recognised as an independent predictor of cardiovascular events, and the interval between the onset of symptoms and a cardiac event averages around three to five years.
So new erectile difficulty in a man over forty is a reason to check blood pressure, cholesterol and blood glucose, not only to consider a prescription.
Spontaneous morning erections are a rough marker of whether the physical mechanism is intact.
If you still get them reliably but struggle during sex, the cause is more likely psychological, relationship-related, or medication. If they have disappeared alongside the difficulty, a physical cause is more likely, which includes vascular disease, low testosterone and diabetes.
Their loss is also one of the symptoms most specifically associated with genuinely low testosterone, more so than fatigue or low mood.
Vascular disease, including the early stages that have not yet caused any other symptom.
Medication. Antidepressants, particularly SSRIs, along with some blood pressure drugs, finasteride and others. If difficulty began within months of a new prescription, that is the first lead.
Diabetes, which damages both vessels and nerves and is present in a substantial proportion of men presenting with this.
Low testosterone, though it is a less common cause than most men assume, and usually presents with low libido rather than erectile failure alone.
Psychological factors, including performance anxiety, stress and depression. These are more common in younger men and often present with preserved morning erections.
Sleep apnoea, through its effects on both testosterone and vascular health.
Blood pressure, lipids, HbA1c, and two morning testosterone samples with LH and SHBG. A medication review if anything changed recently.
Treatment is available and effective, and PDE5 inhibitors work for the majority of men. But treating the symptom without investigating the cause misses the point of the warning.
Related reading: Morning erections and testosterone · Medications that lower libido · Testosterone and type 2 diabetes · Libido: the full picture
Educational only, not medical advice. New erectile difficulty is worth discussing with a doctor.