Adult Erectile Dysfunction Treatment (Erectile Dysfunction)
Fast MD-only erectile dysfunction care by secure online video visit, $49 flat-fee, no insurance required.
Erectile dysfunction (ED) is the ongoing difficulty achieving or maintaining an erection firm enough for satisfactory sexual activity. It can be related to blood flow, nerves, hormones, medications, or stress and relationship factors. Our board-certified MDs use guideline-based evaluation to review your symptoms, health history, and medications and, when appropriate, prescribe evidence-based oral ED medication with clear safety limits.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Online MD-Only ED Care (Age-Based Approach)
- Adult 18+ ED evaluation with focus on safety and cardiovascular risk
- Under 40: refills only when there is proof of a current ED prescription
- Age 40+: may start ED medication when clinically appropriate after full video evaluation
- Clear criteria for when in-person primary care, cardiology, or urology is needed
Adults 18+ only. TeleDirectMD does not prescribe controlled substances, testosterone, or injection therapies for ED via telehealth. New chest pain, exertional shortness of breath, or stroke symptoms require emergency in-person care, not an online ED visit.
What Is Adult Erectile Dysfunction?
Erectile dysfunction is defined as the persistent or recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Occasional difficulties are common and not always a medical problem; ED refers to symptoms that are frequent, bothersome, and present for several weeks or longer.
ED can be caused by vascular disease, diabetes, high blood pressure, high cholesterol, nerve damage, low testosterone, medications, stress, anxiety, depression, or relationship issues. Importantly, ED can sometimes be an early warning sign of cardiovascular disease. TeleDirectMD focuses on adults with stable health who are appropriate for oral ED medications via telehealth and will direct you to in-person primary care, cardiology, or urology when red flags or complex issues are present.
Symptoms and Red Flags in Adult Erectile Dysfunction
Most adults with ED can be evaluated safely via a video visit. Certain symptoms, however, suggest underlying heart or vascular disease, hormonal problems, or neurologic conditions that need in-person evaluation before, or in addition to, telehealth-based ED treatment.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Gradual onset difficulty maintaining erections over months | Common pattern of vascular or mixed-etiology ED | Yes, often appropriate for telehealth ED evaluation | Not a red flag by itself if no cardiopulmonary symptoms |
| ED with normal morning erections and erections during masturbation | Possible performance anxiety or psychogenic component | Yes, appropriate for telehealth discussion and options | Red flag only if associated with severe mood symptoms or self-harm thoughts |
| Sudden ED after starting a new medication | Possible medication side effect (for example, some antidepressants, antihypertensives) | Telehealth can review and coordinate with primary prescriber | In-person care needed if there are additional neurologic or systemic symptoms |
| ED plus exertional chest pain or shortness of breath | Possible coronary artery disease or cardiac ischemia | No | Requires urgent in-person or emergency cardiac evaluation before any ED medication |
| ED plus leg pain with walking, known vascular disease, or prior heart attack | Higher cardiovascular risk | Telehealth may identify risk and recommend in-person clearance | Red flag if chest pain, syncope, or unstable symptoms present |
| Penile curvature, painful erections, or palpable plaque | Possible Peyronie’s disease | Telehealth may triage | Needs in-person urology evaluation if painful or function-limiting |
| Loss of body hair, low libido, fatigue, or testicular changes | Possible hypogonadism, endocrine, or systemic disease | Telehealth can screen and direct lab and in-person follow-up | Red flag if associated with rapid systemic decline or neurologic signs |
| Use of nitrates (for example, nitroglycerin) for heart disease | Contraindication to standard oral ED medications | Telehealth appropriate for counseling only | ED prescriptions via telehealth are not appropriate without in-person specialist clearance |
| Very low blood pressure, severe heart failure, or recent stroke | High risk for complications from ED drugs | No as primary management | In-person cardiology or primary care evaluation needed before any ED treatment |
Differential Diagnosis: ED vs Other Adult Sexual Health Conditions
During your TeleDirectMD visit, the MD will review your symptom onset, pattern, medical history, and medications to differentiate erectile dysfunction from other sexual health concerns that may need a different approach or in-person testing.
Findings Consistent With Erectile Dysfunction
- Persistent difficulty achieving or maintaining erections for at least several weeks
- Reduced rigidity or duration of erections during partnered sex
- Normal or reduced libido depending on underlying cause
- Possible association with cardiovascular risk factors or diabetes
Other Conditions Considered
- Premature ejaculation: Normal erections but ejaculation earlier than desired despite adequate arousal.
- Low testosterone or endocrine disorders: Low libido, fatigue, reduced muscle mass alongside ED.
- Depression or anxiety: Low mood, anhedonia, or performance anxiety affecting arousal and erections.
- Peyronie’s disease: Penile curvature, shortening, or painful plaques requiring in-person urology.
When there are red flags for cardiovascular disease, significant endocrine issues, severe mood symptoms, or Peyronie’s disease, our MDs will prioritize safety and recommend in-person evaluation, using telehealth mainly for counseling and coordination rather than sole management.
When Is a Video Visit Appropriate for Adult ED Treatment?
When a Video Visit Is Appropriate
- Adult 18+ with bothersome ED symptoms and stable overall health
- Under 40: seeking refill of an existing ED prescription and able to provide proof of current prescription
- Age 40+: seeking evaluation and possible initiation of ED therapy when clinically appropriate
- No active chest pain, exertional shortness of breath, or unstable heart disease
- No use of nitrates or medications that are absolute contraindications to oral ED drugs
- Not requesting testosterone, controlled substances, or injection therapies via telehealth
- Willing to follow up with in-person primary care, cardiology, or urology as advised
Red Flags Requiring In-Person or ER Care Before ED Treatment
- Chest pain, pressure, or shortness of breath, especially with exertion
- History of recent heart attack, stroke, or unstable arrhythmia without specialist clearance
- Severe uncontrolled hypertension or very low blood pressure
- Use of nitrates or certain advanced heart medications that interact with ED drugs
- New neurologic deficits, vision loss, or significant leg pain with walking
- Severe depression or suicidal thoughts linked to sexual function
- Refusal of recommended in-person evaluation despite high-risk features
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD visits are not appropriate for emergency evaluation of chest pain, stroke symptoms, or unstable heart disease, and ED medications should not be started or refilled until safety is clarified.
Treatment Options for Adult Erectile Dysfunction
ED treatment focuses on improving erections while keeping cardiovascular safety at the center. Our MDs use guideline-based recommendations and your age, history, and current medications to decide whether oral ED medications are appropriate and what non-pharmacologic steps may also help.
Lifestyle and Non-Pharmacologic Measures
- Address blood pressure, cholesterol, diabetes, and weight with your primary care clinician.
- Stop smoking and avoid vaping and illicit drugs that impair blood flow and erection quality.
- Limit heavy alcohol use, especially before sexual activity, which can worsen ED.
- Increase regular physical activity as tolerated, which improves vascular health and ED over time.
- Consider mental health or couples counseling when stress, anxiety, or relationship issues contribute.
Oral ED Medications (When Appropriate)
- Short-acting and longer-acting phosphodiesterase-5 (PDE5) inhibitors for adults without contraindications.
- As-needed regimens for anticipated sexual activity in suitable patients.
- Daily low-dose regimens in selected adults when clinically appropriate and safe.
- Clear counseling about not combining ED drugs with nitrates or certain heart medicines.
TeleDirectMD does not prescribe testosterone replacement, intracavernosal injections, vacuum devices, or surgical treatments for ED via telehealth. Those therapies, when indicated, require in-person endocrinology or urology care. Our role is to provide safe, MD-only oral ED treatment and comprehensive counseling for adults who meet telehealth criteria, with a stricter refill-only policy under age 40 and carefully considered initiation over age 40.
Common Medications Used for Adult ED
The specific medication and dose depend on age, cardiovascular risk, other medications, and prior response. The table below shows typical examples your MD may consider when refilling or, for adults 40+ when appropriate, initiating oral ED therapy.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Sildenafil tablet | 25–100 mg by mouth about 30–60 minutes before sexual activity, maximum 1 dose per day | As needed with periodic reassessment | Adults with ED and low to moderate cardiovascular risk who are not taking nitrates |
| Tadalafil tablet (as needed) | 5–20 mg by mouth at least 30 minutes before sexual activity, maximum 1 dose per day | As needed, with effect lasting up to 24–36 hours | Adults preferring a longer window for sexual activity and without contraindications |
| Tadalafil tablet (daily) | 2.5–5 mg by mouth once daily at the same time each day | Daily regimen with regular follow-up | Selected adults with frequent sexual activity or combined ED and urinary symptoms, when safe and appropriate |
| Vardenafil tablet | 5–20 mg by mouth about 30–60 minutes before sexual activity, maximum 1 dose per day | As needed with periodic review | Alternative PDE5 inhibitor for adults who tolerate and respond to this class and have no contraindications |
| Non-sedating antihistamine or nasal spray (adjunctive) | Standard doses per product | Ongoing as needed for comorbid allergic symptoms | Not an ED treatment, but might be relevant when ED coexists with conditions treated by other TeleDirectMD services |
These are example regimens only. Actual medications, strengths, age-based eligibility, and refill quantities are determined by the MD after reviewing your age, cardiovascular and endocrine history, other diagnoses, and current medications. TeleDirectMD does not prescribe ED medications for adults using nitrates or certain advanced cardiac therapies and uses a refill-only policy under age 40, with initiation generally reserved for adults 40+ when clinically appropriate.
Home Care, Expectations, and Return to Normal Activities
ED management is typically a long-term process rather than a one-time prescription. The goal is to improve erectile function, sexual satisfaction, and overall health without compromising cardiovascular safety.
- Take ED medication exactly as prescribed and do not exceed the recommended dose or frequency.
- Allow time for lifestyle and cardiovascular risk-factor changes to improve ED over months, not just days.
- Monitor for headaches, flushing, nasal congestion, or visual changes and report concerning or persistent effects.
- Seek emergency care immediately for chest pain, vision loss, or erections lasting longer than 4 hours.
- Coordinate long-term cardiovascular and endocrine risk management with an in-person primary care clinician.
ED medications, when used safely, should not limit your ability to work or perform usual activities. TeleDirectMD can provide documentation of evaluation and treatment planning if you wish to share details with your primary care, cardiology, or urology clinicians for ongoing in-person management.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual care for adults using secure video visits to evaluate conditions such as erectile dysfunction. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, clarify what can be safely managed via telehealth, and explain when in-person primary care, cardiology, endocrinology, mental health, or urology evaluation is more appropriate. ED treatment is tailored by age and risk, with refills under 40 only when there is proof of a current prescription and carefully considered initiation for adults 40+ when clinically appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.
Adult Erectile Dysfunction Treatment FAQs
Erectile dysfunction is the ongoing difficulty achieving or maintaining an erection firm enough for sexual activity. It becomes more common with age and with conditions such as diabetes, high blood pressure, high cholesterol, obesity, and cardiovascular disease. Occasional problems are normal; ED refers to more persistent issues that affect quality of life or relationships.
TeleDirectMD uses an age-based safety approach. For adults under 40, we generally only offer refills when there is proof of a current ED prescription from another clinician and your history is appropriate. For adults 40 and older, we can evaluate and, when clinically appropriate, initiate or adjust ED therapy after a full video assessment. In all age groups, red flags may require in-person evaluation before ED medications are prescribed or refilled.
Yes. Because erections rely on healthy blood vessels, nerves, and hormones, ED can sometimes be an early marker of cardiovascular disease, especially in men with risk factors such as diabetes, high blood pressure, high cholesterol, or smoking. During your TeleDirectMD visit we will review your risk profile and may recommend in-person primary care or cardiology follow-up in addition to any ED medication decisions.
In general, no. For adults under 40, TeleDirectMD focuses on refills only when there is proof of a current ED prescription and your evaluation does not reveal red flags. New ED prescriptions in younger adults often require broader in-person workup to look for endocrine issues, medication side effects, mental health factors, or cardiovascular risk. We may recommend seeing an in-person primary care clinician or specialist before starting treatment if you are under 40 without an existing ED prescription history.
For adults 40 and older, we review your ED symptoms, cardiovascular risk factors, medications, blood pressure history, and any prior heart or stroke events. We also ask about chest pain, exertional shortness of breath, and use of nitrates or other interacting drugs. If risk appears acceptable, we can typically initiate an oral ED medication and provide clear guidance on when you should see in-person primary care, cardiology, or urology for additional evaluation and long-term risk management.
TeleDirectMD offers oral ED medications from the PDE5 inhibitor class when safe, along with lifestyle and risk-reduction counseling. We do not prescribe testosterone replacement, controlled substances, intracavernosal injections, vacuum devices, or perform surgical interventions via telehealth. Those options, when appropriate, require in-person evaluation with endocrinology, urology, or other specialists and cannot safely be handled entirely online.
The most important contraindication is the use of nitrates such as nitroglycerin, isosorbide dinitrate, or similar agents for heart disease. Certain severe heart conditions, recent heart attack or stroke, very low blood pressure, advanced liver or kidney disease, and some rare eye conditions can also make ED medications unsafe or require specialist clearance. During your visit we will review your medications and history; if risk is too high, we will not prescribe ED drugs and will advise in-person follow-up instead.
ED pills should be taken exactly as prescribed, usually once on days you anticipate sexual activity, with enough time for the medication to take effect. You should not take more than the prescribed dose or more than 1 dose in a day. Moderate alcohol may be tolerated by some adults but can worsen ED and increase side effects; heavy drinking, recreational drugs, and nitrates are unsafe combinations. We will review specific timing, food considerations, and interactions during your visit based on the medication chosen for you.
Common side effects include headache, facial flushing, nasal congestion, mild indigestion, or brief vision changes such as a blue tinge or increased light sensitivity. These are usually short-lived. You should seek emergency care for chest pain, severe shortness of breath, sudden vision loss, or an erection lasting longer than 4 hours. These rare but serious issues require immediate in-person evaluation and cannot be managed safely through telehealth alone.
Improving cardiovascular health through regular exercise, healthy eating, weight management, blood pressure and cholesterol control, and smoking cessation can significantly improve ED over time. Managing stress, addressing mood or anxiety disorders, limiting alcohol, and communicating openly with partners also make a major difference. TeleDirectMD can help you build a realistic plan and coordinate with your primary care clinician and mental health professionals when those steps will meaningfully improve your long-term outcomes and ED symptoms.
TeleDirectMD offers MD-only, guideline-based ED care with a clear age-based safety framework and attention to cardiovascular risk. Every visit is a real-time video visit with a physician, not a brief questionnaire alone. We combine oral ED treatment, when appropriate, with education about heart health, mental health, and when in-person primary care, cardiology, or urology is needed, all within a simple $49 flat-fee model across 25+ states and without insurance requirements.