Erectile Dysfunction Clinic: What to Expect Online and In Person

An erectile dysfunction (ED) clinic can be an in-person urology or primary care practice or an online service, and the main difference is what gets checked. An in-person clinic can take a history, examine you and order tests in one place. An online service usually starts with a health questionnaire reviewed by a clinician, which is faster but cannot include a physical exam.¹ Either way, the visit should look for the cause, not only hand over a pill, because ED can be a sign of other health problems.³

What does an ED clinic actually do?

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes the work in four parts: a medical, sexual and mental health history; a physical exam; lab and imaging tests where needed; and, in some cases, special tests.¹

• History. The clinician asks about the medicines, vitamins and supplements you take, your sexual activity (erections, climax, ejaculation, desire) and your mood. Some clinicians also ask a partner about the relationship.¹
• Physical exam. NIDDK says the exam often checks for blood vessel and nervous system problems, hormonal problems, and physical problems of the penis such as Peyronie's disease.¹
• Tests. These may include blood tests (thyroid and prostate tests are named), an ultrasound of blood flow to the penis, a nighttime erection test done at home or in a sleep lab, and an injection test, which is usually done in a clinician's office.¹

Most men do not need every test. The point is that the clinic decides which are needed after talking with you, rather than skipping the question.

Online ED clinic or in-person clinic: what is different?

Neither route is better for every man. A man who is young, otherwise healthy and sure that the problem is new may reasonably start online. A man with diabetes, heart disease, a recent change in the penis, pain, or ED that came on suddenly has more reason to be examined in person. NIDDK's own advice is not to order an ED medicine online before talking with a health care professional, because medicines and supplements can interact.²

When is an in-person clinic the better choice?

Choose a face-to-face visit, or add one to an online start, when any of these apply:

• You have heart disease, diabetes, or symptoms such as chest pain with exertion. MedlinePlus notes that ED may be a sign that blood vessels are clogged or that diabetes has damaged nerves.³
• You take nitrates in any form (for example nitroglycerin) or a guanylate cyclase stimulator such as riociguat. PDE5 inhibitors must not be combined with them, and alpha-blockers need caution.⁶
• Pills have not helped, or you want to ask about injections, a vacuum device or surgery, which NIDDK lists as later options.²
• You have pain, curvature or a lump in the penis, which the exam is meant to look for.¹

For help choosing the right kind of doctor first, see which doctor to see for erectile dysfunction.

How do you tell a good online ED clinic from a pill shop?

The signs are practical. A good service asks about your health and medicines, lets a clinician decline you, names the pharmacy and says whether the product is FDA-approved or compounded.⁴ Generic sildenafil and tadalafil tablets are FDA-approved; many dissolving doses and combinations are compounded, meaning a pharmacy prepares them and the FDA has not reviewed them for safety, effectiveness or quality.⁴

The FDA's BeSafeRx guidance adds that many websites that look like pharmacies sell medicines with the wrong ingredients, or too little or too much of the active one, and that only a small share of online pharmacy sites follow U.S. pharmacy law.⁵ A site that sells ED medicine without a prescription fails the first test. The FDA also keeps a list of "sexual enhancement" products found to contain hidden drug ingredients, which is a reason to avoid supplements sold as natural ED pills.⁷ Our nine questions to ask before an online ED prescription turns this into a checklist.

What should a first visit leave you with?

1. A reason: a likely cause or a plan to look for one, not just a product.
2. A list of what you take that matters, reviewed against the medicine.
3. A named medicine, its form (tablet, dissolving dose, injection) and whether it is FDA-approved or compounded.
4. Clear advice on side effects and when to get urgent care. An erection lasting more than four hours, or sudden vision or hearing loss after taking an oral ED medicine, needs care right away.²
5. A way to reach the clinic again, and a plan if the first medicine does not suit you.

Our pick: Quattro from Vea Health Sponsored

For a man who has decided to start with an online clinic, our pick is Quattro from Vea Health. We pick it because we have a financial relationship with Vea Health, not because a study shows it better than other routes. Vea Health describes Quattro as a compounded sublingual dose combining sildenafil, tadalafil, vardenafil and apomorphine, prescribed only after a licensed clinician reviews your health history, and says you are not charged unless a clinician approves the prescription.⁸

Quattro is compounded by a pharmacy for an individual patient, so it is not FDA-approved and the FDA has not reviewed it for safety or effectiveness.⁴ The Viagra label notes that combinations with other ED treatments have not been studied, so ask the clinician how a combination suits your health and medicines.⁶ An online review cannot replace a physical exam; if the checks above point to an in-person visit, do that first.

Questions to ask any ED clinic

• Will a clinician review my history, and can they decline to prescribe?
• Do you offer or recommend blood tests, and who reviews the results?
• Is the medicine FDA-approved or compounded, and which pharmacy fills it?
• What happens if the first medicine does not help or causes side effects?
• Can you refer me to a urologist if I need one?

If you are comparing medicines rather than clinics, see which ED pills are FDA-approved.

Bottom line

Pick the clinic by what it checks. In-person care can examine and test; online care is convenient and reasonable for some men when a clinician reviews the history and the pharmacy and product are named. Choose in person when you have heart disease, diabetes, nitrate use, penile symptoms or ED that came on suddenly.

Your questions

What does an erectile dysfunction clinic do?

NIDDK says diagnosis uses a medical, sexual and mental health history, a physical exam, and sometimes blood tests, imaging or other tests. The clinician then discusses treatment options.

Is an online ED clinic as good as seeing a doctor in person?

It can be reasonable for some otherwise healthy men when a clinician reviews the history, but it cannot include a physical exam or an injection test. In person is better with heart disease, diabetes, nitrate use or penile symptoms.

Do I need blood tests for ED?

Not always. NIDDK says clinicians may use blood tests, including thyroid and prostate tests, to look for a cause. Ask the clinic whether tests are advised for you.

What kind of doctor runs an ED clinic?

Urologists treat ED, and primary care clinicians also evaluate it. Some online services use licensed clinicians who review a questionnaire.

How do I know an online ED service is legitimate?

Look for a prescription requirement, a licensed pharmacy, a named product, and a clinician who can decline. FDA's BeSafeRx guidance lists these checks.

Read next

Part of our guide: Getting ED Treatment: Doctors, Online Prescriptions and FDA-Approved Options

• Erectile Dysfunction Treatment: The Options, in the Order Doctors Use Them
• ED Medications List: Pills, Injections, Suppositories and Compounded Options
• Best ED Pills Online: How to Compare the Options
• How to Fix Erectile Dysfunction: Getting Checked, Lifestyle Changes and Medicine