Erectile Dysfunction Specialist on Long Island
A Complete Guide — Causes, Symptoms & All Treatment Options
What Is Erectile Dysfunction?
Erectile dysfunction — also called ED or impotence — is when a man cannot get or keep an erection firm enough for satisfying sex. It is one of the most common medical conditions in men.
Almost every man has trouble getting an erection at some point in his life, and that is completely normal. Stress, alcohol, fatigue, or just a bad night can cause a temporary problem. But when it happens regularly — more often than not — it is called erectile dysfunction, and it deserves medical attention.
The good news is that ED is highly treatable. There have never been more effective options available — from simple pills like Viagra (sildenafil) and Cialis (tadalafil), to penile injections, to long-term surgical options like penile implants. Dr. Kashani specializes in finding the right treatment for each individual patient.
Worth knowing: ED can sometimes be connected to heart health, diabetes, or blood pressure. Getting evaluated is a good opportunity to check in on your overall health, not just your sex life.
Quick Answers About ED
What is the best treatment for ED when pills don’t work?
If pills like sildenafil or tadalafil aren’t enough, penile injections, vacuum erection devices, and penile implants are all effective next steps. In selected cases, your urologist may also consider combination therapy. A penile Doppler ultrasound can help identify the underlying cause so treatment can be targeted. Most men find an approach that works for them.
Why do I have ED?
Common causes include reduced blood flow, diabetes, high blood pressure, low testosterone, certain medications, stress, and nerve issues — often more than one at once. An evaluation can usually pinpoint the cause.
Is ED a sign of heart disease?
It can be an early warning sign, because the penile arteries are small and may show reduced blood flow before heart symptoms appear. It is worth discussing cardiovascular risk with a doctor — not a reason to panic.
Do ED pills stop working over time?
The pills don’t usually “wear out.” If they seem less effective, it is typically because the underlying condition has progressed. Other options, including injections and implants, remain effective.
Sources: Feldman et al., J Urol 1994 (MMAS); Shamloul & Ghanem, Lancet 2013; Manfredi et al., J Sex Med 2021; Martins da Silva & Anderson, Rev Endocr Metab Disord 2022; Luna et al., J Sex Med 2022 (implant satisfaction).
What Causes Erectile Dysfunction?
Erections require a perfect combination of blood flow, nerve signals, and hormones. Anything that disrupts that process can cause ED. In most men, it is a physical issue — not “all in your head.”
Heart & Blood Vessel Disease
The most common cause. High blood pressure, high cholesterol, and narrowing of the arteries can reduce blood flow to the penis. ED can sometimes show up before other cardiovascular symptoms do, which is one more reason an evaluation is worthwhile.
Diabetes
Up to 66% of men with diabetes develop ED. High blood sugar damages both the nerves and blood vessels needed for an erection. Men with diabetes often require more aggressive treatment options.
Low Testosterone (Low T)
Testosterone fuels sexual desire and helps trigger erections. Low testosterone levels — also called hypogonadism — can cause both low sex drive and difficulty getting erections.
Medications
Many common drugs cause ED as a side effect — including blood pressure medications (beta blockers), antidepressants, antihistamines, and some prostate medications. Never stop a medication without talking to your doctor first.
Stress, Anxiety & Depression
Psychological causes are especially common in younger men. Performance anxiety, relationship stress, depression, and general anxiety can all interfere with the brain signals that start an erection. This is called psychogenic ED.
Surgery or Injury
Prostate cancer surgery (radical prostatectomy), pelvic radiation, or injury to the spine, penis, or pelvis can damage the nerves and blood vessels responsible for erections.
Lifestyle Factors
Smoking, heavy alcohol use, obesity, and a sedentary lifestyle all significantly increase ED risk by damaging blood vessels and reducing testosterone levels over time.
Age
ED becomes more common with age, but it is not an inevitable part of getting older. Many men in their 60s, 70s, and beyond enjoy satisfying sex lives with the right treatment.
Symptoms & When to See a Doctor
The main symptom of ED is difficulty getting or keeping an erection. But ED can look different for different men:
- You can sometimes get an erection but not always
- You get an erection but it doesn’t last long enough
- You cannot get an erection at all
- Your erections are not as firm as they used to be
- You’ve noticed a decrease in your sex drive
Worth checking: If any of these symptoms happen regularly — more than half the time — it’s worth having a conversation with a specialist. It’s also helpful to mention if ED came on suddenly after an injury or a new medication, or alongside chest pain, fatigue, or unexplained weight changes, since those details can guide the evaluation.
How Is Erectile Dysfunction Diagnosed?
Dr. Kashani takes a thorough, evidence-based approach to diagnosing ED — because finding the root cause is the key to choosing the right treatment.
Medical & Sexual History
A detailed conversation about your symptoms, health conditions, medications, and lifestyle. This is always the starting point.
Blood Tests
Checking testosterone levels, blood sugar (diabetes), cholesterol, and kidney and liver function to identify underlying causes.
Penile Doppler Ultrasound
A specialized ultrasound that measures blood flow in the penis — one of the most informative tests for identifying vascular causes of ED. Dr. Kashani performs this in-office.
Physical Exam
Examining the penis, testicles, and nervous system for physical abnormalities contributing to ED.
Treatment Options for Erectile Dysfunction
There is no single “best” treatment for ED — the right option depends on the cause, severity, your health, and your personal goals. Dr. Kashani offers the full spectrum of proven treatments, starting with the least invasive and moving toward surgical options when needed.
Oral Medications (PDE5 Inhibitors)
The most well-known ED treatments. These pills work by increasing blood flow to the penis when you are sexually stimulated. They do not cause automatic erections — you still need arousal. They work for about 70% of men and are very safe for most patients.
Cialis (tadalafil) is available as a daily low-dose pill for spontaneous erections anytime. Generic sildenafil (Viagra) is now widely available at very low cost.
Penile Doppler Ultrasound
Before choosing a treatment, Dr. Kashani may perform a penile duplex ultrasound to measure blood flow in the arteries of the penis. This tells us exactly whether your ED is caused by poor arterial flow, venous leak, or another issue — and guides which treatment will work best for you.
Learn more about penile Doppler ultrasound →
This specialized test is not available at every urology office. Dr. Kashani performs it right here at our Long Island locations.
Penile Injection Therapy (ICI)
Intracavernosal injections (ICI) involve a small, nearly painless needle injected into the penis before sex. The medication causes an erection within 10–15 minutes that lasts 30–60 minutes. Works even when pills have failed — including for men with diabetes or nerve damage from prostate surgery.
Learn more about penile injection therapy →
Most men are surprised by how easy and painless injections are. Dr. Kashani trains patients to self-inject right here in the office.
Penile Implant (Inflatable Penile Prosthesis)
A great option for men who have not had success with pills or injections. A penile implant is a surgically placed device that allows you to get a firm erection on demand, whenever you want. It is completely hidden inside the body and looks and feels natural.
Published studies generally report high patient satisfaction, although individual experiences and outcomes vary. Dr. Kashani is fellowship-trained in penile prosthetic surgery and uses the Coloplast Titan® as his preferred inflatable penile prosthesis.
Can lifestyle changes help ED? Yes — but usually as a complement to medical treatment, not a replacement. Losing weight, quitting smoking, cutting back on alcohol, exercising regularly, and reducing stress can all improve erectile function. For mild ED, these changes alone may be enough. For moderate-to-severe ED, medical treatment is usually still needed.
Frequently Asked Questions About ED
These are the questions Dr. Kashani hears most often from patients — answered in plain language.
Is erectile dysfunction normal?
Yes — it is extremely common. Over 30 million American men have ED, and nearly every man will experience it at some point. It becomes more common with age but is not a normal or inevitable part of aging. It is a medical condition, and it is very treatable.
What is the difference between Viagra, Cialis, Levitra, and Stendra?
All four are PDE5 inhibitors that work the same way. The key differences are timing and duration. Viagra (sildenafil) works in 30–60 minutes and lasts 4–6 hours. Cialis (tadalafil) can be taken as a daily low dose or as a larger dose lasting up to 36 hours. Levitra (vardenafil) is similar to Viagra. Stendra (avanafil) works the fastest — as quickly as 15 minutes.
Are penile injections painful?
Most men are surprised — the needle is very thin and the injection is nearly painless. The medication is injected into the side of the penis, not the tip. Dr. Kashani trains every patient in-office before they do it themselves at home. The vast majority of men who try injections continue using them long-term.
What is a penile implant and is it noticeable?
A penile implant is a device surgically placed inside the penis that lets you control when you have an erection. When not inflated, the device is concealed inside the body. It does not affect orgasm or ejaculation. Published studies generally report high patient satisfaction, although individual experiences vary.
Can young men get erectile dysfunction?
Absolutely. ED affects men of all ages. In younger men under 40, it is often caused by anxiety, stress, or lifestyle factors like smoking and heavy drinking. But it can also signal early cardiovascular disease even in young men.
Can diabetes cause permanent ED?
Diabetes is one of the most common causes of ED because it damages both nerves and blood vessels. While ED from diabetes can be harder to treat with pills alone, it is not permanent. Penile injections and penile implants are highly effective for men with diabetes and can fully restore satisfying sexual function.
Will my insurance cover ED treatment?
It depends on the treatment and your plan. Diagnostic testing — bloodwork and penile ultrasound — is usually covered when medically indicated. Penile implant surgery is often covered by insurance including Medicare when other treatments have failed. Dr. Kashani’s team can help verify your benefits before your visit.
How do I get started?
Simply book a consultation with Dr. Kashani. At your first visit, he will take a thorough history, possibly order blood tests or a penile ultrasound, and walk you through every option available. There is no pressure — just honest, evidence-based advice tailored to your situation.
Why Choose Dr. Kashani for ED Treatment?
Most urologists are generalists. Dr. Kashani has dedicated his career specifically to men's sexual health — completing a specialized fellowship in Male Sexual Health and Reproductive Medicine at Lenox Hill Hospital in New York City.
Dr. Kashani has dedicated fellowship training in Male Sexual Health and Reproductive Medicine and focuses his practice on ED, penile implant surgery, and advanced diagnostics such as penile Doppler ultrasound.
- Fellowship-trained in Male Sexual Health & Penile Prosthetics
- In-office penile Doppler ultrasound
- Private, discreet, judgment-free environment
- Two convenient Long Island locations
- Same-week appointments available
- Custom tailored combination therapies
Ready to Take the First Step?
You do not have to live with ED. Dr. Kashani offers discreet, expert consultations at two convenient Long Island locations. Most patients leave the first visit with a clear plan.