Condition
Impotence and erection problems
You cannot get an erection, it does not last long enough for sex, or it is weaker than before. This is erectile dysfunction, in everyday language impotence; in most cases it has a cause that can be found and treated.
What is it?
An erection needs healthy nerves, healthy blood vessels, enough hormones and a mind that is not under pressure; when any one of these links weakens, the erection weakens. An erection that occasionally fails, after tiredness, alcohol or stress, is not an illness. Under the same name people often mix up a weaker erection, reduced desire, premature ejaculation and the absence of orgasm — these are not the same disorders, so the first step at the examination is to separate out which one applies to you.
Why does it happen?
In most men there is both a physical and a psychological cause: the physical one weakens the erection, and fear of failure switches it off.
Physical causes. Most often narrowing of the blood vessels, which shows up in the penis years before it shows up in the heart; diabetes; low testosterone or raised prolactin; nerve injuries and diseases, and surgery in the pelvis; some medicines for blood pressure, stomach acid, depression and the prostate; smoking, alcohol and being overweight. The cause can also lie in the penis itself — Peyronie's disease, earlier injuries and priapism.
Psychological causes. Fear of failure, stress, tiredness, depression, problems in the relationship; more common in younger men and when the problem began suddenly.
Physical or psychological cause — how can you tell?
The simplest indicator is night-time and morning erections. If you have them and the erection fails only during sex, the cause is probably psychological; if the night-time erections have also gone or weakened, it is probably physical. At the examination each of these is checked.
When should I see a doctor?
When the problem lasts longer than three months, when it is getting worse, or when it bothers you regardless of how long it has lasted. A problem that began recently is solved faster; food supplements and products from the internet do not solve the cause and only delay the examination.
What does the examination involve?
The examination is with a urologist and is mostly a conversation: how long it has lasted, how it began, whether you have night-time erections, which medicines you take, whether you smoke, what your blood sugar and blood pressure are like. An ultrasound of the penis and testicles is done the same day, and blood tests check blood sugar, blood lipids, testosterone and, if needed, prolactin and thyroid hormones. If a cause in the blood vessels is suspected, an ultrasound of the penis is done during an erection brought on by an injection. After the examination you get a clear answer on where the most likely cause is and what the first step is.
What can be done?
| Problem | Procedure | Also, in the same visit |
|---|---|---|
| The erection weakens or does not happen for longer than three months; the first step is an examination | Urological examination and ultrasound | An ultrasound of the penis and testicles is done the same day, in the same visit. |
| A curve with a hardened area you can feel under the skin, along with a weaker erection (Peyronie's disease) | Penile curvature correction | |
| You are interested in treatment with your own plasma (PRP, P-Shot). Whether it is right for you is decided at the urological examination, once the cause has been established. | Penile PRP (P-Shot) |
Procedures that change the shape and look of the genitals, not their function: → Penis enlargement
Specialist and team
Specialty: urology — examination, diagnostics and treatment.
When the procedure is done under sedation or general anaesthesia, the anaesthesia is led by a specialist in anaesthesiology, resuscitation and intensive care who works full time at the clinic.
In the operating theatre, the surgeon is assisted by head nurse Martina Šereg, with the help of nurses Kristina Jurešić and Mateja Tomorad, and in recovery the care assistant Mirjana Kovačić is with you. Martina also looks after preparation, scheduling and contact after the procedure.
Who will operate is decided at the examination, based on the findings and the type of procedure. You know the name of the surgeon before the procedure and meet them at the examination.
→ Doctors and team at Poliklinika Barbel
Frequently asked questions
Is it normal for erections to weaken with age? With age an erection needs more stimulation and comes more slowly, but a complete absence of erections is not a normal part of ageing, even in your seventies. Most men of that age who have a problem also have a cause that can be treated.
Can a weak erection be a sign of heart disease? Yes. The arteries of the penis are narrower than those of the heart, so narrowing shows up in them first. A weaker erection in a man over forty is a reason to check blood pressure, blood sugar and blood lipids, even when your heart causes no symptoms.
Can I come for an examination without a referral? Yes. The examination is paid for privately and you book directly. You can take any results you receive to your own doctor if part of the treatment continues in the public system.
Will anyone know why I came? You book a urological examination, without giving a reason. You tell the doctor the reason in the consulting room; nothing is commented on or compared during the examination.
Medical review: doctors of Poliklinika Barbel · October 2026.