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Because ED can occur as a result of different physiological and psychological causes, most doctors first attempt to narrow down the range of possibilities by having you fill out a questionnaire that covers both your medical and sexual history, according to WebMD.

Among the many tests doctors use to diagnose ED are a complete blood count, or CBC, which can show if you’re suffering from anemia-related fatigue, which can cause ED, and a blood glucose test to determine if you have diabetes, a major cause of erectile problems. A blood test to determine blood lipid levels can indicate you’re suffering from atherosclerosis, another cause of ED. Because improper functioning of your liver and/or kidneys can contribute to ED, your doctor will probably run liver and kidney function tests.

Blood hormone studies can tell if your testosterone levels are low, while urinalysis can reveal the presence of kidney disease, diabetes, or a testosterone deficiency, all of which are possible causes of ED. The stamp test can show whether you’re having nocturnal erections. If you are, the ED cause is more likely to be psychological in nature. Other diagnostic testing may be ordered to determine how well the nerves and blood vessels serving the penis are functioning.

While erection difficulties are increasingly common after the age of 50, they are certainly not inevitable, according to an AARP report. The association cites the results of a landmark University of Chicago study, which found that roughly one-third of all men between the ages of 50 and 64 suffer from ED. Among men between the ages of 65 and 85, the incidence of ED jumps to 44 percent, according to the University of Chicago study. This latter statistic offers some encouragement for older Americans, because it indicates that more than half of elderly men manage to escape the frustration and embarrassment of ED.

However, once you’ve reached the age of 50, you’re likely to experience certain changes in the nature of your erections, according to AARP. Sexual fantasies may no longer be sufficient to trigger erections, and direct fondling may be needed to achieve erection. Also, erections tend to rise more slowly and are not as rock-hard as they were in your younger years.

According to a study published in the August 2003 issue of “Annals of Internal Medicine,” 4 percent of health professionals between the ages of 53 and 90 reported that they first experienced ED between the ages of 40 and 49. Of course, it may be argued that these older men tended to remember their younger years in a more positive light than was actually the case.

Part of the problem with such studies and surveys is the inexactitude of terminology. At the other end of the scale from the study cited above are the findings of the Massachusetts Male Aging Study, which found that a whopping 40 percent of men are affected by ED by age 40.

What isn’t clear from either of these studies is whether the questioning addressed occasional erection difficulties or persistent erectile dysfunction, which are two very different things. The former can be caused by having too much to drink, extreme fatigue, a bout of performance anxiety, or just having a lousy day. Persistent ED, of course, is a problem that must be treated on an ongoing basis.

Very uncommon, according to the National Institutes of Health, which estimates that fewer than 5 percent of men in their 20s have ED. In another large-scale survey of 31,000 health professionals between the ages of 53 and 90, only 2 percent reported experiencing ED before the age of 40.

Furthermore, the vast majority of ED among men in their 20s is probably psychological in origin, because most younger men are close to their peak of sexual function and are less likely to have developed the physical problems that often cause erection problems.

According to a FoxNews report, Dr. Jeffrey K. Cohen, a urologist with the Pittsburgh-based Triangle Urology Group, psychological factors are almost always responsible for erectile dysfunction, whether occasional or persistent. Among the factors that may be causing problems are performance anxiety, latent and/or unrecognized homosexuality, death in the family, illness of a child, and financial problems.

Cohen said the second most common cause of ED among younger men is vascular complications caused by diabetes.

As you may know, the primary physical cause of erectile dysfunction is compromised blood flow to the penis. That being the case, you can help prevent ED as well as cardiovascular disease by following these simple tips suggested by WebMD:

Control your blood pressure and cholesterol levels.

Don’t smoke.

Make lifestyle and dietary changes that reduce your chance of developing diabetes, which sharply increases your risk of ED.

Moderate your use of alcohol and avoid using recreational drugs, such as marijuana, that may make it more difficult to get an erection.

Talk to your family doctor to determine if any of the prescriptions you’re now taking may increase your risk of experiencing ED. If at all possible, switch to medications that don’t have this side effect.

While only 10 percent or so of all ED is psychological in origin, you can minimize such problems by establishing open communications with your sexual partner to ease any tensions that may be affecting your performance.

The average man who has no physical impediments to erection has anywhere from three to five erections per night, according to MedlinePlus. This is known as nocturnal penile tumescence. Each of these nighttime erections lasts for up to 30 minutes, and most occur during REM (rapid eye movement) sleep.

Not only are these nighttime erections normal, but they also play a key role in the maintenance of healthy erectile function, sort of like exercise undertaken in advance of the big game.

While most men are totally unaware of most of their nocturnal erections, almost all of them have awakened in the morning from time to time to find they have an erection. According to the U.K.’s National Health Service, this is usually the last of a man’s nighttime erections and is known by some as a “morning glory.”

As you probably have witnessed yourself, sensitivity to alcohol varies significantly from one person to another. While most men have a higher tolerance for alcohol than women, there is quite a bit of variation from one man to another.

Moderation is the key, according to Chris Iliades, M.D., who points out in an EverydayHealth.com article that moderation means no more than two drinks a day for a man, according to the Centers for Disease Control and Prevention.

A drink or two, at the most, helps to set the stage for romance, says Iliades, easing inhibitions and producing a warm glow that’s almost guaranteed to enhance the overall experience. However, drink more than that and alcohol’s depressant effects are likely to kick in. You’re likely to find that more than two drinks dampens your mood, decreases sexual desire, and makes it increasingly difficult for you to get and keep an erection.

Perhaps the best-known of all is the so-called stamp test. Buy a roll of inexpensive postage stamps. Before retiring for the night, moisten the stamps and apply them in a continuous ring around the mid-shaft of your penis. If you find upon awakening the next morning that the rings of stamps has been broken, it’s a clear sign that the penis achieved an erection during the night and that there is no serious damage to nerves or blood vessels serving the penis. If the ring of stamps is unbroken, it indicates that no nocturnal erection occurred, which is cause for further testing to see what physical impediments to an erection might be present.

Another self-test is the International Index of Erectile Function, or IIEF. The test consists of several questions, each of which can be answered with one of five or six multiple answers. The questions address recent sexual and erectile experience. Each of the multiple answers has a numerical value assigned to it. After answering all the questions, the numbers of your answers can be totaled to gauge your level of erectile function.

According to HealthLine.com, major pharmaceutical companies have been developing and testing creams that contain alprostadil, a drug already widely used in penile injection therapy to overcome erectile dysfunction. However, as of early 2014, the FDA had not yet approved any of these creams for sale in the United States.

Already available on the Canadian and European markets, Vitaros is a cream formulation of alprostadil that is manufactured by Apricus Biosciences, headquartered in San Diego, California. While acknowledging that the PDE5 inhibitors currently on the market are generally effective in treating erectile dysfunction, Apricus points out that they do have some side effects, such as headache, vision and hearing impairment, and muscle aches, that are generally mild but tend to be more problematic for some users.

Vitaros is applied directly to the penis and produces rapid results, according to Apricus, which notes that the topical cream has been tested for efficacy and safety in more than 3,000 patients.