Erectile dysfunction, treated from the diagnosis up
Most of our patients arrive having already tried tablets. The question that matters isn’t which pill next — it’s why the tablets didn’t work.
George W. Carroll, MD Florida license ME48111NPI 1073644985 Men’s sexual medicine since 1992
Where ED comes from
An erection is a vascular event managed by nerves. It can fail for different reasons: blood may not arrive well (an arterial problem), it may not stay (a venous leak), the nerves may be less sensitive than they should be, hormones may be off — or several of these at once.
Each cause points to a different treatment. That is why care here starts with a recommended diagnostic evaluation — duplex Doppler ultrasound plus nerve-sensitivity testing — rather than with a prescription pad.
Treatment options
Oral medication
FDA-approved tablets (sildenafil, tadalafil, vardenafil) are the usual first line, and we prescribe them where they fit. Many of our patients have already been failed by tablets elsewhere — often because the underlying cause was never identified.
Compounded injection therapy
Our most used treatment. Because it acts locally rather than through the whole body, it is also frequently the appropriate option for men who take nitrate heart medication and cannot use ED tablets. How injection therapy works here →
Shockwave therapy
An in-office treatment course offered for selected patients — described on its own page with an honest account of the evidence. Read the honest version →
Hormone work-up
Where labs point to a hormonal contribution, treatment focuses on raising your own testosterone production while preserving fertility. Our approach to hormones →
If the difficulty is finishing too quickly rather than getting or keeping an erection — or both at once — that is a separate evaluation with its own treatments. Premature ejaculation →
Two safety rules every patient should know
- Nitrates: do not use ED tablets with any nitrate medication (nitroglycerin, isosorbide) or riociguat — the combination can cause a dangerous drop in blood pressure. Tell us every medication you take.
- Priapism: seek emergency care for any erection lasting longer than 4 hours, whatever treatment you use.
Common questions
- Do you prescribe generic sildenafil or tadalafil?
- Yes. Sildenafil, tadalafil and vardenafil are the generic names of the FDA-approved tablets that are the usual first line for erectile dysfunction, and Dr. Carroll prescribes them when they are the right fit. What matters here is what happens when they are not: most men arriving at this practice have already tried tablets without success, and that result is information rather than a dead end. It points the evaluation at what a tablet could not reach — blood that doesn’t arrive well, blood that doesn’t stay, or reduced nerve sensitivity — and those call for different treatments. So the next step here is measurement, not another prescription. What the diagnostic study measures →
- Tablets stopped working for me. Is that the end of the road?
- No. It usually means the cause was never identified. Locally acting treatments work differently from tablets, and the diagnostic study shows which pathway makes sense for you. One of the newer options we discuss →
- Can I be seen without coming to the office?
- Yes — for patients in Florida, your first visit with Dr. Carroll can be a private video consultation, and some men get what they need without driving anywhere. When he recommends the diagnostic study, or a treatment that has to be started under supervision, those happen in our Maitland office and he'll tell you why before you make the trip.
- I take heart medication. Can I still be treated?
- Often, yes. Men on nitrates can’t use ED tablets, but locally acting options exist precisely for this situation. Your full medication list is reviewed before anything is prescribed.
- Can a 70-year-old man still get erections?
- Very commonly, yes — with the right diagnosis and treatment. Age raises the odds of an underlying vascular cause, which is exactly what the diagnostic study identifies, and locally acting treatments work independently of age for most men.
- What actually happens at your first visit?
- Here: a private conversation about your history and goals, a recommended diagnostic study that measures blood flow and nerve sensitivity, and treatment chosen from those findings — with alternatives and costs explained before you commit to anything.
- My partner pushed me to look into this. Is that normal?
- It’s one of the most common ways men arrive here. ED affects both people, and partners are welcome at consultations — several of our longtime patients came in exactly this way.
Care provided by George Carroll, M.D.
Medically reviewed by George W. Carroll, MD (Florida license ME48111) · Reviewed August 2026
Get an answer, not another prescription
Even if you choose to do nothing, it’s worth knowing what’s going on. Dr. Carroll will tell you, and the decision stays yours. One call to our office starts it — no obligation, no pressure, and no one pushing you toward a decision.
Office hours: Mon–Fri 9:00 AM – 5:00 PM.