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.
Does Viagra (sildenafil) always work?
Viagra and other PDE5 inhibitors work for about 65–70% of men. However, many men use them incorrectly — taking them on a full stomach, not waiting long enough, or without sufficient arousal. If Viagra has not worked for you, it does not mean all pills will fail. Cialis (tadalafil) works differently and may be more effective. If pills stop working entirely, penile injections and implants are excellent next steps.
What is the difference between Viagra, Cialis, Levitra, and Stendra?
All four are PDE5 inhibitors that work the same way — increasing blood flow to the penis. 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 for on-demand erections anytime, 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. Dr. Kashani will help you choose the right one.
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 penis looks and feels completely natural — no one can tell you have an implant. It does not affect orgasm or ejaculation. Patient satisfaction rates are over 90%, the highest of any ED treatment.
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. If you are under 40 and experiencing ED regularly, you should see a doctor.
Is ED a sign of heart disease?
Often, yes. The arteries that supply blood to the penis are very small — smaller than coronary arteries. When cardiovascular disease begins to narrow blood vessels, the penis is usually affected first, often years before a heart attack. For this reason, ED is sometimes called the "canary in the coal mine" for heart health. Getting evaluated for ED can literally save your life.
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. Generic sildenafil and tadalafil are now very affordable. 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. Most men leave the first visit with a clear plan and renewed confidence.
