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The first thing I worry about when someone has erectile dysfunction in the presence of a disc herniation is a pinched nerve (specifically cauda equina syndrome). Typically, cauda equina syndrome also causes urination problems (trouble flowing or uncontrollable going). The bowel incontinence can also be a serious indicator of nerve problems. If the nerves are working well, then I consider sexual dysfunction to be a two-fold problem: pain inhibition of sexual function (when the brain senses threat/danger, it will shut down system not immediately needed like reproduction and digestion) and/or medications lowering the testosterone levels. I will check testosterone and PSA levels before starting someone on testosterone supplementation usually a cream or gel. It also comes in pills and patches. Dealers choice. Sometimes it works well. But it is not a 100% rock solid solution, just a possible solution. Dr. Christina Lasich, MD