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What is erectile dysfunction (ED)?

Erectile dysfunction (ED) is a common issue affecting many men. The term covers a range of erection problems, from not being able to get an erection at all, to not being able to maintain a firm enough erection to have sex. This may happen all the time or just occasionally.

What causes erectile dysfunction?

When a man is sexually aroused, signals from the nervous system cause blood to flow to the penis, resulting in an erection. In men with erectile dysfunction, something stops that from happening effectively. This can be for a number of different reasons, either physical or psychological, such as:

  • An underlying physical condition such as diabetes or high blood pressure, which may narrow the blood vessels supplying the penis, making it harder for blood to flow through
  • Changing hormone levels, for example as a result of an overactive thyroid
  • A neurological issue which prevents the nerves from functioning properly, such as stroke or multiple sclerosis
  • Physical damage resulting from injury, surgery or conditions like Peyronie’s disease
  • A side effect of medication
  •  A result of taking drugs or drinking too much alcohol
  • Depression, anxiety, stress or emotional issues relating to sex, such as relationship problems.
  • Being overweight, smoking and leading a sedentary lifestyle are all factors that can make you more likely to experience erectile dysfunction.

Psychological erectile dysfunction

A number of psychological therapies can help men to get to the root of the psychological issues that are causing erectile dysfunction.

  • Sensate focus is a strategy that a man can try with his partner. It involves agreeing not to have sex for a certain period of time, usually several weeks. During this time you can explore different types of closeness and focus on your relationship without any pressure to have sex.
  • Psychosexual counselling is a talking therapy that can help a man to explore any issues around relationships and sex. It can be done with our without your partner.
  • Cognitive behavioural therapy (CBT) is a practically-focused type of therapy that concentrates on changing your attitude and mindset.

How is erectile dysfunction diagnosed?

It’s very common for men aged over 40 to experience erection problems from time to time. If this happens to you for more than a few weeks, it’s a good idea to visit your GP or GUM clinic for an examination. The doctor or nurse will ask some questions about your general health, mental wellbeing and sexual history before doing some physical checks and tests. These may include:

  • Blood pressure check
  • Blood test
  • Heart rate
  • Height and weight

A health professional may also want to examine your penis if they suspect an injury or other anatomical issue may be causing your erection problems. If there are signs of prostate issues, they may need to do a rectal examination.
These questions and checks will help to determine the cause of erectile dysfunction, so that action can be taken to treat it.

How to cope with erectile dysfunction

Erectile dysfunction isn’t easy to live with. You may find it affects your confidence or leaves you feeling frustrated. If you have a partner, you may worry about how it will affect them.
Although it isn’t always easy, the best way to cope is to be honest about the problem and to seek help to find treatment. Talk to your GP or sexual health practitioner about your symptoms and possible solutions. Rather than avoiding sex, be open with your partner about what you are going through.

If your erectile dysfunction is partly or wholly caused by psychological issues – or if the condition itself is affecting your mental wellbeing - counselling may help. You may choose to go to couples’ therapy to talk about any problems in your relationship, or speak to someone by yourself to better understand the issues you are experiencing.

How to talk to your partner about erectile dysfunction

Your partner may have already noticed a problem, or you may have avoided the issue with them. Either way, being honest is the best approach. Let them know that it’s not something you can control or be blamed for, and it’s nothing personal – it doesn’t mean that you don’t find them attractive. Let them know that it’s a common issue and tell them the steps you are taking to fix it. By talking honestly about erectile dysfunction, you may find that you become more relaxed with your partner, which may help your erection problems.

How to support your partner with erectile dysfunction

Erectile dysfunction doesn’t just affect the person with erection problems – it has a big impact on their partner, too. If your partner is affected by erectile dysfunction, you might understandably feel rejected or insulted, but erection problems are not the same as a lack of desire. Erectile dysfunction does not have to harm your relationship, but in order to cope as a couple, it’s important to be open and honest with each other about your respective feelings.
To support your partner, let him know that you are there, and reassure him that erectile dysfunction doesn’t change your commitment to him. Don’t be afraid to share your own experiences, but be constructive in finding solutions that you can work on together. Keep your relationship intimate by adjusting your sex life so that there’s no ‘pressure to perform’, and stay close by carrying on talking and doing things together. Support any lifestyle changes he is advised to make – for example, by joining him in a new exercise regime.


What are the symptoms of erectile dysfunction?

The symptoms of erectile dysfunction are the inability to get an erection, or to sustain a firm enough erection to have satisfactory sex. These may occur all the time, or just occasionally. Some men may be able to get an erection while masturbating, but not during sex with another person.


How can I improve my ED?

That depends on what’s causing your erection problems. It’s important to see your GP or visit your GUM clinic, so that a health professional can check you over and assess why you are experiencing erectile dysfunction.

That said, erectile dysfunction is more likely if you are overweight, a smoker or a drug user, so lifestyle changes such as giving up smoking and taking more exercise may help.

How can erectile dysfunction tablets help?

Erectile dysfunction tablets help erectile dysfunction by causing extra blood flow to the penis, which enables men to get an erection when they are sexually aroused.

How is erectile dysfunction treated?

The treatment for erectile dysfunction will depend on the cause:

  • If your GP suspects that your erection problems are caused by restricted blood flow to the penis, treatment may involve:
    •  lifestyle changes, such as losing weight, cutting down on alcohol or stopping smoking
    • medication to lower blood pressure.
  • If hormonal changes are behind your erectile dysfunction, you may be prescribed hormone replacement treatment.
  • If you are taking medication that may be affecting your ability to achieve an erection, your GP may suggest switching to an alternative type of medication.
  • If your erectile dysfunction has a psychological cause, psychological therapies, sex therapy or counselling may be the most effective treatment. Sometimes you may also be prescribed medication to help you overcome ED in the short term. 

What medications are available for erectile dysfunction?

The main type of medication for erectile dysfunction is a class of medicines known as Phosphodiesterase-5 (PDE-5) inhibitors. These work by temporarily increasing the blood flow to the penis.

Four types of PDE-5 inhibitors are available:

  • Sildenafil (Viagra)
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)
  • Avanafil (Spedra)

These all work in the same way, but they vary in the time it takes for them to take effect, and how long the effects last.

PDE-5 inhibitors are the most common type of medication for erectile dysfunction. An alternative to PDE-5 inhibitors is a hormone treatment called Alprostadil, which is available as an injection or a pellet to be inserted into the urethra.

How effective is ED medication?

The efficacy of different erectile dysfunction treatments varies between different people. On average, around 6 in 10 men who use one of the four PDE-5 inhibitors available find that it works for them.

It’s important to note that in addition to taking the medication correctly, you must also be sexually aroused in order to achieve an erection.

Which erectile dysfunction medication is right for me?

Your choice of erectile dysfunction medication will depend on how often you would like to be sexually active, how long you would like the effects to last, and whether you have tried any similar medications before without success. Our flow chart below is designed to help you decide which type of PDE-5 inhibitor is right for you.

Why do I need to try different ED medications?

You may need to try different ED medications to find out which one works best for you. Not all ED medications work well for everyone and you may experience unwanted side effects. Therefore, it's worth trying a few different ED medications to decide which is best got you.

Which is the best ED medication?

That depends on your individual needs and preferences. Everyone is different, so what’s best for one person may not work so well for someone else. However, of the four available PDE-5 inhibitors, Sildenafil (Viagra) has the highest success rate, working for 65% of people.

What are the alternatives to erectile dysfunction medication?

A vacuum pump is the main alternative to erectile dysfunction medication. A plastic tube connected to a pump is placed over the penis, and when the pump is operated, a vacuum is created inside the tube, which causes blood to flow to the penis and make it hard. To maintain the erection, a rubber ring is placed at the base of the penis, which can be worn while you have sex.
For psychological causes of erectile dysfunction, counselling and sex therapy can be effective treatments.

How to prevent ED

Most men experience erectile dysfunction at some time in their life, but you can reduce the risk by making changes to your lifestyle. These may include getting regular exercise, eating a healthy diet and cutting down or giving up alcohol, tobacco products, steroids and illegal drugs.

Lifestyle changes to improve erectile dysfunction

You may be able to improve erectile dysfunction by making some changes to your lifestyle. 

These could include:

  • Giving up smoking, or cutting down on the amount of cigarettes you smoke
  • Drinking less alcohol
  • Stopping taking drugs
  • Getting more exercise
  • Losing weight if you are overweight
  • Avoiding stress

Can sex therapy help erectile dysfunction?

Some cases of erectile dysfunction are caused by psychological issues surrounding sex and relationships. In these cases, a qualified sex therapist may be able to help you get to the bottom of the issues that are leading to erection problems. You can see a sex therapist by yourself or with a partner.

Can you have surgery for erectile dysfunction?

Occasionally, some men do have surgery to treat erectile dysfunction. However, this is rare, and is usually only considered if all other options have been tried to no avail, or if there are physical injuries or impairments. During surgery, a penile implant is fitted.

Side Effects

What are the complications of ED treatment?

Side effects of PDE-5 inhibitors can include:

  • Headaches
  • Flushing (redness)
  • Indigestion
  • A blocked or runny nose
  • Nausea or vomiting
  • Back pain
  • Muscle pain
  • Vision disturbances.


Can cycling cause ED?

Some people worry that riding a bike will cause erectile dysfunction. While cycling for more than three hours a week can increase men’s chances of developing ED (due to the potential for damaged nerves and arteries in the perineal area), being inactive or overweight can also increase the risk.  The cardiovascular benefits of regular exercise and of being within a healthy weight range help to protect against many serious diseases, as well as making ED less likely.

Does diet affect erectile dysfunction?

Yes, your diet can affect your chances of developing ED. Men who are overweight are more likely to experience erection problems, so by eating a healthy diet and consuming the recommended number of calories for your size, you can reduce your risk of ED.

Which diseases can cause erectile dysfunction?

There are several diseases and conditions that can lead to erectile dysfunction.

  • Vascular conditions, such as heart disease, high blood pressure and diabetes, can all reduce blood flow to the penis, making it harder to get an erection
  • Neurological conditions, such as stroke, multiple sclerosis and spinal injuries, can affect nerve function
  • Hormonal conditions, such as over- or under-active thyroid, hypogonadism and Cushing’s syndrome, can all cause erectile dysfunction
  • Peyronie’s disease, which affects the tissue of the penis, can make it difficult to get an erection.

Which medications can cause ED?

There are several types of prescription and over-the-counter medicine that can make changes to the body, causing erectile dysfunction. These include:

  • Antidepressants, such as Fluoxetine
  • Anticonvulsant medicines used to treat epilepsy
  • Antihistamines, which are commonly used to treat hay fever
  • Antihypertensive drugs such as beta blockers, which are used to treat high blood pressure
  • Antipsychotic drugs
  • Corticosteroids
  • Diuretics, which can reduce the blood flow to the penis

This is not an exhaustive list, so if you are taking any type of medication and think that it may be affecting your sex life, talk to your GP, who may be able to prescribe an alternative.

What is psychological ED?

Psychological ED is erectile dysfunction that results from psychological problems, such as depression, anxiety or unresolved issues surrounding sex and relationships.

What is porn-induced erectile dysfunction and is it real?

Porn-induced erectile dysfunction (PIED) is a recognised issue, particularly among younger men. Studies show that erectile dysfunction and other sexual problems have become more common with the rise of easy-to-access internet pornography. Reducing or stopping exposure to pornography has been shown to help some men combat their erectile dysfunction.

Do alternative therapies help ED?

You may have heard of herbal alternatives to Viagra, which claim to treat erectile dysfunction. However, there is no evidence that these are effective.  In fact, the ingredients in some herbal remedies could interfere with the way Viagra and other medicines work, so it is important to consult a doctor before considering them.

What causes erectile dysfunction in young men?

Erectile dysfunction in men under 40 is less likely to be caused by physical problems and more likely to be a psychological issue. Young men may feel under pressure to perform sexually, or anxious about the possibility of an unwanted pregnancy.  

Can stress cause erectile dysfunction?

Yes, stress can be a factor in erectile dysfunction. On its own or in combination with other psychological or physical problems, stress can lead to problems getting an erection or maintaining it. Avoid stressful situations can often help in the treatment of ED.

What are the physical causes of ED?

The physical causes of erectile dysfunction include:

  • pre-existing medical conditions such as diabetes, stroke, hormone imbalance and high blood pressure
  • side effects of medications
  • injury or damage to the penis.

What are PDE-5 inhibitors?

PDE-5 inhibitors are the most common type of medication used to treat erectile dysfunction. They work by increasing blood flow to the penis.

Are erectile dysfunction and premature ejaculation related?

In some cases, erectile dysfunction and premature ejaculation could be related. If you are experiencing both of these issues, they shouldn’t be treated in isolation: talk to your doctor about possible causes and treatments.

Can ED be reversed?

Yes, in the vast majority of cases, it’s possible to treat the causes behind erectile dysfunction.

Are ED medications safe?

When obtained from a regulated supplier, PDE-5 inhibitors such as Viagra are safe for most people to use. Like any other medication, your ED medicine must be taken according to the directions in the patient information leaflet, and there may be some side effects, including:

  • Headaches
  • Flushing (redness)
  • Indigestion
  • A blocked or runny nose
  • Nausea or vomiting
  • Back pain
  • Muscle pain
  • Vision disturbances

PDE-5 inhibitors are not safe for:

·         Those taking poppers (butyl nitrate) or angina medication that contains nitrates. This could lead to a dangerous interaction between the two drugs
·         People with low blood pressure
·         Those who have angina
·         Men who have recently had a stroke, or who have had a heart attack
·         Those with a history of on-arteritic anterior ischaemic optic neuropathy.

PDE-5 inhibitors may not be recommended for people with some other conditions, such as heart disease or Peyronie’s disease. Talk to your GP about the right treatment for you.

At what age is erectile dysfunction most common?

Erectile dysfunction is most common in men aged between 40 and 70. It is thought to affect as many as half of all men in this age group at some time.

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