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Erectile dysfunction

Key points

  • Erectile dysfunction (ED) is the regular inability to achieve or maintain an erection sufficient to have penetrative sex.
  • It’s a very common problem that becomes more likely as you get older.
  • Erectile dysfunction is often associated with problems with your heart and blood flow, including high blood pressure and diabetes.
  • The condition can also have psychological causes or it may be a side-effect of certain medicines.
  • Making changes to your lifestyle may help erectile dysfunction, or you may be prescribed medicines to treat it.

Featured FAQ

Is there a link between erectile dysfunction and heart disease?

Yes, one of the main causes of heart disease is the build-up of fatty deposits. These can narrow and may eventually block the arteries that supply your heart with blood. This process is known as atherosclerosis and can also affect the blood vessels that take blood to your penis. A lack of blood getting to your penis can cause erectile dysfunction.

Erectile dysfunction, also known as ED and impotence, is the frequent inability to achieve or maintain an erection sufficient for sexual activity to take place. It can be an early sign of heart problems that need treatment.

About erectile dysfunction

If you have erectile dysfunction, it’s likely that you often have difficulty getting an erection or keeping one for long enough to have penetrative sex.

Erectile dysfunction is one of the most common sexual problems and affects up to 20 men in every 100. You’re more likely to get it as you get older. It’s important to see your GP because erectile dysfunction can be a sign of a problem with your heart and blood flow around your body.

It’s important to be aware that erectile dysfunction isn’t the same as problems with ejaculation or orgasm. If you have erectile dysfunction, you may be able to ejaculate even if you’re not able to have penetrative sex.

Causes of erectile dysfunction

There a number of reasons why you may have erectile dysfunction.

Physical causes

A number of conditions may cause erectile dysfunction, including:

  • high blood pressure
  • high cholesterol
  • diabetes
  • multiple sclerosis
  • Parkinson’s disease
  • stroke
  • treatment for prostate problems, such as an operation to remove your prostate gland or radiation to your pelvic area
  • a problem with your hormones (chemicals occurring naturally in your body), such as hypogonadism, which causes low levels of testosterone
  • Peyronie’s disease – a condition that causes your penis to curve when it’s erect

Psychological causes

Psychological problems can affect your ability to get and keep erections. These include:

  • feeling anxious, guilty or depressed
  • performance anxiety
  • stress at work or home
  • relationship problems
  • unresolved issues about sexual orientation
  • sexual boredom

Lifestyle causes

Many factors to do with your lifestyle can influence your ability to get and keep erections. These include:

  • smoking
  • drinking excessive amounts of alcohol
  • taking illegal drugs, such as cannabis
  • being physically inactive

Medicines

The side-effects of some medicines, such as treatments for high blood pressure and certain antidepressants, can cause erectile dysfunction. Medicines can also affect your sex drive or cause problems with ejaculation and orgasm.

Diagnosis of erectile dysfunction

It’s a good idea to see your GP if you’re consistently having problems getting an erection. Not being able to get an erection occasionally is common and doesn’t mean that you will have persistent problems in the future.

Your GP will ask you about your symptoms and lifestyle, such as whether you smoke and how much alcohol you drink, and examine you. This may involve an examination of your penis, scrotum or prostate gland.

Your GP is also likely to check your weight and waist circumference, as well as measuring your blood pressure and heart rate. This helps to indicate how healthy your blood flow is and whether you’re at risk of diabetes or heart disease, which are often associated with erectile dysfunction. Your GP may arrange a blood test to check the levels of glucose (sugar), cholesterol and other hormones, such as testosterone, in your blood.

Treatment of erectile dysfunction

Self-help

Making some changes to your lifestyle may help to prevent your erectile dysfunction from getting worse. The following may help.

  • If you smoke, try to stop. Ask your GP for information about help and support that is available to you.
  • If you’re overweight, lose excess weight.
  • Do regular physical activity. Aim for 150 minutes of moderate exercise over a week in bouts of 10 minutes or more.
  • Eat a low-fat, high-fibre diet, including at least five portions of fruit and vegetables a day and two portions of fish (one oily) a week.
  • Drink alcohol in moderation. The recommended daily limit for men is three to four units, with at least two alcohol-free days per week.
  • Try to reduce stress where possible.
  • If you cycle for more than three hours a week, your GP may advise you to stop for a while to see if your condition improves. However, there is no good evidence to show that cycling leads to erectile dysfunction.

Medicines

If your GP thinks that prescription medicines you’re taking for other conditions may be causing or contributing to your erectile dysfunction, he or she will discuss possible alternatives with you. Don’t stop taking any medicines that are prescribed to you before speaking to your GP.

Your GP may prescribe you a type of medicine called a phosphodiesterase-5 inhibitor. These medicines increase the blood flow to your penis and can help you to get and sustain an erection. They don’t increase your sex drive so you will still need sexual stimulation. The medicines enable you to have an erection for several hours.

The most common phosphodiesterase-5 inhibitors are:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

Phosphodiesterase-5 inhibitors may cause side-effects, including headaches, feeling sick, vomiting and indigestion.

You won’t be prescribed these medicines if you’re taking medicines that contain nitrates, for example glyceryl trinitrate (GTN) for angina. Your GP may also not prescribe them if you have heart disease.

It’s now possible for you to buy some of these medicines over the counter in pharmacies, following a consultation with a pharmacist. Be careful if you’re considering buying medicines on the internet, particularly prescription medicines. Speak to your GP about the provider first.

If phosphodiesterase-5 inhibitor medicines don’t work for you, or you can’t be prescribed them, your GP may offer you a medicine called alprostadil. This is a synthetic (man-made) hormone that stimulates blood flow to your penis. Alprostadil can be injected directly into your penis or a small pellet can be inserted inside the opening at the tip of your penis. A new cream containing alprostadil has been developed and authorised for use in Canada. However, it hasn’t yet been approved or licensed for use anywhere else and there is no evidence available about its long-term effectiveness or safety.

If your erectile dysfunction is caused by a problem with your hormones, your GP may prescribe you testosterone replacement therapy.

Non-surgical treatments

You may wish to try using a vacuum erection device if medicines haven’t worked or you can’t be prescribed them. This is a device that pumps air out from around your penis to create a vacuum. This draws blood into your penis, leading to an erection. You can use these with a constriction band that traps the blood inside your penis, which helps to maintain your erection.

Talking therapies

If your erectile dysfunction is caused by a psychological problem, you may benefit from a talking therapy. This could be psychosexual counselling or cognitive behavioural therapy (CBT). Your GP may recommend that you try this as well as prescribing medicines for you.

Psychosexual counselling is a type of therapy you can do alone or with your partner if you have one and he or she is willing. It involves discussing any sexual or emotional issues that may be contributing to your erectile dysfunction. The counsellor may also give you some practical advice about sex, such as foreplay techniques and how to use other treatments for erectile dysfunction.

CBT is a talking therapy in which you work with a trained therapist to challenge negative thoughts, feelings and behaviour. CBT may help you to address problems such as anxiety or depression if these are contributing to your erectile dysfunction.

Surgery

You may be able to have surgery to increase the blood flow to your penis or have a penile implant inserted – this involves inserting a cylinder down the centre of your penis to make it rigid. However, this is very rarely needed. Ask your GP for more information.

Complementary therapies

Some complementary therapies, such as acupuncture or herbal remedies, claim to treat erectile dysfunction. However, there is little clinical evidence to prove this. Some herbal remedies may contain ingredients, including prescription-only medicines, that can affect other medicines and cause side-effects. Always speak to your pharmacist or GP before trying any complementary therapies.


Reviewed by Polly Kerr, Bupa Health Information Team, September 2013.

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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