Erectile dysfunction

Published by Bupa’s Health Information Team, June 2011.

This factsheet is for men who have erectile dysfunction, or for anyone who would like information about it.

Erectile dysfunction, also known as impotence, is the frequent inability to achieve or maintain an erection for sexual activity to take place.

About erectile dysfunction

If you have erectile dysfunction, you may have frequent difficulty with either getting an erection or keeping one for long enough to allow penetrative sex.

Erectile dysfunction is one of the most common sexual problems and affects around one in 10 men in the UK. You’re more likely to get it as you get older.

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
• obesity
• multiple sclerosis
• Parkinson’s disease
• stroke
• surgery (such as an operation to remove your prostate gland) or radiation to your pelvic area
• hormone imbalances such as hypogonadism, which causes low levels of testosterone
• Peyronie’s disease – a condition affecting the sheath that surrounds the erectile tissue of the penis

Psychological causes

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

• feeling anxious, guilty or depressed
• 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:

• drinking excessive amounts of alcohol
• taking illegal drugs such as smoking cannabis
• smoking
• being physically inactive
• cycling for more than three hours a week – this can damage your nerves through contact with the saddle

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 erections, ejaculation and orgasm.

Diagnosis of erectile dysfunction

You may decide to see your GP if you’re having problems getting an erection. Occasional episodes of not being able to get an erection are common and don’t mean that you will have persistent problems in the future.

Your GP will ask you about your symptoms and examine you. This may involve an examination of your penis, scrotum or prostate gland. He or she may also ask you about your medical history.

Your GP may check your blood pressure and the pulses in your legs. This helps to indicate how healthy your circulation is. Your GP may also take a blood sample to test for any related conditions such as diabetes or hormone imbalances.

If necessary, your GP may refer you for more specialised tests to assess your blood flow and how well your nerves are working.

Treatment of erectile dysfunction

Self-help

Adopting a healthy lifestyle may help to prevent your erectile dysfunction from getting worse. The following changes may help.

• Stop smoking.
• If you’re overweight, lose excess weight.
• Do regular physical activity – 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. Try not to exceed four units of alcohol a day.
• Aim to reduce stress where possible.

Medicines

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

Medicines called phosphodiesterase-5 inhibitors can help you to get and sustain an erection. These medicines increase the blood flow to your penis, leading to 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.

There are different types of phosphodiesterase-5 inhibitors. The most common include:

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

You may not be able to take these medicines if you have coronary heart disease or take certain other medicines.

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

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. If you buy medicines over the internet, there is a risk that they are from unregulated and illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness of the medicines provided. If you do wish to purchase medicines online, speak to your GP about the provider first.

If your erectile dysfunction is caused by a hormone imbalance, your GP may refer you for testosterone replacement therapy.

Alternative treatments

An external vacuum pump is a device that pumps air out from around your penis to create a vacuum. This sucks blood into your penis, leading to an erection. You can use these with a constriction band to trap blood inside your penis, which helps to maintain your erection.

If you still get erectile dysfunction after trying phosphodiesterase-5 inhibitors medicines and vacuum pumps, your GP may give you a medicine called alprostadil. This is a synthetic (man-made) hormone to stimulate blood flow to the penis. Alprostadil can be injected directly into your penis or a small pellet can be placed inside your urethra.

You may be able to have surgery to increase the blood flow to your penis or have a penile implant inserted. However, this is very rarely needed. Ask your GP for more information.

Talking therapies

If your erectile dysfunction is caused by psychological problems, you may benefit from talking therapies such as cognitive behavioural therapy (CBT) or psychosexual counselling.

CBT is a talking therapy from a trained therapist that challenges negative thoughts, feelings and behaviour. CBT can also teach you stress management and relaxation techniques that may help you to find it easier to get and keep erections.

Psychosexual counselling is a type of relationship therapy where you and your partner can discuss 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.

Complementary therapies

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 that can affect other medicines and cause side-effects, so always speak to your GP before trying any complementary therapies.

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

For sources and links to further information, see Resources.