Erectile dysfunction

Erectile dysfunction (ED), also known as impotence, is the inability to get and then maintain an erection.

Why is this important?

Erectile dysfunction can be a sign of more serious health conditions, such as heart disease or diabetes, or a result of a mental health condition, such as depression.

Who does it affect?

Erectile dysfunction is a very common problem, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.

What does this mean for me?

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. If this is the case, it is likely the underlying cause of erectile dysfunction is psychological or stress related.

If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.

If you have erectile dysfunction for more than a few weeks, it is important to visit a sexual health clinic or see your GP.

Why does it happen?

When a man becomes sexually aroused, his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.

There are many reasons for erectile dysfunction so your clinician will talk to you about your lifestyle to determine the cause of the problem.

Physical causes of ED include:

  • Narrowing of the blood vessels going to the penis - commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
  • Hormonal problems, such as an overactive thyroid
  • Surgery or spinal injury
  • Conditions that affects the body’s movement, such as Parkinson’s disease
  • Erectile dysfunction can also be a side-effect of using certain medicines.

Psychological causes of ED include:

  • Anxiety
  • Depression
  • Relationship problems.

Treatment

Erectile dysfunction can be treated by tackling the cause of the problem.

The narrowing of blood vessels is one of the most common causes. In these cases, your clinician may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health. You may also be given medication to reduce your blood pressure.

Medication, such as Viagra, can be used to manage erectile dysfunction in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.

Psychological treatments include cognitive behavioural therapy (CBT) and sex therapy. Read more in our Questions section.

Overall, treatments for erectile dysfunction have improved significantly in recent years.

More support

Get tested

If you have erectile dysfunction for more than a few weeks, you can visit a sexual health clinic or your GP to get help. A clinician will ask you about your lifestyle and sexual history to assess your general state of health. The clinician may then physically examine you, check your blood pressure and take a blood sample.

Questions?

If this is a new problem then you should wait for a few weeks as it may settle on its own. If it continues beyond a few weeks then you should discuss it with your sexual health clinic or GP.

Erectile dysfunction can often be improved by making changes to your lifestyle, such as:

  • Losing weight if you are overweight
  • Giving up smoking
  • Cutting back your alcohol consumption
  • Not taking illegal drugs
  • Exercising regularly
  • Reducing stress.

Cognitive Behavioural Therapy (CBT) is a form of counselling based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction - for example, to do with:

  • Your self-esteem (the way you feel about yourself)
  • Your sexuality
  • Your personal relationships.

Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.

Erectile dysfunction can be an embarrassing problem, so some men are tempted to look for treatment on their own. It is possible to buy medication over the internet, but many sites offer counterfeit medicines. These medications are not regulated and the amount of active ingredients in them can vary. They could cause unpleasant side effects or they may not be suitable for you.

Always ensure that any online doctor service is registered with the Care Quality Commission (CQC), that all doctors are registered with the General Medical Council (GMC), and that any prescribed medicines come from a pharmacy which is registered in the UK.

It is also possible that an underlying health condition may be causing your erectile dysfunction and getting this diagnosed and treated may resolve your symptoms. Therefore, always see your GP or visit a sexual health clinic for a full check-up.