What is Erectile Dysfunction?

Erectile dysfunction, otherwise known as ED or impotence, is when a person cannot get or keep an erection long enough to have sex. This happens to many people occasionally and is usually caused by stress, anxiety, or drinking too much alcohol. However, if it happens often, it can be a sign of underlying health issues and may need treatment.

How common is Erectile Dysfunction?

ED is a common problem affecting almost half of men in the UK at some time in their lives. Erectile dysfunction is more common in older men, though it is normal for younger men to have occasional difficulties with their erections.

• 2% first experienced ED before age 40
• 4% first experienced ED between ages 40 to 49
• 26% first experienced ED between ages 50 to 59
• 40% first experienced ED between ages 60 to 69
• 28% first experienced ED at age 70 or above

What are the symptoms of Erectile Dysfunction?

Symptoms of erectile dysfunction include:

• being able to get an erection, but it doesn’t last long enough to have sex
• being able to get erections some of the time, but not every time you want to have sex
• not getting erections at all

Does erectile dysfunction affect fertility?

Erectile dysfunction does not directly affect your fertility. However, if having ED means you are unable to have sex, it will reduce your chances of conceiving.

Infertility in men is a separate condition that happens when you don’t produce enough sperm or your sperm is low quality. Erectile dysfunction does not affect the quality or quantity of the sperm you produce.

Can erectile dysfunction be a sign of another problem?

Yes, erectile dysfunction can be a sign of an underlying health problem. If you experience ED on a regular basis, it's important to get checked by your GP to see if you have any other health issues. 

Common underlying causes of ED include: 

• diabetes
• cardiovascular diseases such as high blood pressure, high cholesterol, and hardening of the arteries
• kidney disease
• neurological diseases like stroke, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease 
• spinal cord injury
• injury to the penis
• surgery for bladder, prostate, or colon cancer 
• Peyronie's disease (a build-up of scar tissue leading to curving of the penis)

What are the complications of erectile dysfunction?

Common complications of ED include: 

• low self-esteem
• depression and anxiety
• lack of intimacy with your partner can cause problems within the relationship
• difficulty getting your partner pregnant
• an unfulfilling sex life

What causes Erectile Dysfunction?

There is no singular cause of erectile dysfunction. There are many factors which can cause erectile dysfunction, and it’s usually caused by a combination of things rather than one issue.

Some common causes of ED include: 

• medical conditions like diabetes and high blood pressure
• certain medications like those for blood pressure and depression
• psychological issues like stress, depression or anxiety
• lifestyle choices like smoking and drinking alcohol

What are the main causes of erectile dysfunction?

The most common causes of ED are: 

• being overweight (79%)
• heart conditions (57-64%)
• sleep disorders (54-60%)
• metabolic syndrome (a combination of high blood pressure, high blood sugar, high cholesterol, and abdominal obesity) (48%)
• drinking too much alcohol (47-71%) 
• high cholesterol (42%)
• high blood pressure (41%) 
• smoking (40-70%) 
• medication side effects (25%) 
• diabetes (20%)
• prostate disorders (16-28%)
• anxiety (15-22%) 
• depression (10-16%)
• Peyronie's disease (a condition where the penis is curved due to a build-up of scar tissue) (8%)
• atherosclerosis (hardening of the arteries) (6-13%) 
• low testosterone (4-9%) 
• spinal cord injury (3-5%) 

Rarer causes of ED include: 

• Parkinson’s disease
• multiple sclerosis
• stroke
• liver or kidney problems
• chronic obstructive pulmonary disease
• injuries to the penis
• hyperprolactinemia (high levels of the hormone prolactin in the blood)
• lower urinary tract infections
• thyroid disorders
• recreational drug use
• cycling a lot

Is age a cause of erectile dysfunction?

Age is the most common factor in men who have difficulties getting or keeping an erection.

While ageing doesn’t directly cause erectile dysfunction, the condition becomes much more common as you get older. This is because you’re more likely to develop certain health conditions that do cause erectile dysfunction as you get older.

How to tell what’s causing your erectile dysfunction

It can be difficult to tell exactly what’s causing your ED because of how many different factors can contribute to having problems getting an erection. However, looking at when and how often your ED happens can help narrow it down. 

If you only have difficulty getting or keeping an erection occasionally, it is likely to be temporary erectile dysfunction caused by one-off situations, like drinking too much alcohol or being tired. 

If you find it difficult to get or keep erections unless you are by yourself, or first thing in the morning, your ED may be caused by psychological issues like anxiety or stress. This is more likely if you are under 40. 

If you find it difficult to get or keep erections all the time, your ED may have a physical cause like diabetes or heart disease. This is more likely if you are over 40. 

How is Erectile Dysfunction diagnosed?

Erectile dysfunction can be diagnosed by your doctor, either in a face to face appointment or in an online consultation. So if you think you may have erectile dysfunction, your first step should be to speak to a doctor. Some men may feel embarrassed about having ED and may try to diagnose or treat themselves, which is likely to be ineffective or make the situation worse. You should also make sure to see a doctor in case your erectile dysfunction is caused by an underlying health condition you’re not aware of.

What tests might a doctor perform if needed?

Your GP will start by asking you some questions about: 

• your medical history
• your physical health and any medical conditions you have 
• any medications you are taking
• how much alcohol you normally drink 
• whether you use recreational drugs
• your diet and lifestyle
• whether you smoke
• your mental health
• your symptoms 
• your current and past sexual relationships 
• your sex drive

Sometimes a GP may want to perform a physical examination. This is to check for possible physical causes and may include:

• blood pressure checks
• heart rate analysis
• height measurement
• weight measurement
• waist measurements
• blood tests
• an examination of your penis to check for physical abnormalities

How is Erectile Dysfunction treated?

There are several different treatments for ED including oral medications, injections, creams, lifestyle changes, and counselling. The right treatment for you will depend on what’s causing your erectile dysfunction.

Can Erectile Dysfunction be treated?

Yes. The good news is that ED can be treated. Your GP will recommend the best treatment for you. If one treatment doesn’t work, your GP may want to try another treatment option. 

 Can Erectile Dysfunction be cured?

Whether or not your ED can be cured permanently depends on the cause. When there is a physical cause and a lack of blood supply to the penis is the cause of your ED, stopping smoking, lowering blood pressure, or losing weight may be enough to reverse ED permanently. If your ED is psychological, getting treatment for depression or talking to a counsellor or sex therapist can help make your ED a thing of the past. 

When should I talk to a doctor about my Erectile Dysfunction?

You should talk to your doctor if you have been experiencing ED for several weeks, even if it's not every time you want to have sex, it's best to make an appointment with your GP.

Erectile Dysfunction treatments

There are many treatments for ED ranging from lifestyle changes and counselling to medications and medical devices. Your doctor will discuss which treatment options are right for you.  

Erectile Dysfunction Tablets

The most common erectile dysfunction tablets are:

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

Erectile dysfunction tablets are a type of medication called phosphodiesterase type 5 inhibitors, more commonly known as PDE-5 inhibitors. These tablets work by causing the muscles in the penis to relax and increasing the blood flow to the area, which helps you to get and keep an erection. 

Erectile dysfunction tablets will not cause you to get an erection automatically. Instead, they help you to get an erection when you are sexually stimulated. If you are not aroused, you won’t get an erection even if you take these medications.

Though all erectile dysfunction tablets work in similar ways, there are some differences between these medications such as how long they take to work, how long the effects last, and how often you need to take them. Some men may find that certain tablets work better than others for them, so you may want to try other options if the tablets you take don’t have the desired effect. Your doctor will help you decide which erectile dysfunction table is right for you.

Erectile Dysfunction Creams

Alprostadil (Vitaros) is a synthetic version of the hormone prostaglandin E1 (PGE1) and works by dilating (widening) blood vessels and increasing blood flow to the penis, allowing an erection to occur. It is available as a cream that is applied to the tip of the penis, an injection to the base of the penis, or a small pellet inserted into the tube (urethra) inside the penis. 

Alprostadil normally starts working within five to twenty minutes and lasts for one to two hours depending on the dose. On the downside, Alprostadil can cause prolonged and painful erections as a side effect. It is normally used when other treatments like oral medications haven’t worked. 

Medical devices for erectile dysfunction

Penis pumps, also known as vacuum pumps or vacuum erection devices consist of a tube that fits over the penis, a hand or battery-operated pump, and a ring that fits over the base of the penis to constrict blood flow and maintain the erection. Penis pumps are effective at helping you achieve and maintain an erection long enough to have sex. They may be a good choice if other treatment methods haven’t worked or have caused unpleasant side effects. 

Lifestyle changes

In addition to medical treatments, changes to your lifestyle can make a big difference in preventing or reducing your ED. 

Being overweight is a significant factor in the development of ED and 79% of men with ED have a BMI of 25 or above. Being overweight can contribute to ED in a variety of ways including damaging blood vessels, lowering testosterone levels, and increasing the likelihood of conditions such as high blood pressure. If you are overweight, losing weight can often reduce the likelihood of erectile dysfunction. 

Smoking causes damage to the blood vessels, reducing the flow of blood to the penis, and is another major lifestyle factor in the development of ED. Stopping smoking, especially before middle age, can reverse this damage and improve your ability to get and keep an erection. 

Many men find it difficult to get or keep an erection after drinking alcohol. This is because alcohol interferes with the signals in the brain that lead to an erection. Excessive drinking over time can also lower your testosterone levels, reduce your sex drive, and make it more difficult for you to ejaculate. Stick to the recommended limits of alcohol consumption, and if alcohol affects your ability to get or keep an erection, try to drink less before engaging in sexual activity.  

Exercise is vital for all aspects of health, and sexual health is no different. Lack of physical activity is linked to many health issues including obesity, high blood pressure, and metabolic syndrome. One study showed that 40 minutes of moderate to vigorous exercise four times a week over six months resulted in a decrease in erectile problems in men with obesity, heart disease, metabolic syndrome, and high blood pressure. 

Counselling

Sometimes ED doesn’t have a physical cause but is a result of psychological issues including:

• depression
• anxiety
• low self-esteem
• nervousness about sexual performance
• relationship issues

Your GP will ask you some questions to try and determine whether the cause of your ED is physical or psychological. If the cause is likely to be psychological, sexual health therapy can help. This is often more effective when your partner participates in the therapy too. 

Supplements and natural alternatives

There are many supplements and natural alternatives claiming to cure ED. In reality, these claims are often unproven, untested, and untrue. At best, spending your money on “herbal Viagra” may leave you out of pocket, but at worst it can interfere with your other medications, or make your ED worse. Always talk to your doctor or healthcare provider before taking any medications for your ED, including herbal supplements or those bought online or over the counter. 

How to prevent Erectile Dysfunction

Erectile dysfunction isn’t usually something most men think about until it happens to them. Prevention, however, is always better than cure and you can reduce the likelihood of developing ED by taking care of your physical and mental health. Some lifestyle changes you can make to reduce the risk of developing ED include: 

• not smoking
• eating a healthy, balanced diet low in sugar and saturated fat
• keeping your weight within healthy limits
• avoiding recreational drugs
• avoiding drinking too much alcohol
• taking regular exercise
• communicating effectively within your relationship

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