Erectile dysfunction

What is erectile dysfunction?

Erectile dysfunction is the inability to get or keep an erection. It’s also called impotence and is very common in men over 40.

Most men will suffer from erection problems at some point and it’s generally nothing to worry about unless it becomes an ongoing issue.

Erectile dysfunction causes

The most common triggers of erectile dysfunction are:

• Stress

• Anxiety

• Fatigue

• Drinking too much alcohol

If problems getting or keeping an erection keep happening, it could be due to an underlying cause or a medical condition. For example:

• Diabetes

• Heart disease or high blood pressure

• High cholesterol

• Hormone deficiencies

• Chronic mood disorders, such as depression

An underlying condition is more likely to be the cause if you’re experiencing erection problems with a partner as well as when you’re alone, and if it’s your morning erections that are affected.

Certain medication can also cause impotence, including antidepressants, diuretics, tranquilizers and medication for high blood pressure and irregular heart action.

Some surgical procedures, like surgical treatment for prostate problems, can also increase your risk of erection problems.

Erectile dysfunction symptoms

The most common signs of erectile dysfunction are:

• Ongoing difficulty getting an erection

• Trouble keeping an erection long enough for satisfactory intercourse

• A loss of interest in sex

When should you see a GP?

If you’re having repeated episodes of erectile dysfunction, particularly if you’ve also lost your normal morning erections, it’s best to discuss it with a GP as it could be a sign of an underlying medical condition.

You can also go to your local sexual health clinic for help and advice about erectile dysfunction. Many offer walk-in appointments without the need to book first.

Erectile dysfunction treatment

When impotence is caused by tiredness or drinking too much alcohol, it’s often an isolated situation that’s nothing to worry about and it will go away on its own.

Treatment based on the underlying cause

Treatment for ongoing impotence problems often depends on the underlying cause. For example:

• Stress – Regular exercise, meditation, mindfulness, yoga, and deep breathing exercises can all be helpful in reducing stress.

• Mental health conditions – Mild anxiety and depression may respond well to psychological talking therapies like cognitive behavioural therapy (CBT) or counselling.

• Health conditions like diabetes or heart disease - Treatment will be targeted towards the specific condition, for example, medication to improve diabetic control, or to lower blood pressure.

• Hormone problems – If you have low testosterone levels it can cause erection problems. This can be treated with testosterone replacements like gels, applied to the skin.

• Relationship problems – If you only have erection problems during intercourse with a partner (and not when masturbating or with morning erections), sexual counselling for performance or sexual anxieties can help.

Medical treatment and procedures

If there’s no obvious underlying cause for your erection problems, or if they don’t improve after treatment of an underlying condition, there are other treatment options. These include:

• Phosphodiesterase 5 inhibitors (for instance, viagra) – Oral medication that helps stimulate an erection when taken around an hour before intercourse. You can buy it over the counter after a discussion with a pharmacist, but always talk to a GP first if you’re taking other medication and avoid it if you have pre-existing heart problems.

• Vacuum pumps – These encourage an erection by improving blood flow to the penis and can be used by most men.

• Penile injections – This involves being trained to inject medication into your penis to stimulate blood flow and trigger an erection. You’ll need a referral to a specialist by a GP.

• Surgery – In rare cases, penile implants may be considered, but this is a ‘last resort’ and isn’t always available on the NHS.

Erectile dysfunction prevention

You can help to reduce your chances of having erection problems by making simple changes to your lifestyle, including:

• Maintaining a healthy body weight

• Exercising regularly

• Drinking alcohol moderately (no more than 14 units per week)

• Eating a healthy diet

• Stopping smoking if you smoke

• Finding ways to manage your stress levels