Key Points
- Erectile dysfunction (ED) is very common — it affects half of men over 40 at some point
- It's often a sign of underlying health issues, especially cardiovascular problems
- ED can be an early warning sign of heart disease
- Effective treatments are available, but the cause should be investigated
of men over 40 experience erectile dysfunction at some point
What Is Erectile Dysfunction?
Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough for satisfactory sexual activity. Occasional difficulty is normal and doesn't necessarily mean you have ED.
ED is considered a problem when it:
- Happens frequently (more than half the time)
- Has lasted for several weeks or months
- Is causing distress or relationship problems
ED and Heart Disease: An Important Link
The blood vessels in the penis are smaller than those in the heart. This means they can be affected by cardiovascular disease before symptoms appear elsewhere.
ED can be an early warning sign of heart disease. Studies show that men with ED are more likely to have a heart attack or stroke in the following years.
If you have ED, especially if you're over 40, your GP should assess your cardiovascular risk factors.
Causes of Erectile Dysfunction
ED usually has physical causes, but psychological factors are also common.
Physical Causes
- Cardiovascular disease
- Diabetes
- High blood pressure
- High cholesterol
- Obesity
- Low testosterone
- Prostate problems/treatment
- Neurological conditions
- Medications (see below)
- Smoking
- Alcohol excess
Psychological Causes
- Stress and anxiety
- Depression
- Relationship problems
- Performance anxiety
- Past sexual trauma
- Low self-esteem
Medications That Can Cause ED
- Blood pressure medications — Especially beta-blockers and thiazide diuretics
- Antidepressants — SSRIs are common culprits
- Antihistamines
- Prostate medications — Finasteride, some alpha-blockers
- Opioid painkillers
Never stop prescribed medications without talking to your doctor — there may be alternatives.
Treatment Options
Lifestyle Changes
These can significantly improve ED and your overall health:
- Stop smoking — Smoking damages blood vessels
- Reduce alcohol — Excess alcohol impairs erections
- Lose weight — Obesity is strongly linked to ED
- Exercise regularly — Improves cardiovascular health and erections
- Improve diet — Mediterranean diet is beneficial
- Manage stress — Anxiety worsens ED
Medications (PDE5 Inhibitors)
The pharmacy leaflet and prescriber supplied with each of these medicines typically describes how and when they are taken. Only take them if prescribed for you, and follow the advice given by your GP or pharmacist. The summaries below are general information taken from common UK product information.
Sildenafil (Viagra)
Pharmacy leaflet information: usually taken 30–60 minutes before sex; effect lasts around 4–6 hours. Available over the counter in the UK under pharmacist supervision.
Tadalafil (Cialis)
Pharmacy leaflet information: effect can last up to 36 hours. Sometimes prescribed as a low daily dose; your GP will advise which regimen is appropriate for you.
Vardenafil (Levitra)
Pharmacy leaflet information: similar to sildenafil, usually taken 25–60 minutes before sex.
Avanafil (Spedra)
Pharmacy leaflet information: faster-onset PDE5 inhibitor, typically works within around 15 minutes.
These medications work by improving blood flow to the penis. They need sexual stimulation to work.
Important Safety Warning
PDE5 inhibitors are not suitable for people taking nitrates (such as GTN spray or isosorbide mononitrate), because the combination can cause a dangerous drop in blood pressure. Always tell your GP or pharmacist about all medicines you take so they can assess suitability.
- Tell your GP about all medications you take
- Avoid if you've had a recent heart attack or stroke
- Use with caution if you have low blood pressure
Other Treatments
- Vacuum pumps — A device that draws blood into the penis
- Injections — Alprostadil injected into the penis
- Urethral pellets — Alprostadil inserted into the urethra
- Testosterone replacement — If low testosterone is the cause
- Counselling/psychotherapy — For psychological causes
- Penile implants — Surgical option for severe cases
Seeing Your GP
Many men feel embarrassed talking about ED, but GPs deal with this issue regularly. It's an important health matter to discuss.
What to Expect
- Questions about your symptoms and relationship
- Medical history and medications review
- Blood pressure check
- Blood tests (cholesterol, blood sugar, testosterone, kidney function)
- Possibly a physical examination
- Cardiovascular risk assessment if appropriate
Questions to Ask
- What's likely causing my ED?
- Should I have tests for heart disease or diabetes?
- Could any of my medications be contributing?
- What treatment options would suit me?
- Are ED medications safe for me to use?
Buying ED Medications
Sildenafil (Viagra Connect) is now available without prescription from pharmacies. However:
- You'll need a consultation with the pharmacist
- It may not be suitable if you have heart problems or take certain medications
- Underlying causes won't be investigated
If you're over 40 or have risk factors for heart disease, see your GP first. ED can be an important warning sign that shouldn't be ignored.
Avoid Buying Online from Unregulated Sources
Fake medications are common online. They may:
- Contain no active ingredient
- Contain dangerous substances
- Be the wrong dose
Only buy from UK-registered pharmacies or get a prescription from your GP.
Relationships and Communication
ED can affect both partners. Open communication is important:
- Talk to your partner about what you're experiencing
- Reassure them it's not about attraction
- Consider involving your partner in treatment discussions
- Focus on intimacy beyond penetrative sex
- Consider couples counselling if it's affecting your relationship