---
title: "Erectile dysfunction: Symptoms & Treatment | HealthAnswers"
description: "Erectile dysfunction is common and usually treatable — and can flag heart health issues. What works, and when to see a GP. Reviewed by UK doctors."
url: https://healthanswers.co.uk/conditions/erectile-dysfunction/
robots: noindex
---

# Erectile dysfunction: Symptoms & Treatment | HealthAnswers

Health A–Z

Erectile dysfunction is common and usually treatable — and can flag heart health issues. What works, and when to see a GP. Reviewed by UK doctors.

Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026

## Quick answer

What is erectile dysfunction? Erectile dysfunction means difficulty getting or keeping an erection firm enough for sex — common and often treatable. Physical causes include blood flow problems, diabetes, and nerve damage; psychological factors also play a role. ED can be an early sign of cardiovascular disease. NHS treatments include lifestyle changes and PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis). Always see a GP for new ED — especially if sudden or with other symptoms.

## Who is this page for?

This page is for people in the UK who want a plain-English overview of Erectile dysfunction, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally.

## Who should skip this page?

Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland.

On this page 15 sections

## Key facts about erectile dysfunction

- ED affects an estimated half of men aged 40 to 70 to some degree — many do not seek help.
- Same blood vessel disease causes both heart attacks and ED — ED can precede cardiac events by years.
- Sildenafil and tadalafil work for about 70 to 80% of men when ED has a physical component.
- ED with sudden onset, loss of morning erections, or associated symptoms needs GP assessment.
- Never take PDE5 inhibitors with nitrates (GTN spray) — dangerous blood pressure drop.

## Erectile dysfunction — what it is and why it matters

**Erectile dysfunction (ED)** — also called impotence — means being unable to get an erection, or keep one firm enough for satisfactory sex. It is **extremely common** — surveys suggest **at least 1 in 2 men aged 40 to 70** experience it to some degree — yet many never mention it to a doctor.

ED is **treatable** in most cases. More importantly, it is often an **early warning sign of cardiovascular disease** — the same atherosclerosis that narrows heart arteries affects penile arteries first because they are smaller.

**Always worth a GP conversation** — not just for sex life, but for overall health.

## How erections work

An erection requires:

- Nerve signals from brain and spinal cord (arousal)

- Blood flow — arteries dilate, corpora cavernosa fill and compress veins

- Hormones — testosterone supports libido and function

- Psychological state — anxiety disrupts the pathway

Failure at any step causes ED. **Morning erections** suggest intact physical mechanism — if these disappear suddenly alongside ED, physical cause is more likely.

## Causes — physical (organic)

### Vascular (most common in older men)

**Atherosclerosis** — cholesterol plaques narrow arteries. Risk factors:

- high blood pressure

- high cholesterol

- smoking

- obesity

- diabetes

- sedentary lifestyle

Penile arteries (~1 to 2mm) clog before coronary arteries (~3 to 4mm) — **ED may precede heart attack or stroke by 3 to 5 years**.

### Diabetes

Damages **endothelium** (blood vessel lining) and **autonomic nerves**. ED affects **50 to 60%** of men with diabetes — often develops 10 to 15 years earlier than in non-diabetic men. Good HbA1c control reduces progression.

### Neurological

- spinal cord injury

- multiple sclerosis

- Parkinson’s disease

- prostate surgery (radical prostatectomy) — nerve-sparing techniques reduce but do not eliminate risk

- pelvic surgery or radiotherapy

### Hormonal

**Low testosterone (hypogonadism)** — reduced libido, fatigue, ED. Less common as sole cause but contributes. Obesity and diabetes lower testosterone. **Thyroid disorders** occasionally affect function.

**Prolactinoma** (pituitary tumour) — rare — high prolactin suppresses testosterone.

### Medicines

Common contributors:

- some antidepressants (SSRIs, especially paroxetine)

- blood pressure medicines (thiazide diuretics, beta-blockers — though newer agents less problematic)

- finasteride for hair loss or prostate — small percentage

- antiandrogens for prostate cancer

- opioid painkillers long term

- antipsychotics

**Never stop prescribed medicines without GP advice** — alternatives often exist.

### Other physical

- Peyronie’s disease — scar tissue causing curvature and painful erections

- sleep apnoea — linked to ED independently of obesity

- chronic kidney disease

- liver cirrhosis

- alcohol excess long term

## Causes — psychological (psychogenic)

- performance anxiety — often starts after one failed attempt

- depression and anxiety

- relationship conflict

- stress — work, financial, bereavement

- pornography-related ED — debated; performance anxiety more established

**Psychogenic features:**

- sudden onset

- situational (works with one partner, not another)

- morning/nocturnal erections preserved

- young age with no risk factors

**Mixed ED** — physical cause plus anxiety about performance — is very common.

## When to see a GP urgently

- Priapism — erection lasting more than 4 hours without sexual stimulation — medical emergency (999) — risks permanent damage

- ED after pelvic fracture or spinal injury

- ED with testicular pain , breast enlargement , or severe headaches/visual changes (rare pituitary problems)

- Chest pain or breathlessness on exertion alongside new ED — possible angina

## What happens at a GP appointment

Expect a thorough but confidential assessment:

- History — onset, morning erections, relationship, libido, alcohol, smoking, exercise

- Medical history — diabetes, heart disease, surgery, medicines

- Examination — blood pressure, BMI, genital exam, testicular size, peripheral pulses

- Blood tests — fasting glucose or HbA1c, lipids, testosterone (morning sample if indicated), thyroid, prolactin if suggested

- Cardiovascular risk assessment — QRISK score — ED counts as a risk factor in some guidelines

Referral to **urology** or **sexual medicine clinic** if:

- young man with suspected primary organic cause

- failed first-line treatments

- Peyronie’s disease

- considering injections, vacuum devices, or surgery

- psychosexual therapy needs

## First-line treatment — lifestyle

Evidence-based improvements:

| Change | Effect on ED |
| --- | --- |
| Stop smoking | Improves vessel function within weeks to months |
| Weight loss (5 to 10%) | Significant improvement in obese men |
| Exercise (150 min/week) | Improves endothelial function |
| Reduce alcohol | Excess impairs nerves and hormones |
| Treat sleep apnoea | CPAP improves ED in studies |
| Control diabetes/BP/cholesterol | Slows vascular damage |

Pelvic floor exercises strengthen **bulbocavernosus muscle** — helps venous leakage pattern. 6 months daily practice — free and side-effect free.

## PDE5 inhibitors — sildenafil, tadalafil, vardenafil

See our dedicated [sildenafil and tadalafil](https://healthanswers.co.uk/treatments/sildenafil-and-tadalafil/) guide for dosing and safety detail.

**How they work:** Block **phosphodiesterase-5 (PDE5)**, prolonging cGMP — the chemical that relaxes smooth muscle and increases blood flow when sexually aroused. **Require arousal** — they do not create spontaneous erections.

### Sildenafil (Viagra, generic)

- Dose: 25 to 100mg — typical 50mg

- Onset: 30 to 60 minutes

- Duration: 4 to 6 hours

- Food: High-fat meal delays absorption — take on empty stomach for fastest effect

- Side effects: Headache, flushing, indigestion, nasal congestion, visual colour tinge (rare)

### Tadalafil (Cialis, generic)

- Dose: 10 to 20mg as needed, or 2.5 to 5mg daily for continuous effect

- Onset: 30 minutes (daily dosing removes timing pressure)

- Duration: Up to 36 hours

- Food: Less affected by meals

- Side effects: Back pain, muscle ache, headache, flushing

### Vardenafil (Levitra)

Similar to sildenafil — alternative if others poorly tolerated.

**Effectiveness:** **70 to 80%** of men achieve improved erections with PDE5 inhibitors when ED has physical cause. Less effective with severe diabetes, post-prostate surgery, or low testosterone untreated.

**NHS availability:** Generic **sildenafil** on NHS prescription — quantity limits vary. **Tadalafil** increasingly available. Pharmacist-supplied without prescription possible for some brands after consultation.

### Critical safety — nitrates

**Never combine PDE5 inhibitors with:**

- GTN spray or tablets (angina treatment)

- Isosorbide mononitrate/dinitrate

- Recreational poppers (amyl nitrite)

Combination causes **severe hypotension** — potentially fatal. If you have angina, discuss with cardiologist before ED treatment.

**Caution with:** alpha-blockers (tamsulosin for prostate — separate timing), recent stroke or heart attack (usually wait 6 months), unstable angina, severe heart failure.

## Second-line treatments

If PDE5 inhibitors fail or contraindicated:

### Vacuum erection devices (VED)

Plastic cylinder over penis — manual or battery pump creates vacuum, drawing blood in; **constriction ring** at base maintains erection. **70 to 80% success** — bruising, coldness, ejaculation trapped by ring. NHS prescription possible.

### Alprostadil — injections or urethral pellets

**Intracavernosal injection (ICI)** — alprostadil (Caverject) into side of penis — produces erection in 5 to 15 minutes. **80 to 90% effective** — training required; risks priapism, scarring with overuse.

**Urethral pellet (MUSE)** — less popular — less effective.

### Testosterone replacement

Only if **confirmed low testosterone** with symptoms — gel or injections. Does not help if testosterone is normal. Monitored for prostate effects.

### Psychosexual therapy

**CBT and couples counselling** — especially for primary psychogenic or mixed ED. Available through GP referral or Relate.

## Surgical options

**Penile implants** — inflatable or malleable rods — for severe ED unresponsive to other treatment. Last resort — high satisfaction in selected patients. NHS funding for specific criteria.

**Vascular surgery** — rarely performed now — limited evidence except in young men with pelvic trauma.

## ED after prostate treatment

**Radical prostatectomy** — ED rates depend on nerve-sparing and age — **25 to 80%** at 12 months. Recovery can take **18 to 24 months** — early PDE5 inhibitor use may aid recovery (“penile rehabilitation”).

**Radiotherapy** — ED develops more slowly over years.

Discuss preservation strategies **before** surgery with urologist.

## ED and mental health

ED causes **anxiety, depression, and relationship strain** — which worsen ED in a vicious cycle. Breaking the cycle often needs:

- open communication with partner

- realistic expectations — treatment improves function, not necessarily teenage performance

- professional support when needed

**SSRIs for depression can cause ED** — mirtazapine or bupropion may have lower risk — discuss with GP if antidepressant-related.

## Myths — the facts

**Myth: “ED means low testosterone.”** Fact: Most ED is vascular — testosterone is normal in majority. Test only if clinical suspicion.

**Myth: “Young men can’t have physical ED.”** Fact: Diabetes, obesity, and congenital vascular issues affect young men. Psychogenic is more common under 40 but not exclusive.

**Myth: “Herbal Viagra is safer.”** Fact: Unregulated supplements may contain **hidden sildenafil** — dangerous with nitrates or heart conditions. Buy from registered UK pharmacies only.

**Myth: “You must take Viagra every day forever.”** Fact: Use as needed or daily tadalafil — dose can be adjusted or stopped if underlying cause improves.

## Partner and communication

ED affects couples — partner may feel rejected or blame themselves. **Medical cause, not lack of attraction**, is usually the explanation. Involving partner in GP discussion (if both agree) improves outcomes.

## Summary checklist

- Book GP — do not suffer in silence

- Check cardiovascular risk — treat blood pressure, cholesterol, diabetes

- Stop smoking, move more, lose weight if overweight

- Try PDE5 inhibitor if safe — sildenafil or tadalafil

- Pelvic floor exercises — daily

- Referral if no improvement — urology or psychosexual therapy

Erectile dysfunction is common, treatable, and medically important. Effective help exists on the NHS — asking is the first step.

## ! When to see a GP about erectile dysfunction

See a GP for persistent ED lasting more than a few weeks — especially if you also have chest pain on exertion, diabetes, high blood pressure, or depression. ED can signal cardiovascular disease. Seek urgent help for erection lasting more than 4 hours (priapism) — phone **999**. See a GP promptly for ED after pelvic injury or prostate surgery.

## Common questions about erectile dysfunction

What causes erectile dysfunction? Physical causes — reduced blood flow (atherosclerosis), diabetes, high blood pressure, obesity, nerve damage (spinal injury, MS), hormonal problems (low testosterone), and side effects of medicines (some antidepressants, finasteride). Psychological — stress, anxiety, depression, relationship issues. Most long-term ED has a physical component, often mixed with psychological factors. Is erectile dysfunction normal with age? ED becomes more common with age but is not an inevitable part of ageing — it often signals treatable conditions like cardiovascular disease, diabetes, or medication effects. Many older men maintain normal function with appropriate treatment. Can Viagra cure erectile dysfunction permanently? PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis) treat