Overview
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. It is common and becomes increasingly prevalent with age. Importantly, ED can be an early warning sign of cardiovascular disease.
How common is it?
ED affects about half of men aged 40 to 70 to some degree. About 1 in 5 men over 40 has significant, persistent ED.
Causes and risk factors
Erection requires healthy blood vessels, functioning nerves, normal hormone levels, and psychological readiness. Problems in any of these systems can cause ED.
Common risk factors
- Cardiovascular disease and atherosclerosis (most common physical cause)
- Diabetes causing nerve and blood vessel damage
- High blood pressure
- Obesity
- Hypogonadism (low testosterone)
- Medications including antidepressants, antihypertensives, and antiandrogens
- Psychological factors: anxiety, depression, relationship problems, stress
Symptoms
- Difficulty achieving an erection
- Difficulty maintaining an erection long enough for intercourse
- Reduced sexual desire associated with low testosterone
- Psychological distress related to sexual performance
When to see a doctor
See a doctor if ED is persistent and causing distress. Because ED can be a marker of cardiovascular disease, all men with new ED should have a cardiovascular risk assessment including blood pressure and cholesterol measurement.
Diagnosis
Blood tests including testosterone, blood glucose, cholesterol, and full blood count. Blood pressure and cardiovascular risk assessment. Specialist investigation of nocturnal erections and penile blood flow in complex cases.
Treatments
PDE5 inhibitors (sildenafil, tadalafil)
Tablets such as Viagra (sildenafil) and Cialis (tadalafil) work by increasing blood flow to the penis. Effective in about 70% of men. Available on prescription and some available over the counter.
Lifestyle modification
Weight loss, regular exercise, stopping smoking, and reducing alcohol improve erectile function significantly, sometimes without additional treatment.
Testosterone therapy
For men with confirmed low testosterone causing ED, testosterone replacement therapy improves symptoms alongside or before PDE5 inhibitors.
Self-care and lifestyle
- Regular aerobic exercise (walking, cycling, swimming) is one of the most effective treatments for mild to moderate ED
- Stop smoking as it causes direct vascular damage to penile arteries
- Reduce alcohol intake
- Address relationship stress or performance anxiety with your partner and consider couples therapy
Prevention
Maintaining cardiovascular health through exercise, healthy diet, not smoking, and controlling blood pressure and diabetes is the best prevention. ED is often the earliest sign of heart disease, so its development should prompt cardiovascular review.