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Erectile Dysfunction

Consultation & treatments

What is erectile dysfunction?

Erectile dysfunction (ED) is the inability to get or keep an erection for sexual intercourse. It’s estimated that half of all men between the ages of 40 and 70 have experienced some form of erectile dysfunction (often referred to as impotence). Though it is more common in men over 40, research has also shown a prevalence of ED in younger men.

Rather than living with the condition, a simple consultation can provide you with the right advice, counselling and medication according to your needs. A range of effective ED treatments are available from our Online Doctor service, including Viagra, Cialis and Levitra.

Getting treatment is as easy as 1, 2, 3!

1. Start your consultation
Complete a short online questionnaire.
2. Our GPs prescribe
Our UK-registered GPs review, usually within 24 hours.
3. Treatment delivered
Your medicines are sent in discreet packaging.

What are the causes?

To understand the reasons for erectile dysfunction, it’s important to know how an erection occurs. When aroused, your brain sends signals to the blood vessels in your penis, relaxing the arteries and allowing blood to flow in. The veins then close to trap the blood in your penis, causing it to expand and harden.

Dr Shori Discusses Erectile Dysfunction

Anything that interferes with this process can lead to erectile dysfunction. Causes of the condition can be broken down into two categories: physical and psychological.

Physical Factors

  • Circulatory problems such as narrowing of blood vessels, high blood pressure, high cholesterol, or hardening of arteries (atherosclerosis)
  • Diabetes
  • Hormonal problems such as low testosterone, high prolactin or abnormal thyroid levels
  • Medications such as antidepressants, sleeping pills or drugs to treat high blood pressure, pain or prostate cancer
  • Obesity
  • Injuries causing nerve damage from the brain to the penis such as spinal cord injuries, multiple sclerosis, pelvic or prostate surgery, radiation therapy or trauma from a bicycle seat
  • Any chronic kidney and liver disease that affects the circulatory system, nervous system or hormone levels
  • Smoking, or alcohol or drug abuse

Psychological factors

  • Stress or being unhappy at work, home or in your relationship
  • Anxiety or being self-conscious about sex, fear of failure or developing sexual performance, worsened for those who’ve experienced erectile dysfunction previously
  • Depression where you feel guilty you are not satisfying your partner, low self-esteem or loss of interest in sex

Psychological factors can often be a secondary reaction to erectile dysfunction itself and can go on to cause subsequent episodes of erectile dysfunction. You may also often find you experience both physical and psychological causes of erectile dysfunction.

Frequently Asked Questions

Is Erectile Dysfunction normal?

Erectile dysfunction is a common condition. However, it is not a normal part of aging – older men should still be able to get an erection and enjoy sex. With so many treatments available for the condition, there is no need to suffer in silence.

What are the symptoms of Erectile Dysfunction?

The main erectile dysfunction symptoms are the inability to achieve an erection or maintain an erection that is sufficient for sexual intercourse. Some men with erectile dysfunction cannot get an erection at all, while others are unable to sustain an erection for more than a short time. Loss of interest in sex or sexual performance anxiety can also be symptoms of the condition.

Can Erectile Dysfunction be prevented?

You can help prevent erectile dysfunction by maintaining a healthy lifestyle, which can include regular exercise, a balanced diet and keeping an eye on your blood pressure and cholesterol. Anything that is bad for your heart is also likely to be detrimental to your erectile function. You should look to quit smoking and make sure you’re getting enough sleep each night (at least seven hours) to achieve better health.

Is impotence the same as Erectile Dysfunction?

Yes, erectile dysfunction and impotence can be used interchangeably. The two are often confused with premature ejaculation, a condition where a man climaxes before or immediately after penetration during sex. This condition may accompany ED but treatment is not the same.

Do drugs like Viagra work?

Tablet medicines, known as phosphodiesterase-5 (PDE-5) inhibitors have been proven effective in treating erectile dysfunction. Viagra (sildenafil) at 50mg or 100mg has been shown to help around four out of five men achieve and maintain erections suitable for sexual intercourse . Other PDE-5 inhibitors that work in the same way include Cialis (tadalafil), Levitra (vardenafil) and Spedra (avanafil).

How is erectile dysfunction diagnosed?

Diagnosing erectile dysfunction is relatively simple and a process that should leave you with nothing to be embarrassed about. You will need to consult with a registered doctor, who will recommend a treatment based on your symptoms and your physical and mental health, among other things.

What you may be asked

  • Whether you have difficulty obtaining an erection, if your erection is suitable for penetration, if your erection can be maintained and if ejaculation occurs
  • Details of any medication you have taken during the past year, including vitamins and supplements
  • Details of your tobacco, alcohol and caffeine intake, as well as any recreational drug use
  • Any psychological issues such as lack of libido, problems in your relationship, anxiety and fatigue
  • Details about your relationship with your sexual partner, including whether they know you are seeking help, if this is a major issue between you and whether they are willing to help in the treatment process. The condition affects both of you, so our partner’s guide to erectile dysfunction can help significantly with support during your treatment.

Tests that might be included

  • Blood tests to check for signs of diabetes or hormonal conditions such as low testosterone
  • Urine tests to check for signs of diabetes or other underlying health condition
  • Ultrasound to check for blood flow problems (this might involve an injection of medication into the penis to stimulate blood flow and give an erection)
  • Overnight erection test to be done at home – this can determine whether the causes of erectile dysfunction are psychological or physical and involves wrapping a special monitoring device around your penis while you sleep.

What treatments are available for erectile dysfunction?

There are various types of erectile dysfunction treatments available.

Oral medicines, known as phosphodiesterase-5 (PDE-5) inhibitors, are the most common treatments for erectile dysfunction and work by blocking the PDE-5 enzyme, smoothing the muscles of the penis and increasing blood flow. These include:

Viagra Sildenafil
Cialis Tadalafil
Levitra Vardenafil
Spedra Avanafil

Some treatments are injected into the penis. These include:

Invicorp2 Aviptadil & phentolamine
Caverject Alprostadil
Viridal Duo Alprostadil

If you do not wish to have injections, creams and urethral suppositories are available. These include Vitaros (alprostadil) cream and MUSE (alprostadil) urethral suppository, which are applied to the eye of the penis. They’re also used to treat men who experience unacceptable levels of side effects from tablets or those who cannot take tablets for medical reasons.

Addressing underlying problems

Such as low testosterone levels – may resolve cases of erectile dysfunction. If you suspect you may have low testosterone, we offer an online questionnaire for that condition too. Treatment for depression can also help resolve erectile dysfunction.

For many men, lifestyle changes are an important factor in treating erectile dysfunction. Research has shown that erectile dysfunction is often a precursor to heart disease, in some cases appearing up to five years before heart problems are diagnosed. Making some healthier life choices can help reduce erection problems and prevent circulation problems. These include:

  • Regular exercise. This can get the blood pumping and some exercises such as weight lifting can increase the natural production of testosterone, both crucial for erectile strength and sex drive.
  • Kegel/pelvic floor exercises. Research has shown pelvic exercises helped 40% of men with erectile dysfunction regain normal erections.
  • Balanced diet. Studies have shown that men eating a diet rich in fruit, vegetables, whole grains and fish – with fewer red and processed meats – were less likely to suffer from erection problems.
  • Stopping smoking. Studies have shown that men who smoke more than 20 cigarettes daily have a 60% higher risk of erectile dysfunction, compared to non-smokers.
  • Limiting alcohol. Too much alcohol affects your brain and your penis – studies have shown that sober men gain erections more quickly than intoxicated men.

Other treatment options for erectile dysfunction

  • Vacuum constriction devices (VCDs). This is an external cylinder with a pump placed over the penis, which draws blood into the penis causing an erection. To maintain the erection for intercourse, a constriction ring can be placed around the penis. Studies suggest that up to 80% of men are satisfied with VCD results.
  • Penile implants and surgery are also further options that you can discuss with a GP.

If psychological problems are interfering with your ability to get or maintain an erection, a psychotherapist specialising in sexual difficulties may also be able to help you.

Erectile Dysfunction medicine comparison

Viagra Sildenafil
Cialis Tadalafil
Levitra Vardenafil
Spedra Avanafil
25mg, 50mg or 100mg 10mg or 20mg 5mg, 10mg or 20mg 50mg, 100mg or 200mg
Recommended Starting Strength
50mg 10mg 10mg 100mg
Before Sex Before Sex Before Sex Before Sex
Affect of food
Any food may slow Viagra or sildenafil action down Not affected Heavy or high-fat meals may slow Levitra action down Not affected
How long before sex is it used?
1 hour At least 30 mins 25 mins to an hour 15 to 30 mins
Effective for?
4-5 hours 36 hours 4-5 hours 6 hours
Side effects (seen in more than 10% of men)
Headache Headache Headache None

What if erectile dysfunction tabelts don't work?

The main advice here is that you shouldn't give up. Your doctor will talk you through various other options suitable to your needs.

Check our quick guide for options of treatment that you could consider next: