Erectile dysfunction: treatment, causes and symptoms

The NHS says treatment can usually help improve ED. The main treatments are medicines that increase blood flow to the penis, called PDE-5 inhibitors. These are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). You can get sildenafil on prescription or buy it from a pharmacy; the other types need a prescription.

Vacuum pumps encourage blood to flow to the penis, causing an erection. The NHS says they work for most men and can be used if medicine is not suitable or does not work, though they are not always available on the NHS.

There are also treatments for the causes of ED. Your doctor may switch you to a different medicine if it is causing the problem, high blood pressure, high cholesterol and hormone problems may be treated with medicine, and counselling and therapy can help if erection problems are linked to emotional or mental health problems. The NHS notes there can be a long wait for these services on the NHS.

NICE CKS advises that primary care management includes lifestyle and risk factor changes, optimising management of any underlying conditions, offering a PDE-5 inhibitor if clinically appropriate with counselling on its use, and arranging follow-up after 6 to 8 weeks with possible dose escalation or drug switching.

ED is when you are unable to get an erection, or unable to keep one for long enough to have sex. The NHS says that depending on the cause you may still be able to get an erection at other times, such as when you wake up. Sometimes there is also low sex drive.

NICE CKS points out that ED is a symptom and not a disease. It may have a physical or psychological cause, but most cases are of mixed cause, and incidence and prevalence increase with age.

The main symptom is difficulty getting or keeping an erection. The NHS says most men occasionally fail to get or keep an erection and this is usually due to stress, tiredness or drinking too much alcohol. It is the pattern, if it keeps happening, that suggests seeing a GP.

NICE CKS says assessment includes asking about sexual function, onset and duration, sexual desire, arousal, ejaculation and orgasm, life events, relationship dynamics and mental health. Complications of ED may include performance anxiety, reduced confidence, depression and relationship difficulties.

The NHS says occasional ED is usually caused by stress, tiredness or drinking too much alcohol, and can be a side effect of some medicines. If it happens often it may be caused by a condition such as high blood pressure or high cholesterol, diabetes, depression or anxiety, or hormone problems.

NICE CKS gives a wider list. Vascular causes include cardiovascular disease, hypertension, high cholesterol, peripheral arterial disease, diabetes, smoking and obesity. Neurological causes include multiple sclerosis, Parkinson's disease and stroke. Others include chronic kidney or liver disease, pelvic or urological surgery, Peyronie's disease, prostate cancer, and endocrine causes such as hypogonadism. Psychological causes include stress, anxiety, depression and relationship issues. Drug causes include antihypertensives, diuretics, antidepressants, hormonal treatments and recreational drugs.

The NHS says healthy lifestyle changes can sometimes help. These include losing weight if you are overweight, stopping smoking, eating a healthy diet, exercising daily and trying to reduce stress and anxiety.

It also advises not drinking more than 14 units of alcohol a week, and not cycling for a while if you cycle for more than 3 hours a week.

The NHS says the doctor or nurse may ask about your lifestyle, relationships and any problems you are having, do basic health checks such as taking your blood pressure, and examine your genitals to rule out any obvious physical cause. If you have symptoms such as needing to pee more often than usual, you may also have a rectal examination of the prostate.

NICE CKS says all men should have HbA1c, a lipid profile and a fasting morning total testosterone level checked, with further tests depending on the likely cause. Referral to urology is considered for lifelong symptoms, young age, pelvic or genital trauma, a penile or testicular abnormality, or no response to at least two PDE-5 inhibitors; to endocrinology if testosterone deficiency is suspected; and to psychosexual counselling or mental health services if a psychological cause is likely.

NICE CKS says emergency hospital admission is needed for priapism, which it defines as a painful prolonged erection for more than 4 hours and a rare adverse effect of specialist treatments for ED. If this happens, go to A&E or call 999.

The NHS also says ED can be a sign of a health condition, so it is worth getting checked rather than waiting if it keeps happening.

The NHS says to be very careful if you buy sildenafil online because many websites sell fake medicines. Online medicines are not always regulated, and the ingredients can vary from one pack to another. They may cause unpleasant side effects or not be suitable for you.

If you buy online, it says to make sure the pharmacy is registered with the General Pharmaceutical Council (GPhC), any online doctor service is registered with the Care Quality Commission (CQC) and all doctors are registered with the General Medical Council (GMC).

You can see your GP or go to a sexual health clinic. The NHS says sexual health clinics can provide the same treatment as a GP surgery, many offer a walk-in service and they often get test results quicker. You can also pay to see a counsellor or sex therapist privately; the NHS suggests checking membership of recognised professional bodies.