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Health condition · Clinically reviewed

Erectile dysfunction, a marker — and a treatable condition.

ED is common with age and often the first sign of cardiovascular disease. Most men respond to PDE5 inhibitors; a full CV work-up is warranted alongside.

Jump to treatment See red-flag symptoms
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against BSSM, EAU or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK sexual-medicine guidance on assessment, PDE5 inhibitors and the cardiovascular work-up.

Key facts

Erectile dysfunction at a glance.

The essentials, in plain English — what it is, why it matters beyond the bedroom, and how it is treated in the UK today.

  • What it is

    Persistent inability to attain or maintain an erection sufficient for satisfactory sexual activity.

  • Age + CV risk

    Age and cardiovascular risk factors drive most organic ED — the two conditions share the same biology.

  • Correctable contributors

    Obstructive sleep apnoea and low testosterone are common, correctable contributors worth screening for.

  • Psychological overlay

    Anxiety, depression and relationship factors are often layered on top of an organic cause.

  • PDE5 response

    Around 70% of men respond to a PDE5 inhibitor such as sildenafil or tadalafil.

  • CV work-up is standard

    A full cardiovascular risk assessment alongside treatment is the standard-of-care in the UK.

Why this guide matters

Treat the symptom — and the signal.

ED is common, embarrassing and highly treatable. It is also one of the earliest warnings of cardiovascular disease — the three points below shape the whole page.

  • The erection is a stress test

    The small arteries of the penis narrow before the larger arteries of the heart — ED often precedes a cardiac event by years.

  • PDE5 inhibitors work for most

    Around 70% of men respond to sildenafil or tadalafil, taken correctly and given a fair trial.

  • Correctable contributors matter

    Sleep apnoea, low testosterone and medication side effects are common — and often the real fix.

How the diagnosis is made

From first conversation to a clear plan.

The steps a UK GP or sexual-health clinician will normally follow, in order — so you know what to expect and why.

  1. 01

    Assessing

    Sensitive history

    Onset, morning erections, partner factors and psychological context — the story usually points to the cause.

  2. 02

    Assessing

    Focused physical examination

    A brief check of secondary sexual characteristics and the testes — quick, informative, respectful.

  3. 03

    Assessing

    Bloods

    Fasting glucose, lipids, morning testosterone and TSH to pick up correctable metabolic and endocrine drivers.

  4. 04

    Measuring

    Sleep apnoea screen (if symptoms)

    Snoring, daytime sleepiness or a large collar size — a night study is often the missing piece.

  5. 05

    Measuring

    Blood pressure

    Uncontrolled hypertension both causes ED and complicates its treatment — it needs measuring properly.

  6. 06

    Measuring

    Discuss cardiovascular risk

    ED often precedes a cardiac event by three to five years — a full CV risk assessment is standard-of-care.

  7. 07

    Planning

    Urology / andrology referral

    For men who don’t respond to first-line treatment, or where injections, devices or surgery are being considered.

Typical timeline: 2–6 weeks from first appointment to a settled plan.

Symptoms & patterns

The patterns that point to the cause.

ED rarely has a single cause. These common patterns help sort what is organic, what is psychological and what is fixable.

  • PDE5 inhibitor responsive

    Erections return reliably on sildenafil or tadalafil — the commonest pattern in clinic.

  • Medication-related

    SSRIs, antihypertensives and 5-ARIs are the frequent offenders — timing usually gives it away.

  • Depression-related

    Low mood and low libido travel together — treating one often improves the other.

  • Relationship-related

    Performance normal in one context and not another — a strong pointer to a relational cause.

  • Cardiovascular-related

    ED can precede a heart attack by three to five years — the arteries of the penis are small and telling.

  • Diabetes-related

    Both nerve and vessel damage from diabetes contribute — response to PDE5 inhibitors is often reduced.

  • Low testosterone

    Reduced libido, fatigue and morning erections that have faded — a morning blood test is the next step.

  • Red flag — sudden ED + chest pain

    A sudden onset of ED in a younger man with chest pain warrants same-day cardiology work-up.

Treatment

How ED is treated in the UK today.

A tablet works for most men — but the full toolkit runs from lifestyle to injections, devices and, rarely, surgery. Here is what each option does.

  • PDE5 inhibitors

    Sildenafil and tadalafil are first-line — effective in around 70% of men, well tolerated and taken on demand or daily.

  • Address CV risk factors

    Smoking, blood pressure, lipids, weight and exercise — the same interventions that protect the heart help the erection.

  • Sleep apnoea treatment

    CPAP for confirmed OSA often improves erectile function within weeks — a quiet but powerful intervention.

  • Testosterone replacement

    For confirmed hypogonadism with symptoms — restores libido and often the response to PDE5 inhibitors.

  • Vacuum erection device

    A drug-free option that works for most men — useful when tablets are not tolerated or effective.

  • Intracavernosal injection

    Alprostadil injected into the penis before intercourse — highly effective, including after prostate surgery.

  • Intraurethral pellet

    A small alprostadil pellet inserted into the urethra — an alternative to injection for some men.

  • Penile prosthesis

    A surgical implant — the last resort when other options have failed, with high satisfaction rates in well-selected men.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, urologist or sexual-medicine clinician knows your history and can tell you which parts apply to you. If in doubt, book a consultation.

  • British Society for Sexual Medicine. Guideline on the management of erectile dysfunction.

  • European Association of Urology. Guidelines on male sexual dysfunction.

  • NICE Clinical Knowledge Summary. Erectile dysfunction.

  • Sexual Advice Association. Patient information on erectile dysfunction.

Red flags

When ED stops being routine.

Most ED is chronic and manageable. These are the situations where it is not — and you should act today.

  • New ED with chest pain or breathlessness

    Silent coronary artery disease can present this way — same-day cardiology assessment is appropriate.

  • Peyronie’s disease with painful erection

    Curvature and pain need urology review — early treatment gives the best outcomes.

  • Priapism

    A painful erection lasting more than four hours is a urological emergency — attend A&E without delay.

  • ED after pelvic surgery

    Post-prostatectomy or bowel-surgery ED benefits from early rehabilitation — do not wait to seek help.

  • ED after radiotherapy

    Onset can be delayed by months — a dedicated survivorship pathway can preserve function.

  • Neurogenic ED after trauma

    Spinal or pelvic-nerve injury needs specialist andrology input for tailored treatment.

  • Depression with suicidality

    Mental-health safety comes first — speak to your GP, NHS 111 or Samaritans (116 123) today.

  • On anti-androgen therapy

    ED is expected on hormone treatment for prostate cancer — but options exist to preserve function.

  • Failed PDE5 in a young man

    A lack of response in a younger patient warrants specialist review — vascular or endocrine causes may be missed.

Living with it

A common problem, a very treatable one.

Four things that make the biggest difference day to day — habits, monitoring, medication and reviews.

A quiet reminder

Treat the heart, and the rest follows.

The lifestyle changes that protect the heart — exercise, sleep, weight, blood pressure — measurably improve erectile function too.

  1. 01 Daily habits

    Move more, sleep better, drink less

    Exercise, sleep and moderate alcohol give a measurable lift to erectile function within weeks.

  2. 02 Monitoring

    Track blood pressure and glucose

    The same numbers that predict heart disease predict erectile trouble — keep them in range.

  3. 03 Medication

    Give tablets a fair trial

    PDE5 inhibitors work best on an empty stomach and with sexual stimulation — try each drug several times before giving up.

  4. 04 Reviews

    Yearly cardiovascular review

    Blood pressure, lipids, glucose and lifestyle — an annual check keeps both the heart and the erection ahead of trouble.

Frequently asked

Everything we get asked about erectile dysfunction.

Quick answers on the CV link, PDE5 inhibitors, testosterone and when to seek urgent help.

  • Is ED really a sign of heart trouble?

    Often, yes. ED can precede a cardiac event by three to five years because the small arteries of the penis are affected before the larger arteries of the heart. A full cardiovascular risk assessment alongside treatment is standard-of-care.

  • Which PDE5 inhibitor is best?

    Sildenafil (short-acting) and tadalafil (longer-acting, also licensed daily) suit different lifestyles. Response and side effects vary — trying each properly, several times, is the fairest test.

  • Will testosterone replacement fix ED?

    Only if you are genuinely hypogonadal on a morning blood test with symptoms. Restoring testosterone often improves libido and the response to PDE5 inhibitors, but it is not a treatment for ED on its own.

  • How much of ED is psychological?

    Even where the primary cause is organic, anxiety and low mood usually add a psychological layer. Addressing both — sometimes with brief psychosexual therapy — improves outcomes.

  • Can lifestyle changes really make a difference?

    Yes. Exercise, weight loss, better sleep, less alcohol and stopping smoking all improve erectile function — and the effect can be measurable within weeks.

  • When should I be seen urgently?

    A painful erection lasting more than four hours (priapism) is an emergency. Sudden ED with chest pain or breathlessness needs same-day cardiology review.

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