Erectile dysfunction: why a health check comes first and what options exist

The blood vessels supplying the penis are small, so they may show damage before larger vessels in the heart do. Erectile dysfunction can precede heart attack or stroke by a few years, which is why guidance advises cardiovascular risk assessment in men presenting with it. Diabetes, high cholesterol, high blood pressure, smoking and obesity are all linked. Treating the underlying condition can improve erections and protect health.

• When it began, whether sudden or gradual, and whether erections occur at other times such as in the morning.

• Sexual desire, relationship factors, stress, anxiety and mood.

• Medical history, including diabetes, heart disease, prostate surgery or pelvic injury.

• Medicines, alcohol, smoking and recreational drug use.

• Blood pressure, weight, waist and genital examination where appropriate.

• Blood tests: glucose or HbA1c, cholesterol, and morning testosterone where indicated.

Vascular disease, diabetes and nerve damage are leading physical causes. Medicines such as some antihypertensives, antidepressants and prostate treatments can contribute. Low testosterone is a less common but important cause. Psychological factors, including performance anxiety, depression, stress and relationship difficulties, are common alone or alongside physical causes, particularly in younger men.

GPs assess and treat erectile dysfunction. NHS prescribing for medicines has historically been restricted to certain groups and conditions, and policy has changed over time, so ask your GP what applies. Specialist referral may be to urology, endocrinology or sexual health. Private clinics may offer longer appointments and a wider range of devices, and some pharmacists can supply certain tablets after a consultation. Wherever you go, a health check should be part of the assessment.

Many men delay seeking help because of embarrassment. Clinicians discuss this routinely. Writing down your questions can help. Involving a partner, where appropriate, often improves outcomes. If you feel low or anxious, say so, because that matters for treatment.

Erectile difficulties affect both people in a relationship, and a partner may worry that the problem reflects a lack of attraction. If you are comfortable, bringing a partner to an appointment, or at least talking beforehand, can ease pressure and help treatment succeed. Couples often benefit from discussing intimacy beyond intercourse. A psychosexual therapist can help with communication and anxiety. If you have no partner or prefer to attend alone, that is entirely your choice, and clinicians will respect it.