Erectile dysfunction (ED) means regularly struggling to get or keep an erection firm enough for sex. Almost every man has an off night, so a single episode is not ED. When it keeps happening, it is worth looking into.

ED is far more common than most people think, and it becomes more likely with age. The good news is that it is usually treatable, and the cause is often something you can address.

This guide explains the common causes, the treatment routes available in the UK, and when to speak to a healthcare professional. It is general information, not personal medical advice.

What causes erectile dysfunction?

An erection depends on healthy blood flow, working nerves, the right hormones and a calm mind. A problem with any of these can get in the way. Reading the official erectile dysfunction guidance alongside this article gives a useful overview of the causes.

Physical causes

• Narrowed or stiff blood vessels, often linked to high blood pressure or high cholesterol
• Type 2 diabetes, which can damage blood vessels and nerves
• Obesity and being very unfit
• Low testosterone or other hormone problems
• Nerve conditions, spinal injuries and some surgeries around the pelvis

Psychological causes

• Stress, anxiety and low mood
• Worry about performance, which can become a cycle
• Relationship difficulties

Lifestyle and medicine-related causes

• Smoking and heavy drinking
• Recreational drug use
• Poor sleep
• Side effects from some prescribed medicines, including certain blood pressure tablets and antidepressants

Why ED can be an early warning sign

The blood vessels that supply the penis are small, so they can show problems before larger vessels do. For some men, ED is the first sign of heart disease or diabetes.

That is one more reason not to ignore it or treat it in secret. A short check-up can pick up conditions that matter far more than the erection problem itself.

Lifestyle changes that can help

For many men, particularly younger ones, small changes make a real difference.

• Move more. Regular exercise improves circulation and mood.
• Stop smoking. This is one of the most effective single changes.
• Cut back on alcohol. Heavy drinking affects both nerves and hormones.
• Manage weight. Losing even a little can help if you are overweight.
• Prioritise sleep and stress. Both affect desire and performance.
• Talk to your partner. Pressure and silence tend to make things worse.

Treatment options in the UK

Talking therapies

If stress, anxiety or performance worry plays a part, psychosexual counselling or cognitive behavioural therapy can help, on its own or alongside other treatment.

Tablets

The most common medicines for ED are PDE5 inhibitors. They help blood flow to the penis when you are sexually aroused. They do not create desire and they do not work for everyone.

These medicines are not suitable for every man. Anyone taking nitrate medicines, often used for angina, must not use them because the combination can cause a dangerous drop in blood pressure. Some other heart conditions and medicines also need care, which is why an assessment matters.

In the UK, some of these medicines are available only on prescription, while a lower-strength sildenafil can be supplied by a pharmacist after a consultation. Either way, you should be asked about your health and your other medicines first. If you are unsure how that works, our guide explains how to get a prescription through the regulated routes.

Other treatments

• Vacuum pumps: a device that draws blood into the penis, held in place with a band.
• Injections or urethral treatments: prescribed by a specialist for men who cannot use tablets.
• Hormone treatment: only if tests show a genuine hormone problem.
• Surgery: an implant is a last resort for severe cases.

Why you should avoid unregulated sellers

Embarrassment pushes some men towards websites that sell ED tablets with no questions asked. That is risky.

• Products may be counterfeit or contain the wrong dose or ingredients.
• Nobody checks whether the medicine is safe with your heart condition or other tablets.
• You miss the chance to find an underlying condition.

If you buy online, use a pharmacy registered with the General Pharmaceutical Council that carries out a proper consultation.

When to see a doctor

Speak to your GP or a pharmacist if:

• problems last more than a few weeks;
• ED started suddenly or after starting a new medicine;
• you also have chest pain, breathlessness, numbness or very low mood;
• you have diabetes, heart disease or high blood pressure.

Call 999 or go to A&E straight away for chest pain, or for an erection lasting more than four hours, which needs urgent treatment.

Frequently asked questions

Is erectile dysfunction normal as you get older?

It becomes more common with age, but it is not something you simply have to accept. Many causes can be treated.

Can stress alone cause ED?

Yes. Stress, anxiety and low mood are common causes, especially in younger men.

Will my GP be embarrassed or judge me?

No. GPs and pharmacists discuss ED regularly and treat it as a normal health issue.

Can ED be cured?

Often it can be improved or resolved by treating the cause, changing habits or using treatment. The outcome depends on the cause.

Are herbal supplements safe for ED?

Be careful. Some products sold as natural remedies have been found to contain undeclared prescription ingredients. Speak to a pharmacist first.

The bottom line

Erectile dysfunction is common, treatable and often a sign worth checking. Talking to a GP or pharmacist is the safest first step, and it can protect your heart as well as your sex life.

This article is for general information only and does not replace advice from a doctor, pharmacist or other qualified healthcare professional.