What is erectile dysfunction?
Erectile dysfunction is simply the inability to get and maintain an erection long enough to have sexual intercourse. You might find you can still get erections at other times, like when you wake up in the morning.
Sexual health can be fundamental to your physical and emotional wellbeing, not just for individuals but for couples and families too.
So, if ED is affecting your mental health, that's entirely understandable and you're not overreacting. Many men with ED experience anxiety and depression, which is why it's important to address both the physical and emotional sides of ED.
What are the causes of erectile dysfunction?
While ED was previously thought to be primarily psychological, we now understand that for most men, it has a physical basis.
Achieving and maintaining an erection is a complex physiological process requiring coordination between your hormones, blood vessels, nerves, and neurological pathways. When any part of that process is disrupted, ED can happen.
Physical causes (most common)
Most physical causes of ED involve:
- Conditions affecting blood flow, like cardiovascular disease, high blood pressure, and diabetes.
- Neurological conditions like multiple sclerosis, Parkinson's disease, and spinal injuries can disrupt nerve signals between the brain and penis. Stroke is both a cause and potential consequence of ED.
- Hormonal imbalances like testosterone deficiency (hypogonadism), thyroid disorders including hyperthyroidism and hypothyroidism, and conditions like Cushing's syndrome can all affect both libido and erectile function.
Psychological causes
We know that psychological factors play a significant role in erectile function. Depression, anxiety, stress, and relationship difficulties can all interfere with sexual arousal and performance. In some cases, ED begins with a physical cause but develops into a cycle of performance anxiety that worsens the condition.
Medication-related causes
Various medications can cause ED, including:
- certain antihypertensives
- antipsychotics
- antidepressants
- corticosteroids
- H2-antagonists
If you suspect your medication may be contributing to ED, it's important to consult your healthcare provider about potential alternatives rather than stopping any medication.
How long does ED last, and is it curable?
How long ED lasts depends on what's causing it, but most cases are treatable, and many can be completely reversed.
If your ED is caused by temporary factors like stress, anxiety, or fatigue, it often resolves naturally as these situations improve. Similarly, if lifestyle factors like smoking, excessive drinking, or being overweight are contributing to your ED, you'll likely see significant improvement within 3-6 months of making positive changes.
When ED is linked to medical conditions such as diabetes or high blood pressure, getting these conditions under control often leads to substantial improvement in erectile function. While it might not completely disappear in these cases, it can usually be very well managed with the right treatment.
Age-related ED tends to stick around longer, but it responds remarkably well to treatment. Medications like sildenafil (Viagra) and tadalafil (Cialis) work effectively, and if one doesn't suit you, there are always alternatives to explore.
Erectile dysfunction symptoms
The symptoms of erectile dysfunction include:
- Being able to get an erection before sexual intercourse but not being able to maintain it during sexual intercourse.
- Being able to get an erection at random times, but not when you want to have sexual intercourse.
- Not being able to get an erection at all.
- Needing a lot of stimulation to maintain an erection.
When to see a doctor
While occasional erection difficulties are completely normal, you should consider speaking to your GP if ED has been happening regularly for more than a few weeks, or if it's affecting your relationships and self-confidence.
How can erectile dysfunction be treated?
ED has many effective treatments to suit your individual needs, including oral medications like sildenafil (Viagra), penis pumps, injections, hormone therapy, and counselling. Lifestyle changes often help, too.
Learn more about each treatment option below to find what might work best for you.
Sildenafil
- Prescription-only treatment: generic sildenafil, Viagra
- Over-the-counter treatments: Viagra Connect, Aronix, Liberize, Almus
- Available dosages: 25mg, 50mg, 100mg
- Works in: 30-60 minutes
- Lasts for: 4-5 hours
Tadalafil
- Prescription-only treatment: generic tadalafil, Cialis
- Over-the-counter treatment: Cialis Together, Stamiz, Avarante
- Available dosages: 2.5mg, 5mg, 10mg, 20mg
- Works in: 30-60 minutes
- Lasts for: 24-36 hours
Vardenafil
- Prescription-only treatment: generic vardenafil, Levitra
- Over-the-counter treatment: N/A
- Available dosages: 5mg, 10mg, 20mg
- Works in: 25-60 minutes
- Lasts for: 4-5 hours
Avanafil
- Prescription-only treatment: Spedra
- Over-the-counter treatment: N/A
- Available dosages: 50mg, 100mg, 200mg
- Works in: 15-30 minutes
- Lasts for: 4-6 hours
Alternatives to erectile dysfunction pills
If pills aren't suitable or you'd prefer to explore other options, there are some effective alternatives:
- Supplements: Vitamin D, L-arginine, ginseng, and L-citrulline supplements may help improve erectile function, though evidence varies.
- Penis pumps (vacuum devices): A plastic tube fits over your penis and creates a vacuum that draws blood in to create an erection. Once erect, you place a tension ring at the base to maintain it for about 30 minutes. These are highly effective, with 9 in 10 men able to have sex after using one.
- Alprostadil: A synthetic hormone that stimulates blood flow, available as self-injections into the base of the penis or as pellets inserted into the urethra. Creates an erection within 5-15 minutes lasting up to an hour.
- Hormone replacement therapy (HRT): If low testosterone is contributing to your ED, testosterone replacement through gels, patches, or injections may help restore sexual function.
- Penile implants: Surgical options for when other treatments haven't worked include semi-rigid rods that can be bent into position or inflatable implants you control.
- Mental health support: If psychological factors are involved, options include psychosexual counselling for relationship issues, cognitive behavioural therapy (CBT) to address unhelpful thought patterns, or sensate focus therapy to reduce performance pressure.
How to choose the right erectile dysfunction treatment for your needs
Finding the right ED treatment depends on what matters most to you and your lifestyle.
Price
Price is often the first consideration. Generic medications work just as well as branded versions but cost much less. You'll also need to decide between prescription medications and over-the-counter options.
Speed
Different medications work at different speeds and durations. Some take effect in 15-30 minutes for spontaneous moments, while others last up to 36 hours so you don't need to plan ahead. You can read more about how long Viagra lasts.
Side effects
Side effects vary between medications and people. Common ones include headaches and facial flushing, which often improve over time. Starting with lower doses helps minimise these effects. If one medication doesn't suit you, another might work better. Read more about Viagra side effects.
Your other medications
Your health and current medications matter too. Some drugs, especially heart medications, don't mix with ED treatments. This is why the consultation process is so important to ensure your treatment is safe.
Your sexual needs
Consider your relationship and how often you have sex. Daily options work well for regular activity, while on-demand pills suit occasional use.
Erectile dysfunction: the stats
- ED affects 50-55% of men between the ages of 40 and 70.
- One in four men seeking ED treatment are under 40.
- Physical causes account for 80% of cases, with heart disease and diabetes being the biggest culprits.
- Men with heart disease are twice as likely to have ED, while up to 75% of diabetic men experience it.
- Psychological factors like stress and anxiety play a role in 10-20% of cases.
- Oral medications like Viagra are effective for around 70% of men.
- Lifestyle changes alone, like losing weight, exercising and quitting smoking, can reverse ED in about 30% of cases.
- Only 25% of affected men seek help, often waiting years before taking action.
What to expect when treating erectile dysfunction
Starting ED treatment requires realistic expectations to get the best results. ED medication isn't an instant fix, and you'll still need to be sexually aroused for it to work.
The tablets improve blood flow when you're aroused, but they don't create desire on their own. You'll still need the same stimulation and attraction you normally would. Think of them as enhancing your body's natural response, not replacing it.
While many men see improvement immediately, others need to try a medication several times or adjust their dose. Anxiety about whether it will work can actually interfere with effectiveness, so try to relax and give it time.
If stress, anxiety, or depression contribute to your ED, medication alone might not be enough. Many men find that combining tablets with counselling or stress management provides the best results.
Side effects are usually mild and temporary. You might experience headaches, facial flushing, a stuffy nose, or mild indigestion. These typically improve as your body adjusts. Most men find these minor inconveniences worth the benefits, but if they persist, your dose can be adjusted, or you can try a different medication.
Changes you can make to help with erectile dysfunction
- Exercise: lifestyle changes can significantly improve or even reverse ED. Just 30 minutes of daily walking improves blood flow and cardiovascular health, both essential for erections.
- Weight loss: if you're overweight, losing even 10% of body weight can dramatically improve erectile function within months. If you need a helping hand on your weight loss journey, see if a weight loss medication, like Mounjaro or Wegovy, are right for you.
- Reducing the amount you drink: Cutting back on alcohol and quitting smoking can bring quick improvements.
- Dealing with stress and anxiety: managing stress is equally important since stress hormones interfere with arousal. Try meditation, deep breathing, or yoga for just 10 minutes daily.
- Talking to your partner: open communication with your partner also reduces pressure, with many couples finding that removing performance expectations allows natural arousal to return.
