Erectile Dysfunction

Erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is common, particularly with increasing age, and can be an early warning sign of underlying cardiovascular or other health conditions.

• Difficulty achieving an erection
• Difficulty maintaining an erection during sexual activity
• Reduced sexual desire in some cases, depending on the underlying cause
• Occasional difficulty is common and not necessarily a concern, but a persistent pattern warrants assessment

• Often results from reduced blood flow to the penis, related to conditions such as diabetes, hypertension, high cholesterol, obesity, or smoking, which damage blood vessels over time.
• Can also result from hormonal imbalances, certain medicines, nerve damage, or psychological factors such as stress, anxiety, or relationship difficulties.
• Often has a combination of physical and psychological contributing factors.

• Diagnosed through a detailed history, including onset, pattern, and any related symptoms, along with assessment of cardiovascular risk factors, since erectile dysfunction can be an early marker of cardiovascular disease.
• Blood tests may be used to check for underlying conditions such as diabetes, low testosterone, or thyroid problems.
• A physical examination assesses for other contributing conditions.

Addressing underlying contributing conditions — such as improving control of diabetes, blood pressure, and cholesterol, and stopping smoking — is an important foundation of treatment and can improve symptoms on its own.

Oral medicines that improve blood flow to the penis are commonly used as first-line treatment and are effective for many men, though they should be used with caution or avoided in certain heart conditions and with certain other medicines.

Psychological or relationship factors, where relevant, may benefit from counselling or therapy alongside medical treatment.

For men who do not respond to oral medicine, or where it is not appropriate, other treatment options may be considered at specialist level.

Given the link to cardiovascular disease, new erectile dysfunction — particularly in men with risk factors — should prompt broader cardiovascular risk assessment.

• Manage cardiovascular risk factors, including blood pressure, diabetes, and cholesterol.
• Avoid smoking and limit alcohol intake.
• Maintain a healthy weight and engage in regular physical activity.
• Seek medical assessment for persistent erectile difficulty rather than assuming it is simply a normal part of ageing, since it can be both treatable and an important health signal.