Erectile difficulties: common causes and real solutions

Occasional difficulty with erections is normal and usually related to tiredness, stress or alcohol. Persistent difficulty over months is worth assessing, both because it is treatable and because of what it can indicate.

Why it is a cardiovascular signal

Erections depend on healthy blood vessels and nerves. The vessels involved are small, so problems can appear there before symptoms arise in the heart. Persistent erectile dysfunction is therefore a reason to check blood pressure, blood sugar and cholesterol, not just to treat the symptom.

Common contributing causes

• Diabetes and high blood pressure
• Smoking, heavy alcohol use and some recreational drugs
• Excess weight and low physical activity
• Certain prescribed medicines, including some for blood pressure and depression
• Low testosterone, thyroid and other hormonal conditions
• Prostate surgery or pelvic injury
• Stress, anxiety, depression and relationship difficulties
• Poor sleep, including untreated sleep apnoea

Physical and psychological causes frequently coexist: anxiety about performance can maintain a problem that began physically.

What an assessment involves

A conversation about the pattern of symptoms, your general health, medicines and mood, followed by checks such as blood pressure, blood glucose, lipids and sometimes hormone levels. A clinician will also ask whether morning erections still occur, which helps distinguish causes.

Treatments that work

• Addressing the underlying condition, which often improves symptoms substantially
• Stopping smoking, reducing alcohol, losing excess weight and exercising regularly
• Reviewing medicines that may contribute, with alternatives where possible
• Prescribed oral medicines, which suit many men but are not safe for everyone, particularly those taking nitrates for heart disease
• Psychological or couples therapy where anxiety or relationship factors are involved
• Specialist options where first-line treatments do not help

Why not to buy pills online informally

Products sold without prescription are frequently counterfeit, wrongly dosed or contaminated, and they bypass the check for conditions that make them dangerous. Combined with nitrate medicines they can cause a severe drop in blood pressure. Get a prescription from a licensed clinician and dispense it at a registered pharmacy.

Raising it in a consultation

Clinicians discuss this regularly, and a private online consultation can make the conversation easier to start. Seek urgent care for an erection lasting more than four hours, which is a medical emergency.