Erectile Dysfunction
Also known as ED, Impotence
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is erectile dysfunction?
Erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sex. It is common and treatable. Importantly it is often an early warning of cardiovascular disease, because the penile arteries are small and narrow before the coronary arteries do, so it warrants a cardiovascular assessment.
Causes
- Vascular disease reducing penile blood flow
- Diabetes related nerve and vessel damage
- Low testosterone
- Medication side effects including some antidepressants and beta blockers
- Psychological factors such as anxiety and depression
- Pelvic surgery or radiotherapy
Symptoms
- Difficulty achieving an erection
- Difficulty maintaining an erection during sex
- Reduced sexual desire in some cases
- Loss of spontaneous night time or morning erections in organic causes
- Associated distress or relationship strain
Risk factors
- Cardiovascular disease and hypertension
- Diabetes
- Smoking
- Obesity and physical inactivity
- Excess alcohol
- Increasing age
Diagnosis
- Sexual, psychological and relationship history
- Cardiovascular risk assessment including blood pressure and lipids
- Fasting glucose or HbA1c
- Morning testosterone measurement
- Medication review
Treatment
- Cardiovascular risk factor modification and exercise
- Phosphodiesterase type 5 inhibitors such as sildenafil or tadalafil
- Reviewing and adjusting contributing medicines
- Testosterone replacement only if deficiency is confirmed
- Vacuum erection devices
- Intracavernosal injection therapy
- Psychosexual therapy, particularly when onset is sudden or situational
Self care
- Increase physical activity, which improves vascular function
- Lose weight if overweight
- Stop smoking and reduce alcohol
- Address sleep, stress and relationship factors
- Review whether new medicines coincided with the change
- Talk to your partner, since silence usually worsens the cycle
When to see a doctor
Book an appointment if:
- Difficulty lasting more than a few months
- Gradual onset with loss of morning erections
- Reduced sexual desire alongside it
- Existing diabetes, heart disease or high blood pressure
- Curvature or pain with erections
- To have cardiovascular risk assessed, which is the key reason
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Keep cardiovascular risk factors controlled
- Stay physically active and maintain a healthy weight
- Do not smoke
- Limit alcohol
- Treat depression, anxiety and sleep apnoea
- Review medicines that commonly contribute
Outlook
Erectile dysfunction is highly treatable. PD5 inhibitors work for the majority, and addressing cardiovascular risk, weight and medication often improves function directly. Because it can precede heart disease by several years, treating it as a prompt for cardiovascular assessment frequently benefits health well beyond sexual function.
Common questions
Why is erectile dysfunction linked to heart disease?
The arteries supplying the penis are narrower than the coronary arteries, so atherosclerosis affects them earlier. Erectile dysfunction can precede a cardiac event by several years, which makes it a valuable prompt for cardiovascular screening.
Is it usually psychological?
Both physical and psychological factors often contribute. Preserved morning erections and sudden situational onset point toward psychological causes, while gradual onset with loss of night time erections suggests a physical cause.
Are these medicines safe with heart problems?
PD5 inhibitors are generally safe for most people with stable heart disease, but they must never be combined with nitrate medicines because the combination can cause a dangerous drop in blood pressure.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.