Erectile dysfunction (impotence)

Erectile dysfunction - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Erectile dysfunction (impotence) Erectile dysfunction (impotence) About erectile dysfunction Symptoms of erectile dysfunction Causes of erectile dysfunction Diagnosing erectile dysfunction Treating erectile dysfunction About erectile dysfunction Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection. Erectile dysfunctionis a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40and 70 will have it to some degree. When to see your GP See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the hearts blood supply is blocked or interrupted). Find your local GP practice Why does erectile dysfunction happen? Erectile dysfunctioncan have a range of causes, both physical and psychological. Physical causes include: narrowing of the blood vessels going to the penis commonly associated with high blood pressure (hypertension), high cholesterol or diabetes hormonal problems surgery or injury Psychological causes of ED include: anxiety depression relationship problems Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical. Erectile dysfunction can also be a side-effect of using certain medicines. Read more about the causes of erectile dysfunction Diagnosis Although you may be embarrassed, its important to get a diagnosisso that the cause can be identified. Your GP can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests. Read more about diagnosing erectile dysfunction How is erectile dysfunction treated? Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological. The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these casesyour GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease . This mayhelp to relieve your symptoms as well as improving your general health. You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure. A number of treatmentshavebeen successful in the treatment of erectile dysfunction. Medication, suchas sildenafil (sold as Viagra),can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases. Psychological treatmentsincludecognitive behavioural therapy (CBT) and sex therapy. Overall, treatments forerectile dysfunctionhave improved significantly in recent years. Most men are eventually able to have sex again. Read more about treating erectile dysfunction Symptoms of erectile dysfunction The main symptom of erectile dysfunction (ED) is the inability to get and maintain an erection for satisfactory intercourse. ED should not be confused withejaculation problems such as premature ejaculation, which is a condition where the process of arousal, orgasm and ejaculation occurs very rapidly. Inability to get an erection Sometimes ED only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. In these circumstances, it is likely that the underlying cause of ED is primarily psychological (stress related). However, if you are unable to get an erection under any circumstances, it is likely that the underlying cause is primarily physical. Seek medical advice See your GP if ED persists for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the hearts blood supply is blocked or interrupted). Many websites offer treatments for ED but their use is not recommended. The medications that are offered by these sites could be fake and may be dangerous. Even if the medications are genuine, they may not be suitable for you. It is important that you only take medication for ED that your GP has prescribed for you. Read more about treating erectile dysfunction Causes of erectile dysfunction Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress. Its important to identifythe cause of erectile dysfunction and treat any underlying conditions. Erections Whena manbecomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead toerectile dysfunction. Anything that affects the level of sexual desire (libido)can also causeerectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression , can reduce libido, as can changes in hormone levels (chemicals produced by the body). Physical causes There are four main types of health conditions that can cause physical problems resulting inerectile dysfunction. These are: conditions affecting the flow of blood to your penis vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord  neurogenic conditions affecting your hormone levels  hormonal conditions affecting the physical structure of your penis anatomical Injuries and surgery Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people whoexperience a severe head injury . Vasculogenic conditions Examples of vasculogenic conditions that cause erectile dysfunction include: cardiovascular disease  a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) high blood pressure (hypertension) diabetes a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition Erectile dysfunctionis strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers whenmaking a diagnosisand planning your treatment. Neurogenic conditions Examples of neurogenic conditions that causeerectile dysfunction include: multiple sclerosis  a condition that affects the bodys actions, such as movement and balance Parkinsons disease  a condition that affects the way that the brain coordinates body movements, including walking, talking and writing a spinal injury or disorder a stroke  a serious condition that occurs when the blood supply to the brain is interrupted Hormonal conditions Examples of hormonal conditions that causeerectile dysfunction include: hypogonadism a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels an overactive thyroid gland (hyperthyroidism) where too much thyroid hormone is produced an underactive thyroid gland (hypothyroidism)  where not enough thyroid hormone is produced Cushings syndrome  a condition that affects the production of a hormone called cortisol Anatomical conditions Peyronies disease, which affects the tissue of the penis, is an example of an anatomical condition that can causeerectile dysfunction. Medicine In some men,certain medicines can causeerectile dysfunction, including: diuretics  these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease antihypertensives such as beta-blockers , that are used to treat high blood pressure fibrates medicines used to lower cholesterol levels antipsychotics used to treat some mental health conditions, such as schizophrenia antidepressants  used to treat depression and some types of pain corticosteroids  medication that contains steroids, which are a type of hormone H2-antagonists medicines used to treat stomach ulcers anticonvulsants used to treat epilepsy antihistamines used to treat allergic health conditions, such as hay fever anti-androgens medication that suppresses androgens (male sex hormones) cytotoxics medication used in chemotherapy to prevent cancer cells from dividing and growing Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. Alternative medication may be available. However,it is important never tostop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care. Psychological causes Possible psychological causes oferectile dysfunction include: depression  feelings of extreme sadness that last for a long time anxiety a feeling of unease, such as worry or fear Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction. There aremany emotional issues that may also affect your physical ability to get or maintain an erection. These include: relationship problems lack of sexual knowledge past sexual problems past sexual abuse being in a new relationship Other causes Other possible causes oferectile dysfunctioninclude: excessive alcohol intake tiredness using illegal drugs, such as cannabis, heroin or cocaine Cycling Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction. Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction. Diagnosing erectile dysfunction Erectile dysfunction (ED) can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination. Your GP may ask you about: your symptoms your overall physical and mental health your alcohol consumption whether you take drugs whether you are currently taking any medication If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic. You can find your nearest GUM clinic on the British Association for Sexual Health and HIV(BASHH) website. Sexual history Youll also be askedabout your sexual history. Try not to be embarrassed becauseerectile dysfunction is a common problem.You can request a male GP at your surgery if you prefer. You may be asked about: your previous and current sexual relationships what your sexual orientation is how long you have been experiencing erectile dysfunction whether you can get any degree of erection with your partner, on your own or when you wake up in the morning whether you have been able to ejaculate or orgasm your libido (your level of sexual desire) Erectile dysfunctionthathappens all the time may suggest an underlying physical cause. Erectile dysfunction thatonly occurs when you are attempting to have sex may suggest an underlying psychological (mental) cause. Assessing your cardiovascular health Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease (conditions that affect the heart and blood flow). Your GP may: measure your blood pressure to see if you have high blood pressure (hypertension) listen to your heart rate to check for any abnormalities measure your height, weight and waist circumference to see if you are a healthy weight for your height ask you about your diet and lifestyle, for example, how much exercise you do test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels Physical examinations and tests Aphysical examination of your penis may be carried outto rule out anatomical causes (conditions that affect the physical structure of your penis). If you have symptoms of an enlarged prostate , such as weak or irregular urination, a digital rectal examination (DRE) may be suggested. Blood tests can alsocheck for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone). Further testing In some cases you may be referred to a specialist for further testing. This might be the case if youare unusually young to be experiencingerectile dysfunction as its rare in men under 40 years of age. Intracavernous injection test An intracavernous injection test involves injecting a man-made (synthetic) hormone into your penis to increase the blood flow. This helpsassess anyabnormalities in your penis and plan surgery. If the injection doesnt result in anerection it may indicate a problem with the blood supply to your penis. In some cases, you may also need an ultrasound scan . Arteriography and dynamic infusion cavernosometry or cavernosography These specialised tests involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels. Psychological assessment If the cause of your erectile dysfunction is thought to be psychological, you may be refferedfor a psychological assessment. Treating erectile dysfunction If you have erectile dysfunction (ED), treatment will depend on whats causing it. The various treatments for erectile dysfunction are outlined below. Treating underlying conditions If yourerectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes , that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem. If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care. Lifestyle changes Erectile dysfunction can often be improved by making changes to your lifestyle, such as: losing weight if you are overweight giving up smoking cutting backyour alcohol consumption not taking illegal drugs exercising regularly reducing stress As well as helping to improve yourerectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels). Read more about preventing cardiovascular disease Phosphodiesterase-5 (PDE-5) inhibitors Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to your penis. In England,four PDE-5 inhibitors are available for treating erectile dysfunction. They are: sildenafil sold under the brand name Viagra tadalafil sold under the brand name Cialis vardenafil sold under the brand name Levitra avanafil sold under the brand name Spedra Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work on demand. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend. Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours. It may take longer to notice the effects if the tablet is taken with food, so its best to take it on an empty stomach. You can then eat after an hour without affecting the medicine. Only take one tablet within a 24-hour period. Your GP should explain the benefits of each medication and how it works. The choice may depend on: how often you are sexually active whether you have tried any of the medications before There have been many studies to test the effectiveness of these medications. In general,at leasttwo-thirds of men report having improved erections after taking one of these medicines. If you do not find that PDE-5 inhibitors are effective it may be because: you have not waited long enough after taking the dose you have waited too long after taking the dose the dose is not high enough you have not had enough sexual stimulation These medications are triggered by sexual stimulation, so you also need to be aroused for it to work. Warnings PDE-5 inhibitors should be usedwith caution in men who have cardiovascular disease , such as coronary heart disease. However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP. PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronies disease (a condition that affects the tissue of the penis). PDE-5 inhibitors should also be used with caution in men who: are at risk of priapism a painful erection that lasts for several hours are also taking long lasting alpha-blockers  a medication used to treat a number of conditions, such as high blood pressure (hypertension) Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates. The combination of the two substances can have a dangerous effect on your heart. Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as poppers. Youarealsowarnednot to take PDE-5 inhibitors if you: have been advised not to take part in sexual activity or in activities that widen your blood vessels have low blood pressure (hypotension) have recently had a stroke  a medical emergency that occurs when the blood supply to the brain is interrupted have unstable angina  an underlying heart condition that causes symptoms such as chest pain have had a heart attack  a medical emergency where the blood supply to the heart is suddenly blocked have a history of non-arteritic anterior ischaemic optic neuropathy an eye condition that causes a sudden loss of vision Side effects PDE-5 inhibitors can cause some side effects, including: headaches and migraines flushing (redness) indigestion nausea (feeling sick) vomiting (being sick) a blocked or runny nose back pain vision disturbances muscle pain Vacuum pumps A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated. You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes. It may take several attempts to learn how to use the pump correctly, but they are usually effective. After using a vacuum pump,nine out of 10 men are able to have sex, regardless of the cause of their ED. Considerations You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines , which reduce the ability of your blood to clot. Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men. Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details). However,some men will need to buy one. The Sexual Advice Association produces a number of factsheets, including one on vacuum pumpsthat provides details of companies that supply them. Alprostadil If yourerectile dysfunction doesntrespond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis. Alprostadil is available as: an injection directly into your penis this is called an intracavernosal injection a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) this is called urethral application You may be trained to correctly inject or insert alprostadil. If your partner is pregnant,use a condom during sex if you are inserting alprostadil into your urethra. Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose. In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men. Warnings Alprostadil should not be used: inmen at risk of priapism (a painful erection that lasts for several hours) for example, those with sickle cell anaemia alongside othererectile dysfunction medications if you have a penile implant or if you have been advised to avoid sexual activity Urethral application may also not be used in: somemen who have anatomical problems with their penis (conditions that affect the physical structure of the penis) men who have infections of their penis, such asbalantis(inflammation of the head of the penis) Side effects Alprostadil can cause some side effects including: changes in your blood pressure dizziness headache pain in your penis urethral burning or bleeding reactions at the site of the injection, such as swelling NHS prescriptions As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available formen with particular health conditions or those receiving some types of medical treatments. If you need to pay the full prescription cost, a single injection of alprostadil costs around 8 to 22, depending on the dose. A single dose of alprostadil for urethral application is around 10. Hormone therapy If a hormonal condition is causingerectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions). Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels. Surgery Surgery forerectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in: younger men who have experienced serious injury to their pelvic area for example, in a car accident men with a significant anatomical problem with their penis In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so its unlikely to be used. Penile implants Penile implants are a type of surgery that may be considered. These can be: semi-rigid implants  which may be suitable for older men who do not have sex regularly inflatable implants  which consist of two or three parts that can be inflated to give a more natural erection Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery. Complications As with all types of surgery, having penile implants insertedcarries a risk of infection. If you take preventative antibiotics, the rate of infection is aroundtwoor threein 100. Mechanical problems with the implants may occur within five years infiveper cent ofcases. Psychological treatments If yourerectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus. If conditions such as anxiety or depression are causing yourerectile dysfunction, you may benefit fromcounselling(a talking therapy). Sensate focus Sensate focus is a type of sex therapy that you and your partner complete together. It starts with youboth agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a womans breasts). The idea is to explore your bodies knowing that you will not have sex. After the agreed period of time has passed, you can gradually begin touching each others genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex. You can find out more about sensate focus from the CollegeofSexual and Relationship Therapists (COSRT) . Psychosexual counselling Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to yourerectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome yourerectile dysfunction. The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments forerectile dysfunction to improve your sex life. Psychosexual counselling may take time to work and the results achieved have been mixed. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you haveerectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it. Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction  for example, to do with: your self-esteem (the way you feel about yourself) your sexuality your personal relationships Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues. Pelvic floor muscle exercises Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles. These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis. Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate. If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist to learn it correctly. By strengthening and trainingthese muscles, you may be able to reduce the symptoms oferectile dysfunction. Complementary therapies Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. However, there is little evidence they are useful. In some cases, they may even include ingredients that could interact with other medications and cause side effects. Always speak to your GP before using any complementary therapies. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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