29 March, 2021 | Jabbar Ali - MPharm
Erectile dysfunction, also known as ED, is one of the most common problems men face in their sex life. Defined as a problem men have when they cannot get a firm erection, or have trouble maintaining it for the entire duration of sexual intercourse, it is much more widespread than many of us realise - affecting roughly 4.3 million men, or about one in five in the UK each year.
At IQ Doctor, we are here to work on a systematic approach to improving your sexual health. In this guide, we run through the main causes of ED, the notable symptoms and how it can be treated. This includes discussing whether it can be reversed and looking at treatment options available in the UK, from lifestyle changes and therapy through to prescription tablets, medical devices and surgery.
ED can be brought on by both physical and psychological factors. These can include:
Finding out the cause of your erectile dysfunction is instrumental in solving the problem. Overcoming ED can also help in improving your mental wellbeing, because a satisfying sex life is a significant contributor to improving wellbeing. As a general rule, anything good for your heart’s health is also good for your sexual health.
When it comes to mental health, we often overlook its impact on sexual health. The stigma attached to erectile dysfunction often prevents people from finding solutions in time. This stigma may lead us to overlook other, more severe problems as well. According to research, about 30% of men below 40 experience problems related to sexual health, such as ED.
While the factors above explain how ED happens, certain lifestyle and health factors make it more likely to happen in the first place. Some of these overlap with the causes already mentioned - since conditions like diabetes and high cholesterol don't appear overnight, but build up as risk factors over time. Long-term risk factors for developing ED include:
For a fuller breakdown of the physical and psychological factors behind ED, read our guide to the causes of erectile dysfunction.
The primary symptom of erectile dysfunction is difficulty getting or keeping an erection firm enough for sexual activity. This can show up in different ways:
It's worth noting that occasional difficulty is common and not usually a cause for concern - most men experience this at some point, especially under stress, fatigue, or after drinking alcohol. ED becomes a more relevant concern when the problem is persistent or recurring, rather than a one-off.
If erectile dysfunction is becoming a recurring and persistent problem, a consultation with your doctor is warranted. As already discussed, if for no other reason, because ED can be a leading warning sign of one of several cardiovascular diseases, as well as strokes, heart attacks or circulatory problems in your legs.
This is one of the first questions most men ask, and the honest answer is nuanced. Studies have shown that although erectile dysfunction cannot be cured outright, the symptoms can be eliminated or reduced to a large extent, especially in the case of secondary ED.
Primary ED is rare and occurs when a man has never been able to have an erection. Secondary ED is far more common and is a fairly temporary condition, which is why so many men see their symptoms improve significantly with the right treatment.
It also helps to understand the difference between short term and primary treatments. Short term treatments are effective in helping men gain or sustain an erection without actually treating the underlying cause. Men who have diabetes or atherosclerosis, for example, can get short term relief from sildenafil, which increases the flow of blood to the penis. Primary treatments, on the other hand, address the actual issues causing erectile dysfunction. Medication and exercise are recommended to improve overall cardiovascular health and blood flow in order to reduce the frequency of ED episodes. Where erections are directly affected by anxiety, stress or low self-esteem, psychological treatment is recommended to deal with the worry and to rebuild confidence, which can in turn improve your sex life and your relationships.
Changes to your lifestyle can improve ED related symptoms and their underlying causes:
Men who repeatedly experience ED symptoms can find it takes a real toll on their self-esteem, leading to stress, depression and problems within a relationship. It is therefore worth couples undergoing therapy together to openly discuss their feelings, concerns and anxieties. This kind of therapy helps couples find constructive ways to communicate and resolve intimacy issues rather than avoiding them.
You can consult your health care professional and work with them to begin a systematic treatment for erectile dysfunction. The approach will involve studying various symptoms and underlying causes to provide the most suitable treatment for you.
The type of treatment you choose for your erectile dysfunction will be your personal decision. However, you should preferably consult with your partner. We suggest you agree on the type of treatment that will be comfortable for both of you as a couple.
The most preferable and ideal starting point for erectile dysfunction is to make calculated changes to your lifestyle. This approach helps in dealing with all underlying causes, chalking them off one at a time.
Lifestyle changes can include:
These changes do more than tick a box. Regular physical activity improves blood flow, reduces stress and anxiety and improves overall cardiovascular health, all of which help reduce ED symptoms, and a balanced diet rich in fruit, vegetables, whole grains and lean protein supports the same goal. Losing excess weight improves cardiovascular health and reduces the risk of ED, and finding ways to manage stress, whether through meditation, yoga or deep breathing exercises, can reduce anxiety and improve symptoms. Both smoking and excessive alcohol consumption have been linked to an increased risk of ED.
If weight is a contributing factor, our weight loss treatments may be worth exploring alongside ED treatment, and our guide to preventing erectile dysfunction covers the lifestyle side in more depth.
Erectile dysfunction is an issue that can become more common as men grow older, although getting older does not guarantee ED. Some men can stay sexually healthy and functional well into their 80s. If you are young and have erectile dysfunction, then it could be a warning sign of a more severe illness, as mentioned before. This is why finding out the root cause of erectile dysfunction is vital before any treatment for it can be started.
Either physical or mental problems can cause erectile dysfunction. The physical causes of erectile dysfunction in older men are usually:
There is no single best treatment for erectile dysfunction. The right option depends on the underlying cause of your symptoms, your general health and what you are comfortable with. Below are all of the main options available, starting with the most commonly prescribed.
The most commonly prescribed medicines for erectile dysfunction are oral tablets that help you sustain an erection. The most frequently prescribed drugs are:
These medications work by inhibiting the enzyme PDE5, which breaks down cGMP, a molecule that helps to relax the smooth muscle in blood vessels. Relaxing those vessels allows more blood to flow into the penis, which is what produces and maintains an erection. The same class of drugs is also used to treat pulmonary arterial hypertension and some types of Raynaud’s phenomenon.
They are generally safe and effective when used as directed, though they can cause side effects such as headache, flushing and stomach upset. Importantly, they should not be used by people taking nitrates for heart conditions, as the combination can cause a dangerous drop in blood pressure.
For the full list of common and uncommon side effects for your specific medication, always check the patient information leaflet, which you can find on the EMC website. Our full guides to sildenafil and tadalafil cover dosage and timing in detail, and our ED treatment options guide compares them side by side.
For men whose ED is caused or worsened by psychological factors such as anxiety, stress or depression, counselling can be an effective treatment in its own right. It helps men identify and address the underlying issues contributing to their symptoms.
One common approach is cognitive behavioural therapy (CBT), which helps men identify and change the negative thoughts and beliefs feeding into their ED, and build coping strategies for managing stress and anxiety. Another is sex therapy, which involves working with a therapist to identify and address the specific sexual issues contributing to the problem. As noted above, couples therapy can also be valuable where the condition is affecting a relationship.
If your symptoms come and go depending on the situation, our guide to telling the difference between ED and performance anxiety is a useful next read.
This non-invasive device, sometimes called a penis pump, uses suction to draw blood into the penis and create an erection. It consists of a plastic cylinder placed over the penis, a pump used to create a vacuum, and a constriction band placed around the base of the penis to maintain the erection once it has formed.
Vacuum erection devices are a safe and effective option for many men and have few side effects, and they can be particularly useful where there is severe nerve damage. However, they are not effective for everyone, and some men find them uncomfortable to use. Speak to a doctor to determine whether a vacuum device is an appropriate option for you.
Alprostadil is a synthetic version of prostaglandin E1, a naturally occurring substance that relaxes smooth muscle and increases blood flow to the penis. It is available in two forms: an injection given directly into the shaft of the penis, which can produce an erection within 5 to 20 minutes, or a small pellet inserted into the urethra, which works within 10 to 20 minutes.
Alprostadil is not effective for everyone, and side effects such as pain and priapism (a prolonged, painful erection) can occur. Consult a doctor to determine whether it is an appropriate treatment option for you.
For men with low testosterone levels, testosterone therapy can be effective in improving ED and other associated symptoms. It is available in several forms, including injections, gels, patches and pellets placed under the skin.
It is important to note that testosterone therapy is not effective for all men with ED, and it may not be recommended for men with certain medical conditions such as prostate or breast cancer, or for those at higher risk of cardiovascular disease. It can also cause side effects including acne, breast enlargement and an increased red blood cell count, so regular monitoring by a doctor is necessary to keep testosterone levels within a safe range.
This is a surgical option for men with severe ED who have not had success with other treatments. It involves inserting a medical device into the penis to help achieve an erection. There are two main types: inflatable implants, made up of two cylinders implanted into the penis, a pump implanted in the scrotum and a reservoir in the lower abdomen, and malleable implants, made up of two bendable rods implanted into the penis.
Penile implant surgery is typically only considered after other treatments have been unsuccessful. It is generally safe and effective, and most men are satisfied with the results, but as with any surgery there are risks including infection, bleeding and device malfunction. Recovery time varies, though most men can resume sexual activity within four to six weeks. Speak to a qualified healthcare provider to determine whether it is the right option for you.
You do not need to sit in a waiting room to get help with ED. iQ Doctor is a registered UK pharmacy offering a discreet online service: you complete a short online consultation, a UK registered prescriber reviews your answers to check the treatment is safe and suitable for you, and approved treatment is delivered discreetly to your door.
“ED is one of the most common things our pharmacists help with, and one of the most put off. It's also a useful health signal. It can point to blood pressure, cholesterol or blood sugar problems before any other symptoms show up. That's why every consultation checks your heart health and current medicines, not just whether a tablet is suitable.”
Omar El-Gohary, Superintendent Pharmacist and CEO, iQ Doctor (GPhC Reg. No. 2059792)
iQ Doctor is a registered UK pharmacy that specialises in medical remedies for erectile dysfunction, weight loss, hair loss support and much more. Whether you require over the counter relief, or prescription only medication, the experts at iQ Doctor can assist. If you have any questions about erectile dysfunction or our treatments, get in touch with IQ Doctor's clinical team.
Most commonly, restricted blood flow to the penis, which is why ED is so closely tied to cardiovascular health. Nerve damage, diabetes, certain medications and psychological factors such as stress and anxiety are also frequent causes, and many men have more than one contributing factor.
ED cannot usually be cured outright, but the symptoms can very often be eliminated or greatly reduced. Secondary ED, which is by far the more common type, responds well to treatment, and addressing the underlying cause through lifestyle changes, therapy or medication can produce lasting improvement.
There is no single best treatment. PDE5 inhibitor tablets such as sildenafil and tadalafil are the most commonly prescribed and work well for most men, but the right choice depends on the cause of your symptoms, your general health and any other medication you take. A prescriber can help you find the option that suits you.
Not necessarily, but it can be an early warning sign. Because ED often reflects restricted blood flow, it can appear before other cardiovascular symptoms do. If ED is persistent, it is worth having your blood pressure, cholesterol and blood sugar checked as part of getting it treated.
Yes. Research suggests around 30% of men under 40 experience sexual health problems including ED. In younger men the cause is more often psychological, such as stress, anxiety or performance pressure, but it can also point to an underlying physical condition, so it is worth getting checked rather than waiting it out.
Yes, from a registered UK pharmacy such as IQ Doctor. You complete an online consultation, which is reviewed by a UK registered prescriber before any treatment is issued, and your medication is delivered discreetly. Avoid any site offering prescription ED medication without a consultation.
This page has been written by a registered UK pharmacist and reviewed by our clinical team to ensure it is accurate, clear and reflects current clinical guidance.
Last medically reviewed: 29 March, 2021
Last updated: 13 October, 2026