Erectile dysfunction (impotence)

Erection problems (impotence) are very common. It becomes more common as men get older, particularly in men over 40. It can be a distressing symptom, but can resolve itself. You should see a GP if it keeps happening.

Causes of erection problems

Most men occasionally fail to get or keep an erection.

This is usually due to stress, tiredness, anxiety or drinking too much alcohol, and it's nothing to worry about.

If it happens more often, it may be caused by physical or emotional problems, see sections below.

When to get medical advice

See your GP or go to a sexual health clinic if:

  • erection problems keep happening

It could be a sign of an underlying health condition.

How sexual health clinics can help

Sexual health clinics treat genital problems. They can provide the same treatment you would get at your GP surgery.

What happens at your appointment

The doctor or nurse will ask about your lifestyle and relationships, and any problems you might be having.

They'll carry out basic health checks, such as taking your blood pressure. They'll also examine your genitals to rule out any obvious physical cause.

If you have symptoms like needing to pee more often, your doctor may also need to examine your prostate.

They might have to examine your bottom (rectal examination).

Treatment for erectile dysfunction problems

Treatment for erection problems depends on the cause. Treatments are much better than they used to be, and the problem often goes away.

Physical causes

Below are some possible physical causes and how they can be treated, these include:

  • narrowing of penis blood vessels, high blood pressure, high cholesterol – treatment can include medicine to lower blood pressure, statins to lower cholesterol
  • hormone problems – treatment can include hormone replacement – for example, testosterone
  • side effects of prescribed medication – treatment can include a change to medicine following discussion with your GP

You may also be asked to make lifestyle changes. These include:

Do

Don't

  • cycle for a while (if you cycle more than 3 hours a week)
  • drink more than 14 units of alcohol a week

Medication

Medicine such as sildenafil (sold as Viagra) is often used by doctors to treat erectile dysfunction. Other medications are available.

There are other similar medicines called tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra) that work in a similar way.

It's possible to buy Viagra over the internet, but many sites sell fake (counterfeit) medicines. The active ingredients in them can vary, causing side effects. Never buy off-prescription Viagra tablets online. Make sure you only take medication prescribed by a doctor and supplied from a UK pharmacy.

The Medicines and Healthcare products Regulatory Agency (MHRA) advises men not to use unlicensed herbal remedies for erectile dysfunction. Test results on several remedies have found unlicensed and potentially unsafe versions of the ‘prescription-only’ medication sildenafil contained within them.

Other treatments

 Other treatments include injections, creams, vacuum devices, surgically implanted devices and physiotherapy (to strengthen the pelvic floor muscles). Your GP will usually refer you for specialist advice if prescribed medications are not helping, or are not suitable for you.  

Emotional (psychological) problems

You should talk to your doctor if the condition is causing emotional problems.

Anxiety and depression can be treated with counselling and cognitive behavioural therapy (CBT).

Your GP might recommend sex therapy, either on its own or in combination with other psychotherapy.

There's usually a long wait for these services on the health service.

You can also pay to see someone privately.

Finding private counsellors or sex therapists

Counsellors and psychotherapists should be a member of the:

Sex therapists should be a member of the:

Relate also offers sex therapy for a fee.

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

This page was published March 2018

This page is due for review December 2020

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