Erectile dysfunction refers to the persistent inability to achieve or maintain an erection firm enough for sexual activity. Occasional difficulties with erections are common and not necessarily a cause for concern; however, when the issue becomes frequent or impacts mental well-being and relationships, addressing it proactively is critical.

ED is not simply a part of ageing—it’s often a symptom of an underlying health issue that can be managed with proper care and treatment.

Erectile dysfunction can result from a variety of physical, psychological, or lifestyle-related factors. Identifying and addressing the root cause is essential to determining the best course of treatment.

1. Physical Causes

• Cardiovascular diseases such as high blood pressure or atherosclerosis (hardening of the arteries), which affect blood flow to the penis.

• Diabetes, which can damage nerves and blood vessels critical for achieving an erection.

• Hormonal imbalances, including low testosterone levels.

• Neurological conditions like multiple sclerosis or Parkinson’s disease.

• Pelvic injuries or surgery that may impair blood flow or nerve function, such as prostate surgery.

2. Psychological Causes

• Stress and anxiety, whether performance-related or general.

• Depression, which can lower libido and disrupt brain signals related to sexual arousal.

• Relationship problems, such as unresolved conflicts or poor communication, which can influence sexual intimacy.

3. Lifestyle Factors

• Smoking, which damages blood vessels and reduces circulation.

• Alcohol consumption, especially excessive intake over the long term.

• Lack of exercise, leading to poor circulation and overall health decline.

• Obesity, linked to both hormonal imbalances and cardiovascular issues.

Diagnosing ED requires sensitivity and a thorough medical assessment to identify its causes, focusing on both physical and mental health. It typically starts with a medical history, where a GP or specialist asks about symptoms, lifestyle, medications, and the nature of erection difficulties. A physical exam may follow, assessing the penis and testicles for abnormalities and checking blood pressure to evaluate cardiovascular health. Blood and hormone tests can detect issues like high cholesterol, diabetes, or low testosterone. If psychological factors like stress or depression are suspected, a mental health evaluation may be recommended. In complex cases, tests like ultrasounds to assess blood flow or nocturnal penile tumescence testing may be used.

Treatment for erectile dysfunction depends on the underlying cause and is usually tailored to the individual for the best results. There is no “one-size-fits-all” solution; instead, treatments often involve a combination of lifestyle changes, medications, therapies, or surgeries where necessary.

1. Lifestyle Modifications

Healthcare professionals often recommend starting with these changes to improve general health and reduce ED symptoms:

• Quitting smoking

• Reducing alcohol consumption

• Exercising regularly to improve circulation and cardiovascular health

• Eating a balanced, heart-healthy diet

• Managing stress through mindfulness or therapy

2. Medications

Prescription medications like PDE5 inhibitors (e.g., sildenafil, tadalafil) are commonly prescribed to improve blood flow to the penis and enhance erections. These medications are effective for many men but should only be taken under medical supervision to avoid adverse side effects.

3. Therapy for Psychological Causes

If psychological factors play a significant role, exploring options such as cognitive behavioural therapy (CBT) or couples’ counselling can be beneficial. Addressing mental health can alleviate symptoms and enhance overall well-being.

4. Medical Devices

Vacuum erection devices, which use suction to encourage blood flow into the penis, are another non-invasive option.

5. Surgical Solutions

For men who do not respond to other treatments, surgical options may be considered as a last resort. These options include penile implants, which involve placing a device inside the penis to allow for better control over erections, or vascular surgery, which aims to improve blood flow to the area. While these procedures are typically rare and only recommended in specific cases, specialists will carefully evaluate each patient’s condition and guide them through the decision-making process, ensuring they fully understand the potential risks, benefits, and outcomes of surgery.

ED is not simply a part of ageing—it’s often a symptom of an underlying health issue that can be managed with proper care and treatment.