Erectile dysfunction (ED) can also be referred to as impotence. ED is a condition that affects men and is the inability to achieve and maintain a satisfactory erection for sexual intercourse, or in response to sexual stimulation.

Erectile dysfunction is a very common condition that can affect any man at any age, although it becomes increasingly common with advancing years. It is estimated that around 50% of men between the ages of 40 and 70 will experience ED at some point.

Erections are caused when a man becomes sexually excited. This arousal causes the brain to send signals to the nerves in the penis. Upon receiving these signals the nerves increase the blood flow to the penis, causing it to enlarge and harden. If anything interrupts this process then erectile dysfunction can occur. This interruption may be physical, psychological or medicinal.

Physical causes of ED include:

• Vascular conditions - such as diabetes, high blood pressure and cardiovascular disease, all of which can affect the flow of blood to the penis.
• Hormonal conditions - such as over or underactive thyroid, hypogonadism and Cushing’s syndrome, all affect the hormonal levels of the body and can lead to impotence
• Neurogenic conditions - such as multiple sclerosis and Parkinson’s disease will affect the body’s nervous system and can interfere with the process of achieving an erection
• Anatomical conditions - like Peyronie’s disease that affect the tissue in the penis and can result in erectile dysfunction

Psychological causes of ED include:

• Mental conditions - such as stress, anxiety and depression can lead to erectile dysfunction
• Emotional problems can affect your physical ability to achieve or maintain an erection too. Examples of which include; lack of sexual knowledge or past sexual abuse, being in a new relationship.

Medicinal causes of ED include:

• Certain medicines can lead to erectile dysfunction in some men. Examples of these include; beta blockers, diuretics, corticosteroids, antidepressants, antihistamines, and cytotoxics.

Erectile dysfunction will present itself as an inability to achieve or maintain a satisfactory erection during sexual intercourse. When dealing with ED it is very important to understand and identify the underlying cause. For example if you’re able to achieve and maintain an erection while you masturbate but find you are unable to get an erection with your sexual partner, this would suggest the cause is psychological. However, if achieving and/or maintaining an erection isn’t possible under any circumstance, it would be safe to assume the problem is primarily physical or potentially medicinal.

Erectile dysfunction is most commonly caused by reduced blood flow to the penis. In a large proportion of cases this can be due to narrowing of the blood vessels flowing into the penis, meaning that there is insufficient blood flow to produce an erection. Some causes of reduced blood flow are; weight gain, high blood pressure, high cholesterol, smoking and diabetes. For this reason erectile dysfunction can be an early indicator of heart disease and it is important to have a full health check with your GP.

In general, symptoms of erectile dysfunction that occur slowly are more likely to indicate a physical cause (e.g. narrowing of the blood vessels to the penis) whereas symptoms that are sudden in onset may suggest psychological causes.

Other causes of erectile dysfunction can include: injury to, or diseases that affect, the nerves going to the penis, hormonal causes (e.g. low testosterone), side effects of medicines, excess alcohol, drug abuse, and psychological causes such as anxiety, depression, stress or relationship issues.

If you feel like you have the symptoms, our guide can help you learn how to complete a discreet online ED consultation.

In general, erectile dysfunction can be self-diagnosed from the obvious symptoms of struggling to achieve or maintain a satisfactory erection. Although ED can be self-diagnosed, it is always recommended that any new symptoms should be discussed with your GP. If you do not wish to discuss ED with your GP, you should book an appointment for a check-up. Erectile dysfunction can be a sign of underlying health conditions, such as heart and circulatory problems, that should be addressed.

When consulting your doctor about erectile dysfunction it will be necessary to answer some questions about your sexual history. It’s important to answer these questions honestly as it may affect the diagnosis. This may include questions about:

• Your sexual orientation
• Your previous and current sexual relationship
• Your levels of sexual desire or libido
• How long you have been suffering from ED and to what degree you are able to achieve an erection
• Whether you have been able to ejaculate or orgasm

Other more general lines of enquiry will likely include:

• Questions about your overall physical health
• Questions about your overall mental health
• Whether you drink alcohol or take recreational drugs
• What medication you are currently taking
• Questions about your diet, exercise levels and lifestyle

The doctor may wish to perform a series of simple tests, as ED can be caused by a more serious underlying condition such as cardiovascular disease or diabetes. These tests may include:

• A blood pressure test
• Height, weight and waist measurements
• A heart rate check
• A blood glucose and lipids test
• An ultrasound

There may be the need to perform a physical examination of the penis. This way the doctor can rule out any physical abnormality or anatomical reason for why ED is occurring. If over the age of 50 then the GP may wish to perform a rectal (prostate) exam where they will insert a gloved finger into the anus. This exam will help the doctor rule out underlying conditions, such as prostate cancer.

In some cases a blood sample may be taken for analysis. This sample will show the hormone levels in the blood. This analyses will help identify or rule-out any hormonal conditions like hypogonadism, which is low levels of testosterone in the blood.

Erectile dysfunction is somewhat rare in men under the age of 40 (if due to physical problems), so for a small number of cases further testing may be required. If this is the case then your GP may wish to refer you to a specialist, though this is rarely necessary.

Treatment for erectile dysfunction has improved significantly in recent years with most sufferers being able to resume normal sexual activity as a result. Treatment is normally a combination of medicines, lifestyle changes and resolving any psychological causes.

There are four main tablets for erectile dysfunction, these are Sildenafil (Viagra & generic sildenafil), Tadalafil (Cialis & generic Cialis), Avanafil (Spedra) and Vardenafil (Levitra & generic Vardenafil).

Ultimately, these treatment options all do the same job, however there are small but important differences between them that we will summarise. Choosing the one that is right for you will depend on a variety of factors, like your health and whether you are taking any other medicines. It also comes down to personal preference.

Vitaros is a new cream treatment for ED that is applied directly to the penis. It offers an additional option to men who cannot take, or do not respond to, traditional ED tablets. It offers easy application and a fast onset of action, however it is less discreet.

Just to note, Viagra and Sildenafil are the same drug. Look closely on a packet of Viagra and you will see it states ‘contains Sildenafil’. Viagra is simply a branded name given by one manufacturer to this particular drug. So for all intents and purposes, they are exactly the same in all but name.

Viagra / Sildenafil:
25mg, 50mg & 100mg tablets
Should be taken an hour before sex and the effects should last between 4-5 hours.
Any food can potentially slow down the action of Sildenafil. As a precaution, it is best to leave a couple of hours in between eating and taking the dose.
Cialis / Tadalafil:
2.5mg, 5mg (once daily tablets), 10mg & 20mg tablets (when required tablets)
Should be taken 30 minutes before sex and the effects last for around 36 hours.
Is not affected by food so no restrictions apply.
Read more about Tadalafil vs Cialis.

Levitra / Vardenafil:
5mg (generic), 10mg & 20mg tablets
Should be taken 25 minutes – 1 hour before sex and the effects last for 4-5 hours.
Heavy meals or food high in fat can affect its action so it is advised to avoid such foods before use.
Spedra (avanafil):
50mg, 100mg & 200mg tablets
Can take effect in as little as 15 minutes and the effects last for 4-6 hours.
Vitaros (alprostadil):
300mcg applicators
Can take effect within 5 - 30 minutes.
Unaffected by food, alcohol or other medicines.
As with all four types of ED tablets, Viagra (Sildenafil), Cialis, Spedra and Levitra, the right strength for you won’t relate to the size of an individual or their blood pressure. It is recommended that new patients start on the middle strength so in the case of Sildenafil and Viagra, 50mg. For Levitra, the starting dose is 10mg, Spedra is 100mg and Cialis, the lower strength of the 'when required' dose is 10mg, which will be the entry-level dose.

This initial trial should be attempted at least four times before it is judged whether that dose is effective or whether it needs to be altered to a higher or lower strength. In some cases, if one drug is proving completely ineffective then trying one of the other drugs may be a more prudent option rather than attempting a higher strength.

Viagra, Sildenafil, Cialis, Spedra and Levitra all need to be taken before sexual intercourse. Their effect should remain viable for several hours after taking. There is a slight variation between them with regards to how long before and for how long these effects last.

For clarity, stating ‘effects last for 4-5 hours’, does not mean the erection will remain constant for this time. The penis will still require stimulation or sexual arousal to maintain an erection.

Headaches and flushing are the most common side effects of Sildenafil (Viagra), Cialis and Levitra.

As with all prescription medicines it is very important to remember that you only take these medicines after having the proper medical consultation such as with your GP or through our Online Pharmacy. Buying them without a consultation with a medical practitioner can be dangerous and leave you susceptible to ineffective, fake or even dangerous medicines.

There are many lifestyle changes that you can make that could help reduce the effects or risk of erectile dysfunction. These include:

Maintaining a healthy body weight
Reducing your intake of fatty and salty foods
Giving up smoking and recreational drugs
Reducing your intake of alcohol
Reducing your stress levels
Participating in a healthy amount of physical exercise
Ultimately, a major cause of erectile dysfunction is cardiovascular disease, and changes you would make to improve your health for a heart attack, are actually going to be the same changes that will help your ED.

Amongst younger men with erectile dysfunction, being checked by a medical professional is a recommendation from the British Heart Foundation, due to it being an early indicator of heart disease.

Oral medications for erectile dysfunction vary in their speed depending on which one you use, and how long you have been taking it for.

Usually, you will find them effective between 15 - 60 minutes after taking them. Some of the oral medications, like tadalafil, can begin to work more quickly after you have been taking it for a while.

As you can see from our comparison above, the correct treatment for you will be impacted by your own sex life, lifestyle choices, sex drive and whether or not you have existing health issues.

For many men, they will benefit from prescription medications (or Viagra connect), you can see here more about the best pills to take for erectile dysfunction.

ED can be caused, or contritubed to, by lifestyle factors, such as smoking, being overweight and feelings of stress and anxiety. It’s easy to reduce the risk of developing erectile dysfunction by making simple changes, for example:

• Quitting smoking
• Losing any extra weight and maintaining a healthy diet
• Moderating the amount of alcohol you drink
• Taking regular exercise
• Reducing your stress levels

These simple lifestyle changes will vastly improve your physical and general health, which will decrease your chances of developing conditions such as diabetes or cardiovascular disease, both of which can cause ED. Having a good level of general health will also reduce the risk of needing any prescription medicine. The less medicine you are taking the lower the risk of suffering an erectile dysfunction inducing side-effect.

When it comes to erectile dysfunction there are a few common misconceptions and associated stigmas that surround this condition.

Erectile Dysfunction is linked to sexual attraction

A variant of the above myth is the notion that if a man needs to take a treatment such as Viagra that means he isn’t sexually attracted his partner. This is simply not the case. Just to reiterate, even with erectile dysfunction medication a man can only achieve an erection if he is properly stimulated.

If there is difficulty achieving and maintaining an erection with your partner because you find her physically unattractive, or if the reason is an unresolved psychological issue then taking erectile dysfunction tablets isn’t likely to resolve this.

Erectile Dysfunction is when you can NEVER get an erection

Another common misconception stems from the belief, ‘I don’t have erection problems all the time and therefore it cannot be erectile dysfunction.’ This belief is false. Men with erectile dysfunction can suffer many different kinds of symptoms, including any of the following:

• You cannot achieve an erection at all.
• You can achieve a mild erection but it’s not hard enough to enter your partner.
• You can achieve an erection but you cannot maintain it throughout sexual intercourse.

Erectile Dysfunction only occurs in old men

Erectile dysfunction can be seen as something that only happens to older men and it’s just a normal part of aging that you simply have to live with. Erectile dysfunction can happen at any age. It simply becomes increasingly more common the older we get. It’s estimated that half of men between the ages of 40 and 70 suffer with erectile dysfunction. This statistic increases as we look beyond the age of 70, with 7 in every 10 men believed to be sufferers.

Taking Viagra will mean you will have an erection until it wears off

The biggest myth that stalks erectile dysfunction, especially in pop-culture, is that treatments such as Viagra cause an erection. In truth, this is not the case. Without the necessary arousal or sexual stimulation an erection cannot be achieved or maintained. The active ingredients in the three main treatments (Sildenafil, Tadalafil and Vardenafil) don’t automatically provide you with an erection. What they actually do is open the veins allowing blood to flow to the penis more freely and effectively when properly stimulated. Essentially, you could take Sildenafil or Tadalafil and still not achieve an erection if lacking the necessary sexual arousal.