Erectile dysfunction

Erectile Dysfunction 101: Causes, Symptoms and Treatment

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Medically approved by Dr Earim Chaudry
Chief Medical Officer
iconLast updated 7th January 2022

In 30 seconds…

Erectile dysfunction affects men’s ability to achieve and sustain an erection. It’s far more common than you think, with 40% having experienced it before age 40.

ED can be-off or chronic. Its causes range from heavy drinking and tiredness in the short-term, to possible disease, trauma or psychological issues in the long term.

Whilst ED can be frustrating, there are effective treatments available. PDE5 inhibitor drugs work a treat for many men, whilst lifestyle changes can help tackle ED’s underlying causes.

Erectile dysfunction: it’s the penis’ boogeyman, but the fear is real. 40% of us experience it before the age of 40, and that number rises to 70% by age 70. While erection problems are actually pretty common, it’s not often talked about – which can make you feel on your own, affect self-esteem, and lead to misinformation and panic. In turn, this can even disrupt your erectile function further.

But is it something to worry about – and is your experience normal? Is erectile dysfunction reversible? Will it go away on its own? In this article, we’ll look at how erectile dysfunction occurs, why you may be experiencing it, how to prevent it and which erectile dysfunction treatments work best.

How Erectile Dysfunction Happens

To understand how erectile dysfunction (ED) starts, it’s helpful to know how you get a healthy erection.

An erection isn’t the work of your penis by itself: it is triggered by your nervous system via a physical, sensory or psychological stimulation – known as arousal – which sets off various reactions in your body. Impulses from the brain and local nerves cause the muscles of your penis’ corpora cavernosa to relax, which allows more blood to flow in.

At the same time, the tunica albuginea, which is a membrane that surrounds the corpora cavernosa, helps trap the blood inside: the increased pressure causes your penis to swell and harden, resulting in an erection.

In healthy men, an erection creates a firm penis which permits a man to enjoy sexual activity – either to have sex or to masturbate until he reaches orgasm. If the penis isn’t firm enough, however, this isn’t possible – even if the man feels aroused.

ED is when something goes awry in the erectile process. The problems begin when your brain doesn’t send enough or any signals to trigger an erection, when the blood flow is inadequate, or when erectile tissue is damaged. There are many possible reasons for this – but there are also many ways to treat it, which we’ll look at in the rest of this article.

Why Erectile Dysfunction Happens: Causes of Erectile Dysfunction

Erectile dysfunction is thought to affect about 4.3 million men in the UK – which is about one in five of us. But what causes erectile dysfunction? There are several possible explanations, from medical conditions to psychological causes – and general health and well being:

1. Compromised cardiovascular health

Your erection owes a lot to your cardiovascular system: without changing the blood flow to your penis, it can’t grow. It’s logical, therefore, that cardiovascular problems such as heart disease, high blood pressure, high cholesterol, and atherosclerosis (clogged blood vessels) are common causes of ED. In fact, research has suggested that erectile dysfunction may be a possible early sign of heart problems. 

How to help: If you’re experiencing ED alongside other signs of poor cardiovascular health, you should talk to your doctor. However, sticking to a low-fat, high-fibre diet and getting plenty of exercise are known to promote a healthy cardiovascular system.

2. Drinking and Smoking

Drinking alcohol is a pretty big culprit when it comes to ED. For one, it depresses the central nervous system, which can prevent the brain signals that trigger an erection, and also dulls your senses. One study measuring the effect of alcohol on erections found that it negatively impacted circumference change and latency to change (i.e., how hard you get and how quickly). Alcohol abuse is also believed to increase angiotensin, a hormone linked to erectile dysfunction.

It won’t shock you to learn that smoking is bad for you, too. But you may be surprised by how much it can affect your sex life: amongst men aged 18-44, heavy smokers are twice as likely to suffer from severe ED. Another study in older men aged 40-79 also found an increased likelihood of ED amongst smokers.

Furthermore, the heavy use of recreational drugs can also have a negative impact on your ability to maintain an erection. Overall, excessive alcohol, smoking, and/or drugs can cause or exacerbate health conditions that make erectile dysfunction more likely.

How to help: the good news is, if you’ve experienced an odd performance issue after a heavy night out, this is normal and you’re probably OK. As with all alcohol-related advice, moderation is key to health. It’s chronic abuse where it gets serious: 72% of men with alcohol dependence were found to have sexual dysfunction, including ED. And stop smoking. You don’t need us to tell you to cut out the cigs.

3. Disease, Trauma or Medication

There are diseases for which ED is common. Up to 75% of men with diabetes will experience ED at some point, 68% of male Parkinson’s Disease patients, and 70% of men with Multiple Sclerosis experience it. Reasons why erectile dysfunction occurs in these examples can be explained by changes in the body that affect nerve, muscle and blood vessel function, or the emotional changes that accompany the disease. 

Trauma is one of the physical causes of ED, particularly if you have sustained injuries to penile tissue. Similarly, it’s possible to have ED after surgery on the spinal cord or pelvic area, and very common to experience it after prostate surgery (in fact, up to 80% of patients experience this), as this could damage nerve, muscle or blood vessel tissue responsible for your erection. 

It could also be the result of medication. Common medications that can cause erectile dysfunction include diuretics, antihypertensives, antihistamines, antidepressants, antiarrhythmics, tranquilizers, muscle relaxants, anti-inflammatory drugs, hormones, chemotherapy medications and anti-seizure medications. 

How to help: If you believe a disease is causing your ED, it’s important to let your doctor know what’s going on – and get a physical examination. If you are on medication, discuss it with your doctor. They will be able to recommend the best solution for you, from taking an ED pill to possible lifestyle changes.

4. Psychological Issues

Psychological factors, such as depression, anxiety and stress, was once considered the most common primary cause for ED – especially amongst young men. Modern medicine now finds this to be less likely, but nevertheless notes that secondary psychological problems are present in all cases of ED. For example, it might not be stress or poor mental health that initially causes your ED, but you’ll probably experience stress as a result, which further compounds the problem.

How to help: if you can’t find an organic cause for your ED, consider psychological therapy. If you’re stressed about your ED, it can become a vicious circle, so take steps to help: lifestyle changes or ED medication can alleviate the physical issue, whilst practicing mindfulness, making time for activities you enjoy and getting more sleep will help you alleviate mental strain.

What Erectile Dysfunction Looks Like

The most obvious sign of erectile dysfunction is an inability to get it up for long enough to have sexual intercourse. That much is pretty clear. But there are plenty of other symptoms and warning signs that you should be aware of. These include:

  • An inability to keep an erection – even if you can get hard, not being able to stay erect is a key indicator of erectile dysfunction.
  • Reduced desire or interest in sex: reduced libido (low sex drive) can be both a symptom and a cause of erectile dysfunction.
  • No morning wood: Erections can occur in healthy men as many as five times a night, and it’s common to have one there to greet you as you wake. If you don’t experience morning wood, and haven’t for a long time, this might be a sign that your erectile health isn’t as it should be.
  • Decreased penis sensitivity: the harder your erections are, the more sensitive your penis is. If you’re experiencing reduced sensitivity, it might be because your penis isn’t fully erect. 

Delayed ejaculation: reduced sensitivity can result in a delay in ejaculation. If you struggle to finish, you might not be fully erect.

Is Erectile Dysfunction Treatable?

Is erectile dysfunction curable? Most of the time, yes. However, nearly half of men with ED do not seek any help, despite the fact there are many different treatment options available that are proven to be safe (FDA approved) and effective. We already outlined some ways to help ED above, but the truth is there are many effective ways to treat it – from lifestyle changes to pills, or even other medical procedures.

Let’s look at the drugs first. Which erectile dysfunction pill is the best? Most ED drugs work in the same way, although they differ in tolerability and effectiveness.

They are known as phosphodiesterase-5 (PDE5) inhibitors, because they work by inhibiting a particular enzyme in your blood vessel walls, thereby causing them to relax. When this happens in your penis, it allows more blood to flow in, which causes an erection.

The best drugs for erectile dysfunction are:

  • Viagra. This is the most famous one. Viagra consists of the active agent, Sildenafil, which is also available as a generic unbranded ED drug itself. Viagra, or a.k.a. “Vitamin V” has a success rate of 80%. It’s taken orally 30 – 60 minutes before you need it and its effects usually last for 4 – 5 hours.

  • Cialis. Known as the “weekend pill”, Cialis (otherwise known by its active agent Tadalafil) is equally effective as Viagra, but it’s the more spontaneous option: It’s taken orally, and causes you to have an erection if you feel aroused at any time within the next 36 hours. Which is pretty handy if you find that having to carefully time your pill kills the mood.

  • Other PDE5 Inhibitors. These include Avanafil, branded as Spedra, Vardenafil or Levitra, and Udenafil. These are usually offered as a second-line treatment to patients for whom Tadalafil or Sildenafil do not work.

Are erectile dysfunction drugs safe? For the most part, yes! But because they interact with your cardiovascular system to increase blood flow to your penis, there are some examples where they are best avoided – particularly when you have certain health problems.

  • If you have cardiovascular disease, you should approach ED treatment with caution, especially if you are on medication for it. Mixing organic nitrates (commonly used to treat heart conditions) with a PDE5 inhibitor can significantly lower your blood pressure, which can lead to dizziness, fainting, heart attack, or a stroke.
  • Nitrates are also a key ingredient in poppers, so these are also best avoided if you use ED pills.
  • Men with significant kidney or liver disease should avoid large doses of ED pills, as should men taking erythromycin, certain antifungal and some anti-HIV medications.

Other ways to treat erectile dysfunction are:

  • Better diet. Cardiovascular health and erectile health are two sides of the same coin. Cut down your intake of fat and added sugars, and eat more fruit and veg and whole grain foods, which will lower your cholesterol.
  • Cut smoking and drinking. Smoking and drinking are both huge risk factors for erectile dysfunction as you age. Quitting the former and cutting down, at least, on the latter will improve your erections by a country mile.
  • Exercise more. Another thing that can help cardiovascular health is exercise – which can have a positive knock-on effect on ED. Exercise is also known to ameliorate stress, and added body confidence could help your ED on a psychological level too.
  • Stress management. Whether it’s exercise, meditation, re-considering your workload or finding someone to talk to about your worries, cutting stress will help your erections. The stress hormone, cortisol, impedes your libido. Being more relaxed also helps you tackle psychological factors preventing an erection.

Better sleep. This goes hand-in-hand with stress management, because losing sleep is a huge stressor to the body that can impact everything from concentration and energy to your ability to get an erection. Get more Z’s and it’ll be more than your sex life that improves.

Non-oral medical treatments for erectile dysfunction are:

  • Vacuum pump therapy. This is when a small plastic tube is placed in the penis. A pump creates a vacuum that draws blood into the penis to make it erect. This is not advisable for people with bleeding disorders or who take anticoagulants.
  • Intraurethral suppository. Alprostadil, which is a hormone medication that stimulates blood flow to the penis, is delivered by injection into the penis
  • Intracavernous injection therapy. Alprostadil is inserted into the urethra in a pellet form, using a urethral stick.
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Cialis (Tadalafil)
Known as the “weekend pill” because it is effective for up to 36 hours, Tadalafil is the generic, unbranded version of Cialis. Clinically proven to help you get an erection when you need it.
Best for
Weekend use
Effective in
Effective in 8 out of 10 men
2.5mg, 10mg, 20mg

Key Takeaways

Erectile dysfunction happens to many men and there are many ways to treat it, but far too many of us do nothing about it. Arming yourself with the facts, however, can help you stop ED in its tracks.

Treatments like Sildenafil and Tadalafil are effective in the vast majority of men, whilst lifestyle improvements can knock the problem on the head for good. If you have any questions about how to treat ED, you can speak discreetly to one of the Manual clinicians. Just give us a call.


NHS – Impotence ‘a sign of heart problems’:


Sukhes Mukherjee (2013). Alcoholism and its effects on the central nervous system:


William H. George, Kelly Cue Davis, and Jeanette Norris (2011). Alcohol and Erectile Response: The Effects of High Dosage in the Context of Demands to Maximize Sexual Arousal:


I B Puddey, R Vandongen, L J Beilin, I L Rouse (1985). Alcohol stimulation of renin release in man: its relation to the hemodynamic, electrolyte, and sympatho-adrenal responses to drinking:


A Natali, N Mondaini, G Lombardi, G Del Popolo & M Rizzo (2004). Heavy smoking is an important risk factor for erectile dysfunction in young men:


Naomi M. Gades, Ajay Nehra, Debra J. Jacobson, Michaela E. McGree, Cynthia J. Girman, Thomas Rhodes, Rosebud O. Roberts, Michael M. Lieber, Steven J. Jacobsen (2005). Association between Smoking and Erectile Dysfunction: A Population-based Study:

icon – Diabetes and Erectile Dysfunction:


Xiang Gao, Honglei Chen, Michael A. Schwarzschild, Dale B. Glasser, Giancarlo Logroscino, Eric B. Rimm, and Alberto Ascherio (2007). Erectile Function and Risk of Parkinson’s Disease:


Prostate Cancer Foundation – Help for ED after Prostate Surgery: The Basics:


C Persu, V Cauni, S Gutue, ES Albu, V Jinga, and P Geavlete (2009). Diagnosis and treatment of erectile dysfunction– a practical update:


NHS – Loss of libido (reduced sex drive):


Harvard Health Publishing – Impotence (Erectile Dysfunction):


Urology Care Foundation – What is Premature Ejaculation?:


While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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