Erectile Dysfunction 101: Causes, Symptoms and Treatment

Written by the Manual Team · Medically approved by Dr Earim Chaudry - MD

In 30 seconds…

Erectile dysfunction (ED) is a condition that affects men’s ability to achieve and sustain an erection. It’s far more common than you think, with 40% of men at age 40 having experienced it.

ED can happen one-off, or be chronic. However, if at any time you have struggled to keep it up long enough for intercourse, you might want to think about what ED might mean. Its causes can be a number of things, from heavy drinking and tiredness in the short-term, to poor cardiovascular health, performance anxiety, or diseases such as diabetes.

Whilst ED can be frustrating, know that there are effective treatments. Drugs known as PDE5 inhibitors, such as Tadalafil and Sildenafil, work a treat for many men, whilst lifestyle changes can help tackle ED’s underlying causes.

What is Erectile Dysfunction (ED)?

Erectile dysfunction, or ED, is a condition that affects men’s ability to achieve and sustain an erection long enough to have sex. It can happen to men of all ages, and it’s probably more common than you think: 70% of men aged 70 are affected by ED – whilst 40% of men at 40 have experienced it to a degree.

Yet, where performance issues can come and pass, you may want to consider the possibility of ED if you are experiencing problems getting it up long-term. It is okay though: ED can be treated. There are a number of ways that you can return to a sex life that is satisfying for both you and your partner.

In this article, we have put together information on everything you might want to know about ED – including its causes, symptoms, and treatments. Let’s take a look.


How Do Erections Work?

The science of what is happening down there when you are aroused involves many different systems in your body. An erection is not an isolated event. Rather, it brings into play processes that relate to your psychology, your circulatory system, your nerves, and your muscles.

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

When a man becomes sexually aroused, his brain will send nerve signals to encourage nitric-oxide -mediated vasodilation of the blood vessels which supply the penis. The penis becomes engorged with blood, which encourages the contraction of the erectile tissues.. This is compounded by the muscles compressing on the veins – thus preventing blood from escaping the penis and maintaining the erection.


And What Happens During ED?

ED happens when a part of this process does not work as it should. If there is not enough blood entering the penis, your erection will not be as firm as you would like it to be. The same is true if the muscles that prevent the blood leaving are not sufficiently strong.

Any illness, condition, or problem that affects this whole process may result in ED. Broadly speaking, this consists of psychological, physiological, physical, and anatomical causes. These can include issues such as heart disease, mental illness, high cholesterol, diabetes, or poor cardiovascular health.


What Causes ED?

Erectile dysfunction is thought to affect about 4.3 million men in the UK. That’s one in five. Yet, the reasons for erectile problems differ from person to person.

Given that erections involve your psychology, your emotions and hormones, and your nervous and cardiovascular systems, there are many possible causes of ED.


Issues with cardiovascular health

Erections are impacted by the flow of blood. Consequently, when people have erectile problems, the circulatory and cardiovascular systems are one of the first places doctors will look for the cause. 

Heart disease, high blood pressure, high cholesterol, and atherosclerosis or clogged blood vessels are all common causes of erectile dysfunction. In fact, research has suggested that erectile dysfunction may be a possible early sign of heart problems. Cardiovascular health and erectile health are often closely linked.


Unhealthy lifestyles

What you do to your body will have an effect on your erectile health too. Your penis is not immune to the lifestyle choices you make.

Tobacco use, alcoholism, and diets high in fatty foods are all risk factors of erectile dysfunction. All of them, in their own way, can have an adverse effect on your cardiovascular system and they will ultimately affect your ability to get it up.

Alcohol abuse in particular is a common cause of trouble with men’s erections. 72% of men with alcohol dependence were found to have sexual dysfunction, including ED.


Other diseases

Other diseases and conditions can cause ED too – including Diabetes, Parkinson’s Disease, Multiple Sclerosis, and Peyronie’s disease. The different illnesses affect your erectile health in different ways. However, in the majority of these cases, the problems usually come from nerve damage.

Peyronie’s Disease, on the other hand, is a condition that is caused by the build-up of scar tissue in the penis. This plaque affects the way that blood can enter the penis during erections, leaving some men with ED. It is best to speak to your doctor for ED treatment alternatives if you have Peyronie’s Disease.


Surgery and medication

It is possible to have erectile dysfunction after surgery on the spinal cord or pelvic area, whilst treatments for prostate conditions can also cause ED. Surgery on the prostate can result in ED in up to 80% of men. This is due to injuries on nerves, muscles, and blood vessels during surgery. Luckily, you can recover from this.


Mental health conditions

Not all erectile dysfunction causes are physical. Psychological processes and mental health conditions can all contribute to ED too. These include depression, anxiety, sleep problems, and stress, conditions which all interfere with the signals that your brain sends to the rest of your body.

Mental health problems can also dampen your libido and distract your attention from sex. Unfortunately, continued ED can have a reciprocal effect on your mental health too.


Relationship issues

Finally, there is the possibility that your ED is the result of relationship issues. If you lack an interest in sex or you struggle to get it up, it may not necessarily be down to a medical issue. Rather, it’s natural that the same things may not excite you as they used to. Talking to your partner is a good place to start.


What Are the Symptoms of ED?

Erectile dysfunction is the inability to achieve and sustain an erection. As such, the symptoms of ED may be quite clear. Let’s take a look.


An inability to get an erection

The most obvious sign of erectile dysfunction is an inability to get it up. You’re in the mood – yet, it’s just not cooperating. It can be hugely frustrating. If it happens once when you’ve had a couple of drinks, or after a particularly stressful day at work, then you don’t need to worry.

But if it keeps happening regularly, it’s time to pay the issue some attention.


An inability to keep an erection

Another common sign of ED is losing hardness during intercourse. Again, this can be difficult to deal with for both you and your partner.


Reduced desire or interest

If you are feeling like you are generally not in the mood, this might also be due to ED. A feeling of reduced libido can be both a symptom and a cause of erectile dysfunction, and it will help to talk to someone to investigate why this is happening.  


And Potential Warning Signs of ED?

Besides the more expected symptoms of ED, there are a number of warning signs that you should look out for, too. Even if you can still have sex, ED might be a possibility if you are seeing these signs.


You miss your morning wood

Erections can occur in healthy men as many as five times a night – and one can often be 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

ED may make you feel like your penis is not as sensitive as it once was. This is because the harder your erections are, the more sensitive they are. If you feel like you have reduced penile sensitivity, it might be because your penis isn’t getting fully erect. 


Delayed ejaculation

Reduced sensitivity – and a reduced size – can result in a delay in ejaculation. If you can never seem to finish, you might not be fully erect – which might be down to ED.


Erectile Dysfunction Treatments

Whilst erectile dysfunction is hugely common, nearly half of men with it do not seek any help. You don’t need to be one of them – as there are many different treatments available for ED that are proven to be safe and effective.


ED Medications

There are a number of ED medications that have been proven to be safe and effective in the vast majority of men. You’ll know the famous Viagra. However, these days, medical ED treatments are not limited to this most well-known of brands

The majority of ED drugs work in the same way, although they differ in tolerability and effectiveness. They are known as PDE5 inhibitors because they work by targeting an enzyme, PDE5, present in the process of smooth muscle contraction in the blood vessels of the penis. By inhibiting that enzyme, blood flow is improved – and erections become more possible to achieve and maintain.


Viagra (Sildenafil)

The little blue pill

It’s the generic (unbranded) form of Viagra. Highly effective in helping you get and keep an erection. Clinically proven and used by millions of men worldwide. Easier erections, happy days.
Start from £15

The famous “Vitamin V” is powered by the active agent with the less sexy name: Sildenafil. This is one of the most effective of the PDE5 inhibitors, with a success rate of over 80%. One study of 82 different trials concluded that Sildenafil was in fact the most effective ED drug around.

Viagra and Sildenafil are exactly the same: they work in the same way and have precisely the same effects. Viagra simply is Sildenafil by a different name – and with a different price. It’s taken orally 30-60 minutes before you need it and its effects usually last for 4-5 hours.


Cialis (Tadalafil)

The weekend pill

Known as the “weekend pill” for its long lasting effects, it’s the generic form of Cialis. Clinically proven to help you get an erection when you need it. For up to 36 hours!
Start from £15

Cialis works on the same principle as Viagra. However, due to its chemical structure, it stays in your system for longer – meaning that its effects last for longer, too. 

This is the major difference between Cialis and Viagra. Where Viagra usually lasts for 4-5 hours, Cialis can go for 36 hours. The result is a bit more spontaneity in your love life, as you don’t need to plan for 30-60 minutes before sex. Some people call it the “weekend pill” for this reason.

Cialis, by the way, contains the active ingredient, Tadalafil. Again, the effects are identical – but, with the latter, you needn’t pay for the brand name. Tadalafil works in over 80% of men.


Other PDE5 Inhibitors

There are other PDE5 inhibitors too – drugs that work in the same way as Tadalafil and Sildenafil. These are 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.

However, they are often less effective and generally less well tolerated in terms of side effects.


Lifestyle Changes

The other treatment for erectile dysfunction that science suggests is most effective is a healthy lifestyle. This can improve your general sexual health – including your libido – it will cost you nothing, and it will improve other aspects of your well-being, too.


Better diet

We mentioned above that cardiovascular health and penile health are two sides of the same coin. Maintaining a balanced diet – one that is low in fat, added sugars, and processed foods – is crucial to both. Turn to fruit and veg and whole grain foods, which will keep your cholesterol and risk of heart disease down.


Quit 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. It’s not an easy treatment. However, stopping smoking is perhaps the one major way to stop your erectile dysfunction.



Another thing that can help cardiovascular health is exercise – and this has a positive effect on ED too. According to the NHS, 150 minutes per week of moderate activity (e.g. a brisk walk) is the minimum of what you should be aiming for to achieve a healthy lifestyle. 


Stress management

Stress and poor penile health go hand in hand – and often each exacerbates the other. Finding ways to manage stress can help your ED. Whether that’s exercise, yoga, meditation, or drinking herbal tea, finding ways to cut through stress and relax is not just good for your erections, but for your whole body.


Better sleep

Sleep deprivation is associated with the production of the stress hormone, cortisol, which makes you less interested in sex. Sleeping well can improve your libido, increase your testosterone levels, and improve your erections. 


Key Takeaways

Erectile dysfunction is something that happens to many men, but far too many of us do nothing about it. In a world in which sexual problems can be felt as shameful, knowing just how common they actually are can be helpful. 40% of men under 40 years-old have had some experience with ED. In total, we’re talking over 4 million men – just in the UK. Yet, there are ways to treat ED that really do work.

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