A Q and A on Erectile Dysfunction
Erectile Dysfunction: straight answers to the questions people actually ask, with the figures behind them.
Ongoing difficulty getting or keeping an erection firm enough for sex.
Key takeaways
- Common underlying causes: heart and blood vessel disease, diabetes, medicines, low mood
- Cardiovascular significance: can come years before other symptoms
- Most useful single change: See your doctor rather than buying online; the cause matters more than the symptom.
- Commonest mistake: Buying medicines or "natural" sexual enhancement products from unregulated websites, which may contain hidden drugs.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
What is Erectile Dysfunction?
Ongoing difficulty getting or keeping an erection firm enough for sex.
Why does it matter?
It is often treated as a purely sexual problem when it can be an early marker of heart disease or diabetes, which makes it worth a proper check.
Common underlying causes for Erectile Dysfunction?
Heart and blood vessel disease, diabetes, medicines, low mood.
Cardiovascular significance for Erectile Dysfunction?
Can come years before other symptoms.
First-line medicines for Erectile Dysfunction?
PDE5 inhibitors such as sildenafil.
How to get them for Erectile Dysfunction?
By prescription, including through licensed telehealth services.
What is the single most useful thing to do?
See your doctor rather than buying online; the cause matters more than the symptom.
What is the most common mistake?
Buying medicines or "natural" sexual enhancement products from unregulated websites, which may contain hidden drugs.
When should I see a doctor?
Never take sildenafil or similar medicines with nitrate drugs such as nitroglycerin: the combination can cause a dangerous fall in blood pressure. Go to the emergency room for an erection lasting more than four hours, which can cause permanent damage. See your doctor promptly for new erectile dysfunction, and call 911 for chest pain.
More questions, answered
Is erectile dysfunction always physical?
No. Psychological factors such as anxiety, depression, stress and relationship problems are common causes, particularly in younger men. In older men, physical causes are more common, but the two often overlap. Your doctor can help sort out which factors are involved. Both deserve attention.
Why should I not buy ED pills online?
The FDA has found many products sold online or as natural supplements contain hidden prescription drugs, wrong doses or contaminants. These can interact dangerously with heart medicines. Licensed telehealth services and pharmacies are safe options, but a check with your doctor matters because of the link with heart disease.
Can alcohol cause erectile dysfunction?
Yes. Heavy drinking can make erections harder in the short term, and long-term heavy drinking can damage nerves, lower testosterone and affect the liver. Cutting back often improves erections, along with sleep and overall health. Limiting drinking before sex can make a noticeable difference in the short term.
Do PDE5 inhibitors increase sex drive?
No. They help the body respond to arousal but do not increase desire. If low sex drive is a main problem, it is worth discussing separately, because it can be linked to hormones, mood, medicines or relationship factors. Your doctor can help.
Can cycling cause erectile problems?
Long periods of pressure on the perineum from a narrow saddle can cause numbness and may affect erections in some riders. Adjusting the saddle, using a wider or cut-out seat, and standing periodically can help. The overall benefits of exercise usually outweigh this risk.
Is erectile dysfunction reversible?
Often, yes, or at least manageable. When it is linked to smoking, weight, alcohol, medicines or mental health, addressing those can improve it. Even when the cause cannot be reversed, treatments allow most men to have satisfying sex. Ask your doctor about all options.
Related topics
- What the Guidance Really Says About Sexual Function (Sexual Health)
- What the Guidance Really Says About Fatty Liver Disease (Liver Health)
- What the Guidance Really Says About Mental Health and Long-Term Illness (Long-Term Conditions)
- Smoking and the Heart: What Published Guidance Supports (Heart Health)
Where to go next
- Erectile Dysfunction: The Practical To-Do List
- Erectile Dysfunction: Separating Myth From Guidance
- Erectile Dysfunction — the reference entry
- Men's Health: The Complete Guide
- What the Guidance Really Says About Male Fertility
- What the Guidance Really Says About Men and Health Services
When to speak to a doctor
Never take sildenafil or similar medicines with nitrate drugs such as nitroglycerin: the combination can cause a dangerous fall in blood pressure. Go to the emergency room for an erection lasting more than four hours, which can cause permanent damage. See your doctor promptly for new erectile dysfunction, and call 911 for chest pain.
Where this comes from
- National Institute of Diabetes and Digestive and Kidney Diseases — Erectile Dysfunction (ED)
- FDA — Tainted Sexual Enhancement Products
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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