Erectile Dysfunction: Separating Myth From Guidance
Erectile Dysfunction: what people commonly get wrong, set against what published US guidance says.
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.
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 the guidance actually says
These are the numbers the corrections below are measured against.
| Measure | Figure |
|---|---|
| Common underlying causes | heart and blood vessel disease, diabetes, medicines, low mood |
| Cardiovascular significance | can come years before other symptoms |
| First-line medicines | PDE5 inhibitors such as sildenafil |
| How to get them | by prescription, including through licensed telehealth services |
| Never combine with | nitrate medicines such as nitroglycerin |
Where people go wrong
Common beliefs that the figures do not bear out.
- Buying medicines or "natural" sexual enhancement products from unregulated websites, which may contain hidden drugs
- Taking PDE5 inhibitors with nitrates, which can cause a dangerous drop in blood pressure
- Treating it as only a sexual issue
What to do instead
- See your doctor rather than buying online; the cause matters more than the symptom
- Ask for blood pressure, cholesterol and diabetes checks at the same time
- Review your medicines, several of which can contribute
- Address smoking, alcohol, weight and activity, all of which are relevant
The part that is genuinely uncertain
Guidance changes, and it changes because evidence does. The figures above reflect current US guidance from the bodies named at the foot of this page; where those bodies revise their position, theirs is the account to follow rather than this one.
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: A Beginner-Friendly Start
- 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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