Erectile dysfunction

Erectile dysfunction (ED), also known as impotence, is the inability to get and/or then maintain an erection. Most people with penises will have problems getting or staying hard at some point in their lives. It doesn’t necessarily mean a loss of interest in sex or that there is something wrong. Most of the time, these difficulties are due to stress and are temporary.

Erectile dysfunction is a very common problem, particularly in older people with a penis. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree. While it is normally fine, it can be a sign of more serious health conditions, such as heart disease or diabetes, or a result of a mental health condition, such as depression.

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. If this is the case, it is likely the underlying cause of erectile dysfunction is psychological or stress related.

If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.

If you have erectile dysfunction for more than a few weeks, you might want to visit a sexual health clinic or see your GP to find out what is causing it.

Why does it happen?

During arousal, blood flow to the penis increases, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.

There are many reasons for erectile dysfunction so your clinician will talk to you about your lifestyle to determine the cause of the problem.

Physical causes of ED include:

  • Narrowing of the blood vessels going to the penis - commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
  • Hormonal problems, such as an overactive thyroid
  • Surgery or spinal injury
  • Conditions that affects the body’s movement, such as Parkinson’s disease
  • A side-effect of using certain medicines

Psychological causes of ED include:

  • Anxiety
  • Depression
  • Relationship problems


Erectile dysfunction can be treated by tackling the cause of the problem.

The narrowing of blood vessels is one of the most common causes. In these cases, your clinician may suggest lifestyle changes, such as:

  • Giving up smoking
  • Cutting back your alcohol consumption
  • Not taking illegal drugs
  • Reducing stress
  • Exercising regularly

You may be given medication to reduce your blood pressure. Other types of medication, such as Viagra, can be used to manage erectile dysfunction in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.

Psychological treatments include cognitive behavioural therapy (CBT) and sex therapy.

Overall, treatments for erectile dysfunction have improved significantly in recent years.

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I cannot get or maintain an erection - what should I do?

If this is a new problem then you should wait for a few weeks as it may settle on its own. If it continues beyond a few weeks then you should discuss it with your sexual health clinic or GP.

Can I buy erectile dysfunction medication online?

It is possible to buy medication over the internet, but many sites offer counterfeit medicines. These medications are not regulated and the amount of active ingredients in them can vary. They could cause unpleasant side effects or they may not be suitable for you.

Always ensure that any online doctor service is registered with the Care Quality Commission (CQC), that all doctors are registered with the General Medical Council (GMC), and that any prescribed medicines come from a pharmacy which is registered in the UK.

It is also possible that an underlying health condition may be causing your erectile dysfunction and getting this diagnosed and treated may resolve your symptoms. Therefore, always see your GP or visit a sexual health clinic for a full check-up.

What is CBT?

Cognitive Behavioural Therapy (CBT) is a form of counselling based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile disfunction - for example, to do with:

  • Your self-esteem (the way you feel about yourself)
  • Your sexuality
  • Your personal relationships

Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.