Erectile dysfunction (impotence)

Erectile dysfunction is when you are either:

• unable to get an erection
• unable to keep an erection for long enough to have sex

Depending on the cause, you may still be able to get an erection at other times, such as when you wake up.

Sometimes you might also have low sex drive (loss of libido).

Most men occasionally fail to get or keep an erection.

This is usually caused by stress, tiredness or drinking too much alcohol, and it's nothing to worry about.

It can also be a side effect of some medicines.

If erectile dysfunction happens often, it may be caused by a condition such as:

• high blood pressure or high cholesterol
• diabetes
• depression or anxiety
• hormone problems

Healthy lifestyle changes can sometimes help with erectile dysfunction.

• lose weight if you're overweight

• stop smoking

• eat a healthy diet

• exercise daily

• try to reduce stress and anxiety

• do not drink more than 14 units of alcohol a week

• do not cycle for a while, if you cycle for more than 3 hours a week

• erection problems keep happening

It might be a sign of a health condition that can be treated.

If you see someone about erectile dysfunction, the doctor or nurse may:

• ask about your lifestyle and relationships, and any problems you might be having
• do some basic health checks, such as taking your blood pressure
• examine your genitals to rule out any obvious physical cause

If you have symptoms like needing to pee more often than usual, you may also have an examination of your prostate (rectal examination).

Treatment can usually help improve erectile dysfunction.

Medicines for erectile dysfunction

The main treatments are medicines that increase the blood flow to your penis, called PDE-5 inhibitors.

These include:

• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra)
• avanafil (Spedra)

You can get sildenafil on prescription or you can buy it from a pharmacy. You need a prescription for the other types.

You can buy sildenafil (Viagra) over the internet. Be very careful if you do this as many websites sell fake medicines.

Online medicines are not always regulated and the ingredients in them can vary from one pack to another. They can cause unpleasant side effects, or may not be suitable for you.

It's best to see a doctor before buying medicines online. They know your medical history and can discuss whether you might benefit from treatment.

If you choose to buy sildenafil (Viagra) on the internet, make sure:

• any online pharmacy is registered with the General Pharmaceutical Council (GPhC)
• any online doctor service is registered with the Care Quality Commission (CQC)
• all doctors are registered with the General Medical Council (GMC)

Vacuum pumps encourage blood to flow to the penis, causing an erection.

They work for most men and can be used if medicine is not suitable or does not work.

They're not always available on the NHS. Speak to a doctor about where to get a vacuum pump.

Treating the cause of erectile dysfunction

There are also treatments for some of the causes of erectile dysfunction.

For example:

• your doctor may switch you to a different medicine if it's causing your erectile dysfunction
• high blood pressure, high cholesterol and hormone problems may be treated with medicine
• counselling and therapy can help if your erection problems are linked to emotional or mental health problems – but there can be a long wait for these services on the NHS

The main symptom of erectile dysfunction is not being able to get or keep an erection.

Erectile dysfunction is often linked to stress, tiredness or alcohol. It can also be caused by conditions like high blood pressure or diabetes.

Making healthy lifestyle changes, such as losing weight, stopping smoking and reducing stress can sometimes help with erectile dysfunction.

The main treatments for erectile dysfunction are medicines and vacuum pumps that increase blood flow to your penis.