Erectile dysfunction (ED) is the persistent difficulty getting or keeping an erection firm enough for sexual intercourse. It is common, especially with age, and can affect mental health, relationships, and quality of life.
What is ED?
Erectile dysfunction (ED) is the persistent difficulty getting or keeping an erection firm enough for sexual intercourse. It is common, especially with age, and can affect mental health, relationships, and quality of life.
Common Causes
ED can result from cardiovascular disease, diabetes, high blood pressure, high cholesterol, obesity, hormonal imbalances (low testosterone), neurological conditions, pelvic surgery, medications (e.g., SSRIs, some antihypertensives), alcohol or substance use, and psychological factors such as anxiety or depression.
Diagnosis & When to Seek Help
See a licensed clinician for a focused history, exam, and labs where appropriate (glucose/A1c, lipids, testosterone). Seek urgent care for chest pain, severe shortness of breath, signs of stroke, or a painful erection lasting >4 hours (priapism).
Evidence-Based Treatments
First-line measures include lifestyle optimization (smoking cessation, exercise, sleep, weight loss if needed) and managing comorbidities. Counseling or sex therapy can help when performance anxiety or relationship stress is prominent. Medical options include PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil), vacuum erection devices, intraurethral alprostadil, intracavernosal injections, and penile implants for refractory cases.
Safe Prescription Pathways
PDE5 inhibitors require a prescription in most countries. Legal access involves telehealth or in-person evaluation to confirm safety (e.g., no nitrate use for angina, no unstable cardiovascular disease). Patients should avoid unregulated online sources. Legitimate telehealth services verify identity, review medical history, and provide follow-up.
Preparing for Your Appointment
Bring a medication list, medical history (especially heart disease, diabetes, surgeries), symptom timeline, and goals. Be ready to discuss libido, morning erections, relationship context, and mental health. Ask about risks, side effects, and interactions, including nitrates and alpha-blockers.
References
- NICE. Erectile dysfunction: diagnosis and management.
- NHS. Erectile dysfunction (impotence).
- Mayo Clinic. Erectile dysfunction: Diagnosis and treatment.
- American Urological Association. ED Guidelines.
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