UTI Information Service
UTI Information Service
Please note: the information below does not constitute medical advice. If you have any concerns at all, speak to your GP or consultant.
Approved: April 2024
Review date: April 2026
Erectile dysfunction (ED) or impotence. It is defined as the inability for a man to achieve or maintain an erection suitable for satisfactory sexual intercourse. It is a common condition in men over the age of 40. It has a variety of causes and it is often treatable. Having trouble with erections from time to time is not necessarily ED. However, having ongoing issues with your erection can be a source of stress, anxiety and may lead to marital problems and lack of self-confidence.
More importantly ED can be a sign of an underlying health condition that needs to be diagnosed and treated accordingly. ED is also an established risk factor for heart disease.
ED is common in the UK, with around 4.3 million men estimated to be suffering from the condition. However, many men are reluctant to visit their doctors.
The symptom of ED is the inability for a man to achieve or maintain an erection suitable for satisfactory sexual intercourse.
Male sexual stimulation is a complex process that involves the brain, emotions, nerves, hormones, muscles and blood vessels. ED can result from a problem with one or a combination of these. The following are some of the common causes of ED:
A urologist or an andrologist takes a full medical and sexual history and performs a thorough clinical examination. The medical and sexual history can reveal diseases or treatments that cause ED. Blood tests and urine tests are also arranged to assess various aspects of your health and to rule out conditions which may be causing your ED. Other specialist tests such as doppler ultrasound scan with a penile injection to achieve an artificial erection, nocturnal penile tumescence test (Rigiscan) can be arranged if required.
Treatment for ED is based on the cause and severity of the erectile dysfunction. Any underlying causes are addressed and dealt with accordingly. The pros and cons of each treatment is discussed with the patient taking into consideration their preferences and circumstances.
Lifestyle changes are the first step in the treatment of erectile dysfunction. Lifestyle changes such as quitting smoking, limit alcohol intake, weight loss, physical activity, quitting illicit drugs can help treat and improve erectile dysfunction. Recent studies have found that aerobic exercise, can improve erectile dysfunction.
Oral Medication
A common treatment for erectile dysfunction is a group of medicines known as PDE5 inhibitors. These help improve blood flow to the penis, making it easier to get and maintain an erection in response to sexual stimulation.
There are different types of PDE5 inhibitors. Some act quickly and are taken shortly before anticipated sexual activity. Others stay in the system for longer, offering a wider window of opportunity. There are also daily options, which may suit men who prefer more spontaneity.
This is why it’s important to speak with your GP or pharmacist, who can help you explore the options and find the treatment that’s best suited to your needs and health. Some of these medicines are available over the counter after a consultation with a pharmacist, while others require a prescription from a GP or specialist.
However, PDE5 inhibitors do not work for everyone. They may be less effective in certain situations, such as after pelvic surgery or in men with poorly controlled diabetes.
A vacuum erection device (VED) is a non-invasive and effective treatment for erectile dysfunction. It can be a good option for men who prefer not to take medication or undergo surgery.
The device consists of a hollow plastic cylinder that is placed over the penis, connected to either a hand-powered or battery-powered pump. The pump removes air from the cylinder, creating a vacuum. This vacuum draws blood into the penis, leading to an erection.
Once the erection is achieved, a flexible rubber ring is placed around the base of the penis to help maintain the erection by preventing blood from flowing back out. The ring can be safely removed after sexual activity.
It’s best to receive training from a healthcare professional who specialises in this area, to ensure the device is used safely and correctly, and to help find the most suitable option for you.
If tablets aren’t suitable or haven’t been effective, other treatments are available that work by widening blood vessels in the penis to improve blood flow. These medicines act locally on the erectile tissue and can be given in a few different ways:
Urethral suppository – A small applicator is used to place a pellet into the opening of the urethra (the tube that carries urine and semen). The medicine is absorbed into the surrounding erectile tissue and usually takes effect within 10–15 minutes. When effective, the erection may last 30 to 60 minutes.
Topical cream –
Prescription-only cream – This is a medicated cream applied to the opening at the tip of the penis (the urethra). It works by increasing blood flow to the area, helping to trigger an erection. It may be suitable for men who cannot take oral medications or prefer not to use injections or suppositories.
Over-the-counter gel – Some non-prescription products are available to buy without a prescription. These are drug-free and classed as medical devices. They work by creating a local warming or cooling sensation, which may help stimulate an erection in some men.
This is applied to the opening at the tip of the penis and is absorbed into the nearby tissue to help trigger an erection.
Injection – The medication is injected directly into the side of the penis using a very fine needle. It works by relaxing the blood vessels and muscles in the penis to allow more blood to flow in. An erection typically occurs within 5–15 minutes.
Possible side effects of these treatments can include minor pain or bruising where the medication is applied or injected, a burning sensation, prolonged and painful erection (priapism), or, rarely, the development of scar tissue with repeated use.
Training and support from a healthcare professional is important to ensure these treatments are used safely, correctly, and with confidence.
Testosterone Levels
Some men develop erectile dysfunction and a reduced sex drive (libido) due to low testosterone levels. This can happen as a result of certain medical treatments, long-term health conditions, or following a period of illness. Men with diabetes are more at risk of developing low testosterone levels.
If you’re experiencing symptoms and think your testosterone levels might be low, it’s important to speak with your GP. A simple blood test can check your hormone levels.
If low testosterone is found to be affecting your health, testosterone replacement therapy may be recommended. It can be used on its own or alongside other treatments for erectile dysfunction.
Erectile dysfunction can sometimes be caused by psychological factors such as stress, anxiety, low mood, or relationship difficulties. In these cases, it’s often referred to as psychogenic ED.
Psychosexual counselling may be recommended, especially when emotional or psychological issues are playing a role. A psychosexual therapist works with individuals or couples to explore and address concerns around sex, intimacy, self-esteem, and communication. This can help reduce performance anxiety and rebuild confidence in a safe and supportive environment.
Even when there is a physical cause for ED, counselling can still be helpful alongside other treatments.
Penile implants are usually considered a last resort when other treatments haven’t worked. The procedure involves inserting a device into the penis to allow an erection. There are different types, and your urologist will discuss the options with you to find the most suitable one.
Inflatable implants are the most commonly used. These come in two-piece or three-piece designs. The three-piece type offers a more natural look and feel, with a hidden pump and reservoir that you control. The two-piece version is slightly simpler and may be offered if a full system isn’t suitable.
Malleable (semi-rigid) implants use bendable rods that keep the penis firm but can be positioned as needed. They’re simple to use and don’t require a pump.
Inflatable implants have high satisfaction rates, especially in men who haven’t had success with other treatments. As with any surgery, there are risks – including infection, mechanical problems, or the device wearing through the skin over time – but serious complications are uncommon.
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