Erectile Dysfunction: Causes, Assessment and Treatment Options

What is erectile dysfunction?

Erectile dysfunction, or ED, means difficulty getting or keeping an erection firm enough for satisfactory sexual activity.

An occasional episode—during stress, tiredness or illness—does not necessarily mean you have an ongoing problem. If the difficulty keeps happening or affects your confidence or relationship, a medical assessment can help.

ED is different from low sexual desire, premature ejaculation and infertility, although these concerns can occur together. It can affect younger men as well as older men, and should not simply be accepted as an inevitable part of ageing.

What causes erectile dysfunction?

An erection depends on blood flow, nerves, hormones and psychological wellbeing. More than one factor often contributes.

• Blood vessel problems: Diabetes, high blood pressure, high cholesterol and smoking can affect blood supply to the penis.
• Hormonal problems: Low testosterone can contribute, particularly when accompanied by reduced sexual desire.
• Nerve problems or previous treatment: Neurological conditions, pelvic injuries and certain pelvic operations can affect erections.
• Medicines: Some antidepressants, blood-pressure medicines and other treatments may contribute. Do not stop prescribed medication yourself.
• Stress and emotional factors: Anxiety about performance, depression and relationship difficulties can cause or worsen ED.
• Other health conditions: Obesity, kidney disease and penile conditions such as Peyronie’s disease may play a role.

What happens during an assessment?

The doctor will ask when the problem began, whether it happens consistently, and whether you have morning or spontaneous erections. Your sexual desire, medical conditions, medications and previous treatments are also relevant.

Assessment usually includes a focused examination and selected blood tests, such as blood glucose, cholesterol and morning testosterone. Further tests, including penile Doppler ultrasound, are needed only in selected cases—not for every patient.

ED can sometimes be an early sign of blood vessel disease. Checking cardiovascular risk is therefore part of looking after your overall health.

What treatment options are available?

Treatment depends on the cause, your health, preferences and response to previous options.

There is no single treatment that suits everyone.

Questions patients often ask

What if tablets have not worked?

Before concluding that they have failed, the doctor checks the dose, timing, food interactions, sexual stimulation and number of attempts. Other treatments remain available.

Are erection medicines safe with heart medication?

Some combinations are unsafe. Sildenafil, tadalafil and similar medicines must not be combined with nitrate medicines used for angina. Tell your doctor about every medicine you take.

Do shockwave therapy or “P-shot” injections cure ED?

Low-intensity shockwave treatment may offer modest improvement in selected patients, but results vary. PRP or “P-shot” treatment remains experimental; neither should be presented as a guaranteed cure.

When should I consider an implant?

An implant provides a mechanical way to achieve rigidity. Discuss inflatable and malleable options, infection risk, possible future revision, recovery and expectations. It does not increase sexual desire or guarantee greater penile length.

When should I seek help?

Arrange an assessment if erection difficulties recur, cause distress, or occur alongside reduced desire, penile pain or curvature.

An erection lasting four hours or longer requires emergency medical attention, especially after an injection or erection medication.

Before your visit, bring your medication list, relevant test results and details of treatments you have tried.