Erectile dysfunction.

What is erectile dysfunction?

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. The key word is persistent — occasional difficulty is universal and not a clinical concern. ED becomes a clinical issue when it happens regularly or starts to affect confidence, relationships, or wellbeing.

ED is not a problem of masculinity, performance, or character. It is a medical condition, almost always with identifiable contributing factors, and almost always treatable. The reason many men avoid getting help has more to do with stigma and the perceived awkwardness of the conversation than with the medical complexity of the problem itself.

How common is it?

ED is one of the most common men’s health concerns and one of the least talked about. Population data suggests:

• Around 50% of men aged 40–70 experience some degree of ED
• Around 10% experience complete inability to achieve erection
• Younger men (20s and 30s) are increasingly affected — in this age group, psychological factors and lifestyle predominate
• The average man waits between 1 and 3 years before seeking help

You are not unusual. The clinician who sees you has seen many men with the same concern. The conversation, once started, is much easier than imagined.

Causes

ED almost always has multiple contributing factors. Identifying which factors apply to you is the first step in effective treatment.

Vascular (most common in older men)

Erections require healthy blood flow into the penis. Conditions that affect blood vessels — high blood pressure, high cholesterol, diabetes, smoking, atherosclerosis — commonly affect the small arteries supplying the penis before larger arteries. This is why ED is an early warning sign for heart disease (see below).

Neurological

Conditions affecting nerve function: diabetes, multiple sclerosis, Parkinson’s disease, spinal injury, stroke, or pelvic surgery (prostate, bladder, bowel).

Hormonal

Low testosterone (hypogonadism) is a less common cause but worth checking, particularly with reduced libido, fatigue, low mood, or loss of body hair. Thyroid disorders also contribute occasionally.

Medication side effects

Many commonly clinician-recommended treatment options can affect erectile function, including some blood pressure medications, antidepressants, anti-androgens, and others. We review your full medication list as part of assessment.

Psychological

Performance anxiety, depression, work stress, relationship difficulties, and past sexual trauma can all contribute. In younger men, psychological factors are often the predominant cause. Importantly, ED with any cause becomes self-perpetuating — performance anxiety builds on top of an initial physical or situational issue.

Lifestyle

• Smoking — one of the strongest predictors of ED
• Excess alcohol
• Recreational drug use
• Obesity
• Sedentary lifestyle
• Sleep deprivation, including untreated sleep apnoea
• Pornography use patterns in some younger men

ED and heart disease — why this matters

For any new ED in a man under 70, particularly if onset has been gradual, we routinely assess cardiovascular risk — blood pressure, cholesterol, glucose, smoking, exercise, family history. For many men, the ED consultation becomes the start of broader cardiovascular protection that benefits them for decades.

How we assess at the clinic

1. The conversation

An unhurried, discreet conversation about your symptoms, history, and what matters to you. We’ll cover onset, pattern (situational, with partner only, morning erections, masturbation), medication, lifestyle, and any other symptoms. This conversation is what most men dread and what almost all men find easier than expected.

2. Examination if needed

A focused physical examination may be appropriate — assessing blood pressure, pulse, general fitness, and sometimes a brief genital examination. We follow GMC guidance on examinations and a chaperone is always offered (see our Chaperone Policy).

3. Investigations

Tests we commonly arrange:

• Fasting blood glucose / HbA1c (for diabetes)
• Lipid profile (cholesterol)
• Morning total testosterone (if hormonal cause suspected)
• Thyroid function (if indicated)
• Full blood count, kidney and liver function (general baseline)
• ECG and cardiovascular risk assessment

Results are typically available within 24–48 hours.

4. Plan

A clear, written plan covering treatment options, lifestyle changes, and follow-up. Many men leave the first consultation with reassurance, an action plan, and a sense that the problem is finally being addressed.

Treatment options

Treatment is individualised based on cause, severity, your overall health, and your preferences. The discussion happens in consultation, after assessment.

Treating contributing factors

The most important step. Improving cardiovascular health, controlling diabetes, reducing alcohol, stopping smoking, and addressing untreated sleep apnoea all directly improve erectile function in most men. For some, these changes alone resolve the problem.

Oral medication

A class of medications is widely used as first-line treatment for ED. These are available only through a doctor and discussed in detail in consultation — including how they work, who they suit, who should avoid them, and what to expect. Under UK law we don’t name specific medications on this website; this conversation belongs in clinic.

Other options

For men who can’t use or don’t respond to first-line medication, other treatments are available: vacuum devices, injectable treatments, and (rarely) surgical options. We discuss what fits your situation.

Testosterone replacement

Where testosterone is genuinely low and ED is partly hormonal, replacement may help. Testosterone replacement is a long-term commitment with monitoring requirements, and is not a routine treatment for ED in men with normal testosterone levels.

Psychological support

Where performance anxiety, depression, relationship difficulties, or past trauma play a role, psychological therapy (alone or alongside medication) is often the most effective long-term treatment. We can refer to a psychologist or sexologist within Tower Bridge Hospital London.

Lifestyle factors

The boring advice is the most effective. Men who improve the following see meaningful improvement in ED:

• Regular aerobic exercise — arguably the single most effective intervention for ED. Improves blood vessel function, mood, sleep, and testosterone.
• Stop smoking — biggest single risk factor; effects reverse with cessation
• Moderate alcohol — below 14 units a week, spread across the week
• Sleep — address chronic sleep deprivation and untreated sleep apnoea
• Healthy weight — particularly reducing visceral (abdominal) fat
• Stress management — psychological pressure is a major contributor in men of all ages

Psychological factors

Even when ED has a physical cause, psychological factors usually develop on top. Performance anxiety after the first few failures becomes a self-fulfilling cycle. Other psychological factors:

• Depression (often both cause and consequence of ED)
• Generalised anxiety
• Relationship difficulties or communication issues
• Body image concerns
• Past sexual trauma
• Cultural or religious shame
• For some younger men, escalation of solo sexual practice patterns

These are addressable. Talking to a clinician or psychologist who has worked with this many times is the start.

When to see us

Consider booking if:

• You’ve had erection difficulties more than occasionally for a few weeks or longer
• You’ve noticed reduced morning erections
• ED is starting to affect your confidence, relationship, or mood
• You’re a man over 40 who hasn’t had a cardiovascular health check recently
• You have other symptoms suggesting low testosterone (fatigue, low libido, low mood)
• You’ve started a new medication and notice ED has begun

The earlier you come, the simpler the conversation and the better the outcome typically is.

Frequently asked questions

Is this confidential?

Absolutely. Medical confidentiality applies. You can choose whether we write to your NHS GP — many men prefer we don’t initially, and that’s fine. Records are held in line with UK GDPR. See our Privacy Policy.

How long is the appointment?

30 minutes for the initial consultation. Long enough to have the full conversation without rushing, short enough to fit a lunchtime.

Will I be examined?

Sometimes a brief examination is appropriate, but not always. If examination is suggested, you’ll be told what’s involved, asked for consent, and offered a chaperone. You can decline any examination.

Can I get treatment on the first appointment?

Often yes. For many men, after assessment we can discuss and arrange treatment where clinically appropriate at the first visit. For others, we wait for blood test results before deciding the best approach.

What if I have heart disease?

Many men with heart conditions can still be treated for ED, but some medications interact with heart-related treatments. We assess this carefully and where needed liaise with your cardiologist.

What about online ED services?

Many online services are reputable but some sell medication without proper assessment. The risk is that you miss treatable underlying conditions (especially cardiovascular). A proper one-off in-person assessment, then potentially ongoing online repeat treatment, is a sensible approach.

How much does it cost?

Current consultation prices are on our Fees page. Blood tests are quoted before they’re done. Medication costs vary by treatment chosen and are discussed in consultation.

What if my partner doesn’t know I’m here?

Your decision. Many men come for an initial consultation alone before deciding what to share with their partner. Others bring their partner from the start. Both approaches work.