Private erectile dysfunction clinic in London, same-day men's health.

The cardiovascular link

Erectile dysfunction of gradual onset, without an obvious psychological trigger, is an independent predictor of heart disease. It typically precedes cardiac symptoms by three to five years. That makes it an opportunity rather than merely a problem: it is a reason to check blood pressure, cholesterol, blood glucose and weight now, while there is time to change the trajectory.

Anyone presenting with erectile dysfunction should have those checks and a testosterone level. If you have been given tablets without any of that, the assessment was incomplete.

Common contributors

• cardiovascular disease, high blood pressure, high cholesterol, diabetes
• smoking, excess alcohol, being overweight, physical inactivity
• medicines — some blood pressure tablets, antidepressants, finasteride, and others
• low testosterone, thyroid problems
• prostate surgery, pelvic radiotherapy, spinal problems
• stress, anxiety, depression, relationship difficulties, and performance anxiety
• sleep apnoea, which is under-recognised and very relevant

Getting the most from tablets

• They do not work without sexual arousal. They amplify the normal response; they do not create one.
• Sildenafil works best on an empty stomach, around an hour before, and a heavy or fatty meal substantially delays it. Tadalafil is much less affected by food and lasts up to 36 hours.
• Try each dose at least four to eight times, at an adequate dose, before concluding it does not work. Most apparent failures are too low a dose, too few attempts, or taking it after a large dinner and a lot of alcohol.
• Alcohol worsens the response — a couple of drinks may relax you, more will not help.
• Headache, flushing, indigestion and a blocked nose are common and usually settle with continued use.

If tablets are not enough

• a different tablet, or a daily low dose rather than on demand
• vacuum devices, which are effective and drug-free
• injection or urethral treatments, which work when tablets do not
• testosterone replacement where levels are genuinely low
• psychosexual therapy, alone or alongside — particularly effective where anxiety has become self-perpetuating
• surgical options for selected men

What helps regardless

Stopping smoking, losing weight, regular aerobic exercise and reducing alcohol all measurably improve erectile function — exercise in particular has an effect size comparable to medication in some studies. None of it is quick, and all of it also improves the cardiovascular risk that sits underneath.