Patient information · Men's health
Erectile dysfunction
why this is a heart conversation as much as a sexual one
Erectile dysfunction is common, treatable, and worth raising rather than working around. It is also one of the earliest warning signs of cardiovascular disease — the arteries supplying the penis are narrower than the coronary arteries and show trouble first, often years before any chest symptoms.
Seek urgent medical help if you have
- an erection lasting more than four hours, which is painful — this is a medical emergency and delay causes permanent damage
- sudden loss of vision or hearing after taking a tablet
- chest pain during sex, or breathlessness on mild exertion
- a sudden bend or lump developing in the penis, with pain
- erectile dysfunction with numbness in the saddle area or leg weakness
Priapism — a prolonged painful erection — needs treating within hours to avoid permanent tissue damage. Go to an emergency department, do not wait. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Do not take these tablets with nitrates
PDE5 inhibitors — sildenafil, tadalafil and similar — must never be taken with nitrate medicines for angina, including GTN spray or tablets, isosorbide, or with nicorandil. The combination can cause a catastrophic drop in blood pressure. Recreational nitrites (poppers) carry the same danger. If you use any of these, tell us. This is also why buying these tablets online without assessment is genuinely risky.
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
Physical or psychological?
Morning erections and erections during masturbation that are normal, with difficulty only in certain situations or with a partner, point towards a psychological or situational component. A gradual, consistent decline in all circumstances, including overnight, points towards a physical cause. Most men have some of both, and treating one does not exclude treating the other.
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.
Book an appointment if this has been going on more than a few months, you have not had a cardiovascular and hormone assessment, tablets are not working, or you are buying them online. We offer discreet men's health consultations, full bloods and cardiology assessment on site, seven days a week.
Discreet assessment, including the heart checks
Men's health appointments seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.