Overview
An erection depends on healthy blood vessels, nerves, hormones and psychological arousal. ED occurs when any of these are disrupted, most commonly through vascular changes related to blood pressure, cholesterol, diabetes, smoking or weight.
Psychological factors, relationship stress, alcohol, medication side effects and low testosterone also contribute. ED affects around half of men over 40 to some degree and is rarely a problem of desire alone.
When to seek urgent medical help
- • Chest pain, breathlessness on exertion or a history of heart disease before starting treatment
- • Sudden ED after pelvic injury, surgery or new medication
- • An erection lasting more than four hours - emergency
Symptoms and signs
- Difficulty achieving an erection sufficient for intercourse
- Difficulty maintaining an erection until completion
- Reduced firmness or shorter-lasting erections
- Loss of early morning erections
- Reduced sexual desire or associated performance anxiety
- Symptoms that vary with situation and partner (suggesting a psychological component)
Management and treatment
PDE5 inhibitors are highly effective first-line treatment, working in around 70-80% of men when used correctly, which includes adequate dosing, sexual stimulation and up to four to eight attempts before judging the response.
Your ChatDoc doctor screens for cardiovascular risk and drug interactions (particularly nitrates), advises on blood tests where indicated and prescribes the option that best fits your lifestyle.
Prescription treatment options
Sildenafil
Taken 30-60 minutes before activity, effective for around 4-6 hours.
Tadalafil
Up to 36 hours of effect, or a low daily dose for spontaneity without timing.
Lifestyle and cardiovascular optimisation
Exercise, weight loss, smoking cessation and blood pressure control measurably improve erections.
Hormonal and psychological support
Testosterone assessment where symptoms suggest deficiency, plus referral for psychosexual therapy when relevant.
Any prescription is issued only after a doctor has reviewed your case and considers the treatment safe and appropriate for you.
Your online Erectile Dysfunction assessment
- 1
Tell us about your concern
Share symptoms, past treatments, medicines and relevant health information.
- 2
Upload clear photos
Upload photos of your concern where applicable.
- 3
Doctor reviews your case
Technology helps organise your answers, but every assessment and prescription decision is made by a doctor, who may message you if they need more information.
- 4
Get your personalised plan
A personalised prescription is issued if treatment is clinically appropriate.
Prognosis and outlook
Most men respond to the first or second PDE5 inhibitor they try, and effects are immediate rather than cumulative. Adjusting dose or switching agents resolves many initial non-responses.
Addressing the underlying vascular or lifestyle drivers often improves erections independently and benefits long-term heart health.
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This page is general medical information and does not replace a personal consultation. Always seek urgent care for severe or rapidly worsening symptoms. ChatDoc is not an emergency service. Call 999 (UK) or 112 (EU) for life-threatening emergencies or 111 for urgent non-emergency help. Do not wait for an online reply.