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Erectile dysfunction, or ED, means regularly finding it difficult to get or keep an erection firm enough for sex. An occasional problem is normal. It is worth seeking help when it keeps happening or causes worry.

ED is very common. It can affect men at any age, but becomes more likely with age and with health problems such as diabetes, high blood pressure or related to low testosterone. It is not something you simply have to accept.

ED often has more than one cause. Physical causes include reduced blood flow, diabetes, high blood pressure, raised cholesterol, obesity, nerve problems, hormonal problems and some operations. Stress, anxiety, low mood, relationship difficulties, smoking, alcohol, recreational drugs and some medicines can also contribute

No. ED may be temporary or longer term, depending on the cause. Even when the cause cannot be completely removed, treatment can often improve erections and sexual confidence.

Yes. ED can sometimes be an early sign of heart or blood-vessel disease, diabetes, low testosterone, high blood pressure or raised cholesterol. This does not mean that everyone with ED has a serious illness, but it is a good reason to have a general health check.

Yes, absolutely. Stress, anxiety, low mood and relationship difficulties can affect erections. A physical problem can also create anxiety and make ED worse. If erections are reliable during masturbation or on waking but less reliable with a partner, stress may be playing a part, although physical causes are still possible.

Blood tests can look for problems that may be causing or worsening ED, such as diabetes, raised cholesterol or hormone issues. Hormones matter – up to 30% of men with ED also have low testosterone. That’s why we offer a blood test with every ED plan.

Low testosterone can contribute to ED, especially when there is also low sexual desire or fewer morning erections. However, many men with ED have normal testosterone. Testosterone deficiency is diagnosed from symptoms and low results on two properly timed morning blood tests. One screening result is not enough.

TRT may help some men with confirmed testosterone deficiency, particularly with sexual desire, but it does not guarantee better erections. It is unlikely to help if testosterone is normal, and some men still need ED tablets. TRT can reduce sperm production, so fertility plans must be discussed before treatment.

Yes. Most men can be helped. Treatment may include improving general health, changing a contributing medicine, reducing smoking or excess alcohol, addressing stress or relationship problems, and using ED tablets. Other options include counselling, vacuum devices, injections and specialist treatments.

Sildenafil and tadalafil help more blood enter the penis when you are sexually aroused. They do not cause an automatic erection, so sexual stimulation is still needed. The dose and timing matter, and sildenafil may work less well after a heavy meal.

Sildenafil is taken when needed and works for a shorter time. Tadalafil lasts longer and can be taken when needed or as a low daily dose. This does not mean having a continuous erection; it gives a longer period in which an erection may be easier with sexual stimulation.

No. ED tablets must never be mixed with nitrate medicines for chest pain, nicorandil or recreational 'poppers', because this can cause a dangerous fall in blood pressure. They may also be unsuitable with some heart, eye, liver or kidney conditions. Please make sure to share all health problems and medicines during the assessment

Common side effects include headache, flushing, indigestion, a blocked nose and dizziness. Tadalafil can cause back or muscle aches, while sildenafil can sometimes affect colour vision. Speak to a clinician if side effects are severe or do not settle.

The dose, timing, food, sexual stimulation and number of attempts should be checked first. A doctor can then look again for underlying causes and discuss another tablet, a vacuum device, injections or specialist treatment. Do not increase the dose or combine ED medicines without medical advice.

Yes. ED and premature ejaculation (PE) are different problems, but they often occur together. Worrying that an erection may fade can make someone rush and ejaculate sooner. Anxiety about PE can also make erections less reliable. ED is usually treated first, then any remaining PE can be assessed separately.

Side effects are uncommon but please seek urgent help for an erection lasting four hours or more, sudden loss of vision or hearing, or chest pain during sex. If you develop chest pain after taking an ED tablet, do not take nitrate medicine. Tell the emergency team what you took and when.