Erectile dysfunction

Also called Impotence, ED

Extremely common, treatable, and one of the earliest warning signs of heart disease.

What it is

Erectile dysfunction affects around half of men between 40 and 70 to some degree. Very few raise it.

The point that changes how seriously it should be taken: the arteries supplying the penis are narrower than the coronary arteries, so they show narrowing earlier. Erectile dysfunction of vascular origin frequently precedes a heart attack by three to five years.

That makes it a cardiovascular warning sign, not just a sexual problem. Anybody presenting with it should have blood pressure, cholesterol, glucose and cardiovascular risk assessed.

Other causes include diabetes, medication, hormonal problems, neurological conditions, prostate surgery, and psychological factors including anxiety and relationship difficulty. Usually more than one.

Signs you might notice

Difficulty getting or maintaining an erection, persistently.

Gradual onset with loss of morning erections suggests a physical cause.

Sudden onset with preserved morning erections and situational variation suggests a psychological component.

Associated symptoms worth noting: reduced libido, which points at hormones, and leg pain on walking, which points at vascular disease.

How it can affect day-to-day life

The silence is the main obstacle. Men wait years, and by then the relationship strain and the loss of confidence have compounded the original problem.

Partners frequently interpret it as loss of attraction, and that misunderstanding does more damage than the symptom.

Medication is a very common cause: some blood pressure drugs, antidepressants and others. Many people stop treatment for a serious condition rather than mention the side effect, which is a genuinely dangerous consequence of embarrassment.

Supporting someone well

Ask about it. Clinicians should raise it routinely in men with diabetes, heart disease or on relevant medication, rather than waiting to be asked.

Treat it as a cardiovascular flag: check blood pressure, cholesterol, glucose and calculate risk.

Review medication rather than assuming it must be endured.

Address lifestyle: smoking, alcohol, weight and exercise all affect it measurably.

Use treatment. PDE5 inhibitors such as sildenafil are effective, safe in most people, and available without prescription in pharmacies in some cases.

Involve the partner where the person wants that, since the relationship element usually needs addressing alongside the physical.

Where to get help

A GP can assess, test and treat, and refer to urology if needed.

Sexual Advice Association provide clear information without embarrassment.

Chest pain, or leg pain on walking, needs separate assessment.