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Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress.

It's important to identify the cause of erectile dysfunction and treat any underlying conditions. When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden.

Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.

Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body). There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are: conditions affecting the flow of blood to your penis – vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic conditions affecting your hormone levels – hormonal conditions affecting the physical structure of your penis – anatomical.

Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.

Examples of vasculogenic conditions that cause erectile dysfunction include: cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) high blood pressure (hypertension) diabetes – a condition caused by high blood sugar levels.

This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition.

Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment. Examples of neurogenic conditions that cause erectile dysfunction include: multiple sclerosis – a condition that affects the body's actions, such as movement and balance Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing a spinal injury or disorder a stroke – a serious condition that occurs when the blood supply to the brain is interrupted. Examples of hormonal conditions that cause erectile dysfunction include: hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced Cushing's syndrome – a condition that affects the production of a hormone called cortisol.

Peyronie's disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction.

In some men, certain medicines can cause erectile dysfunction, including: diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease antihypertensives – such as beta-blockers, that are used to treat high blood pressure fibrates – medicines used to lower cholesterol levels antipsychotics – used to treat some mental health conditions, such as schizophrenia antidepressants – used to treat depression and some types of pain corticosteroids – medication that contains steroids, which are a type of hormone H2-antagonists – medicines used to treat stomach ulcers anticonvulsants – used to treat epilepsy antihistamines – used to treat allergic health conditions, such as hay fever anti-androgens – medication that suppresses androgens (male sex hormones) cytotoxics – medication used in chemotherapy to prevent cancer cells from dividing and growing. Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care. Possible psychological causes of erectile dysfunction include: depression – feelings of extreme sadness that last for a long time anxiety – a feeling of unease, such as worry or fear. Erectile dysfunction can often have both physical and psychological causes.

For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction. There are many emotional issues that may also affect your physical ability to get or maintain an erection.

These include: relationship problems lack of sexual knowledge past sexual problems past sexual abuse being in a new relationship. Other possible causes of erectile dysfunction include: excessive alcohol intake tiredness using illegal drugs, such as cannabis, heroin or cocaine. Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.

Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction. Erectile dysfunction (ED) can often be diagnosed by your GP.

They will talk to you about your situation and may carry out a physical examination.

Your GP may ask you about: your symptoms your overall physical and mental health your alcohol consumption whether you take drugs whether you are currently taking any medication. If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic.

You can find your nearest GUM clinic on the British Association for Sexual Health and HIV (BASHH) website. Try not to be embarrassed because erectile dysfunction is a common problem.

You can request a male GP at your surgery if you prefer.

You may be asked about: your previous and current sexual relationships what your sexual orientation is how long you have been experiencing erectile dysfunction whether you can get any degree of erection with your partner, on your own or when you wake up in the morning whether you have been able to ejaculate or orgasm your libido (

your

measure your blood pressure to see if you have high blood pressure (hypertension) listen to your heart rate to check for any abnormalities measure your height, weight and waist circumference to see if you are a healthy weight for your height ask you about your diet and lifestyle, for example, how much exercise you do test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels. A physical examination of your penis may be carried out to rule out anatomical causes (conditions that affect the physical structure of your penis).

If you have symptoms of an enlarged prostate, such as weak or irregular urination, a digital rectal examination (DRE) may be suggested. Blood tests can also check for underlying health conditions.

For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).

In some cases you may be referred to a specialist for further testing. This might be the case if you are unusually young to be experiencing erectile dysfunction as it's rare in men under 40 years of age. An intracavernous injection test involves injecting a man-made (synthetic) hormone into your penis to increase the blood flow. This helps assess any abnormalities in your penis and plan surgery.

If the injection doesn't result in an erection it may indicate a problem with the blood supply to your penis.

In some cases, you may also need an ultrasound scan. Arteriography and dynamic infusion cavernosometry or cavernosography.

These specialised tests involve injecting dye into the blood vessels of your penis and studying the dye on a scanner.

These are likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.

If the cause of your erectile dysfunction is thought to be psychological, you may be reffered for a psychological assessment.

If you have erectile dysfunction (ED), treatment will depend on what's causing it. The various treatments for erectile dysfunction are outlined below.

If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.

If you are taking medication that can cause erectile dysfunction, there may be an alternative.

It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care. Erectile dysfunction can often be improved by making changes to your lifestyle, sildenafil 20 mg cost walgreens such as: losing weight if you are overweight giving up smoking cutting back your alcohol consumption not taking illegal drugs exercising regularly reducing stress. As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels). Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction.

They

work

In England, four PDE-5 inhibitors are available for treating erectile dysfunction. They are: sildenafil – sold under the brand name Viagra tadalafil – sold under the brand name Cialis vardenafil – sold under the brand name Levitra avanafil – sold under the brand name Spedra. Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work 'on demand'.

Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.

Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine.

After taking tadalafil, the effects will last for up to 36 hours. It may take longer to notice the effects if the tablet is taken with food, so it's best to

take

The choice may depend on: how often you are sexually active whether you have tried any of the medications before.

There have been many studies to test the effectiveness of these medications.

In general, at least two-thirds of men report having improved erections after taking one of these medicines. If you do not find that PDE-5 inhibitors are effective it may be because: you have not waited long enough after taking the dose you have waited

too

PDE-5 inhibitors should be used with caution in men who have cardiovascular disease, such as coronary heart disease.

However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP. PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronie's disease (a condition that affects the tissue of the penis).

PDE-5 inhibitors should also be used with caution in men who: are at risk of priapism – a painful erection that lasts for several hours are also taking long lasting alpha-blockers – a medication used to treat a number of conditions, such as high blood pressure (hypertension) Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates.

The combination of the two substances can have a dangerous effect on your heart.

Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as '

poppers

You are also warned not to take PDE-5 inhibitors if you: have been advised not to take part in sexual activity or in activities that widen your blood vessels have low blood pressure (hypotension) have recently had a stroke – a medical emergency that occurs when the blood supply to the brain is interrupted have unstable angina – an underlying heart condition that causes symptoms such as chest pain have had a heart attack – a medical emergency where the blood supply to the heart is suddenly blocked have a history of non-arteritic anterior ischaemic optic neuropathy – an eye condition that causes a sudden loss of vision.

PDE-5 inhibitors can cause some side effects, including: headaches and migraines flushing (redness) indigestion nausea (feeling sick) vomiting (being sick) a blocked or runny nose back pain vision disturbances muscle pain. A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.

You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes. It may take several attempts to learn how to use the pump correctly, but they are usually effective.

After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.

You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.

Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men. Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details).

The Sexual Advice Association produces a number of factsheets, including one on vacuum pumps that provides details of companies that supply them.

If your erectile dysfunction doesn't respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil.

This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.

Alprostadil is available as: an injection directly into your penis – this is called an intracavernosal injection a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application.

You may be trained to correctly inject or insert alprostadil. If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra.

Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose.