Erectile dysfunction is the ongoing difficulty getting or keeping an erection firm enough for sex. It can be occasional, but if it’s persistent or worsening, it’s worth assessing because it may reflect blood flow, nerve, hormonal, medication, or psychological factors.

Common causes include cardiovascular disease (reduced blood flow), diabetes, high blood pressure, high cholesterol, obesity, smoking, low testosterone, certain medications (e.g., some antidepressants/blood pressure meds), pelvic surgery, and anxiety/stress. Many men have more than one contributing factor.

ED becomes more common with age, but it isn’t “inevitable” and it’s often treatable. Because ED can be linked to heart and metabolic health, a proper assessment can be important beyond sexual function.

It can be. The penile arteries are small, so blood flow issues may show up as ED before symptoms occur elsewhere. If ED is new—especially with risk factors like smoking, diabetes, or high blood pressure—it’s sensible to check cardiovascular health as part of the work-up.

If ED lasts longer than ~3 months, is worsening, affects confidence or relationships, or you have medical risk factors (diabetes, heart disease), a urologist can help. If you’ve tried tablets without success, specialist evaluation is particularly useful.

Diagnosis usually includes a detailed history (onset, rigidity, morning erections, libido), medical review (medications and comorbidities), and targeted examination. Blood tests and sometimes further assessment of penile blood flow may be recommended.

Depending on symptoms and history, tests may include fasting glucose/HbA1c, lipids, kidney function, thyroid function, and morning testosterone (often with repeat confirmation and related hormones if low). Testing is personalised—not everyone needs the same panel.

No. Tablets (PDE5 inhibitors) help many men, but they require sexual stimulation and correct timing/dosing. They’re less effective when ED is severe, when blood flow or nerve damage is significant, or when underlying issues (e.g., poorly controlled diabetes) are driving symptoms.

Often it’s due to changes in health over time, incorrect use (timing with food/alcohol), inadequate dose, rising anxiety, or progression of vascular disease. A specialist review can optimise use, check contributing factors, and offer next-step options.

Options include a vacuum erection device (VED), penile injection therapy, urethral medications (where suitable), and addressing reversible contributors (sleep apnoea, weight, smoking, medication review). For men with severe ED or treatment failure, penile implants are a highly reliable solution.

Injection therapy uses a small needle to deliver medication into the penis to reliably produce an erection. When properly taught and monitored, it can be safe and effective—common issues include bruising and penile pain; rare but important risks include prolonged erection (priapism), which requires urgent care.

A penile implant may be recommended when ED is severe and persistent and other treatments are ineffective, not tolerated, or not desired. It can also be considered when ED occurs after pelvic surgery or long-standing diabetes.

Low testosterone more commonly reduces libido and energy, and it can contribute to ED in some men. Many men with ED have normal testosterone, so testing helps clarify whether hormones are part of the picture.

Yes. Anxiety can interfere with arousal and erections, and a “cycle” can develop where fear of failure worsens ED. Treatment often combines medical options (for confidence and reliability) with addressing stress/sleep/relationship factors.

Seek urgent care if you have an erection lasting more than 4 hours, sudden severe penile pain/swelling after injury (possible penile fracture), or significant chest pain/shortness of breath associated with sexual activity.