Erectile dysfunction (ED) means difficulty getting or keeping an erection firm enough for sex. It is common, especially with age, and usually treatable. Occasional problems are normal, but persistent ED can be an early warning sign of heart disease, diabetes or high blood pressure, so it’s worth seeing a healthcare provider rather than buying unregulated “power” products.
Common causes
Physical
- Narrowed blood vessels (heart disease, high cholesterol, smoking)
- High blood pressure
- Diabetes
- Obesity and inactivity
- Low testosterone
- Nerve damage (e.g. after pelvic surgery or spinal injury)
- Heavy alcohol use and recreational drugs
Psychological
- Stress, anxiety and performance anxiety
- Depression
- Relationship problems
- Tiredness, including from shift work
Medicines
Some blood pressure medicines, antidepressants and other drugs can contribute. Never stop prescribed medicine without talking to your healthcare provider.
Why it can signal heart disease
The arteries to the penis are small, so they may show narrowing before the larger heart arteries do. Men with ED, especially if younger or with risk factors, should have their blood pressure, blood sugar and cholesterol checked.
Treatment options
- Lifestyle: stop smoking, lose weight, exercise regularly, reduce alcohol, sleep better
- Treat underlying conditions like diabetes and high blood pressure
- Prescribed tablets such as sildenafil or tadalafil (PDE5 inhibitors). These must never be taken with nitrate medicines (e.g. glyceryl trinitrate for chest pain) because the combination can cause a dangerous drop in blood pressure
- Counselling or sex therapy for psychological causes
- Other options from specialists: injections, vacuum devices, hormone treatment if testosterone is low
Beware of unregulated products
“Power” herbal mixtures, roadside drugs and online “enhancers” may contain hidden prescription drugs at unknown doses or harmful ingredients. They can be dangerous, especially for men with heart problems or on nitrates.
When to see a healthcare provider urgently
- An erection lasting more than 4 hours (priapism), which is an emergency
- Chest pain during or after sex
Frequently asked questions
Is erectile dysfunction normal with age?
It becomes more common with age but is not inevitable and is usually treatable.
Can stress cause ED?
Yes. Stress and anxiety are common causes, especially in younger men.
Related reading: Enlarged prostate guide · Foods that lower blood pressure · Men’s health: Movember
Checked against NHS guidance on erection problems. Updated 5 November 2026.
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