What Is Erectile Dysfunction? Causes, Symptoms, and Can It Be Cured?

Short answer: erectile dysfunction (ED), also called impotence, is being unable to get an erection, or to keep one for long enough to have sex (nhs.uk). It is very common, particularly in men over 40, and most men occasionally have trouble, usually because of stress, tiredness or drinking too much alcohol; the NHS says to see a GP if it keeps happening. When it happens often, the cause is usually physical, such as high blood pressure, high cholesterol, diabetes or a hormone problem, but anxiety or depression, smoking, alcohol and some medicines can all play a part, and there is often more than one cause (nhs.uk and the British Association of Urological Surgeons). If this is your first time with erection problems, see your GP to check your blood sugar, cholesterol and testosterone, and have a heart health check at least every 5 years. Treatment can usually help: lifestyle changes, erectile dysfunction treatments such as sildenafil and tadalafil tablets, talking therapy, or devices such as a vacuum pump.

This guide follows the NHS, NHS inform and the British Association of Urological Surgeons (BAUS), as read in October 2026, and covers the causes, the checks a GP does, whether it can be cured and how to get treatment on the NHS.

What is erectile dysfunction?

Erectile dysfunction is when you are either unable to get an erection, or unable to keep an erection for long enough to have sex (nhs.uk). BAUS defines it as an inability to get or keep an erection firm enough for penetration and for the satisfaction of both partners. It is also called impotence.

It is very common, particularly in men over 40 (nhs.uk). BAUS says it becomes more common with age and is seen in 50 to 55% of men aged 40 to 70.

Having trouble now and then is normal. Most men occasionally fail to get or keep an erection, usually because of stress, tiredness or drinking too much alcohol, and the NHS says this is nothing to worry about. It is worth looking into when it keeps happening, because BAUS notes that erectile dysfunction can be a sign of other illnesses, such as heart disease or diabetes.

What are the symptoms of erectile dysfunction?

The main symptoms of erectile dysfunction are being unable to get an erection, or being unable to keep one long enough to have sex. NHS inform lists three:

• being unable to get an erection
• being unable to keep an erection for long enough to have sex
• having a low sex drive (loss of libido)

Depending on the cause, you may still get erections at other times, such as when you wake up (nhs.uk). BAUS says erectile dysfunction can come on gradually or suddenly. A GP asks whether you still have night-time or early-morning erections as part of working out the cause (BAUS).

What causes erectile dysfunction?

Erectile dysfunction that keeps happening usually has a physical cause, and often more than one thing plays a part: BAUS says 90% of men with erectile dysfunction have at least one physical cause, and that a purely psychological cause is seen in about 10%. The NHS names high blood pressure, high cholesterol, diabetes, depression or anxiety, and hormone problems as conditions that can cause it when it happens often.

If you think a medicine is the cause, speak to your GP or pharmacist before changing anything: your doctor may be able to switch you to a different one (nhs.uk).

Can stress or anxiety cause erectile dysfunction?

Yes. Stress is one of the usual causes of an occasional problem, and the NHS lists depression and anxiety among the conditions that can cause erectile dysfunction when it happens often. BAUS says a psychological element, such as anxiety about sex, is common in men with erectile dysfunction, even though a purely psychological cause is less common.

The NHS advises trying to reduce stress and anxiety, and NHS inform suggests breathing and relaxation exercises. Counselling and therapy can help when erection problems are linked to emotional or mental health problems; they are available on the NHS, though the NHS notes there can be a long wait. Privately, the NHS says sex therapists should be members of the College of Sexual and Relationship Therapists or the Institute of Psychosexual Medicine, and Relate offers sex therapy for a fee. The COSRT website has a search for registered therapists.

Do smoking, vaping and alcohol cause erectile dysfunction?

Smoking and drinking too much alcohol are both linked with erection problems, which is why the NHS advises stopping smoking and drinking no more than 14 units of alcohol a week. Smoking is also one of the risk factors for heart disease our consultation asks about. This is the advice we give every man in our consultation:

Losing weight, stopping smoking, drinking less alcohol and exercising can all help. If you cycle more than 3 hours a week, try a break from cycling. Drinking less alcohol can help your erections.

The evidence on vaping is limited. A large US survey of men in the Population Assessment of Tobacco and Health study (El-Shahawy and colleagues, American Journal of Preventive Medicine, 2022) found that men who vaped every day were more likely to report erectile dysfunction than men who had never vaped, even after age, heart disease and other risk factors were taken into account. A survey like this shows a link at one point in time; it cannot show that vaping causes erectile dysfunction. The NHS pages on erection problems do not mention vaping.

NHS inform also advises against illegal drugs, and BAUS lists heroin, cocaine and methadone among the drugs linked with erectile dysfunction. Poppers are dangerous with erectile dysfunction tablets: see the box below. Drinking with sildenafil is covered in Viagra side effects.

Can young men get erectile dysfunction?

Yes. NHS inform says erectile dysfunction can happen to anyone, although it is more common in men over 40 (nhs.uk). At any age, an occasional problem is usually down to stress, tiredness or alcohol. If it keeps happening, see a GP whatever your age, because it might be a sign of a health condition that can be treated (nhs.uk).

Erectile dysfunction treatment through this service is for adults aged 18 and over.

Is there a test for erectile dysfunction?

There is no single test for erectile dysfunction: a GP or sexual health clinic diagnoses it by asking about your symptoms, lifestyle and relationships, and doing some basic checks, such as taking your blood pressure (nhs.uk). They may examine your genitals to rule out a physical cause and, if you need to pee more often than usual, your prostate.

BAUS says the usual tests are blood tests (including blood sugar for diabetes, cholesterol, and kidney and liver function), a urine test, and hormone levels, including testosterone. These look for a treatable cause, such as diabetes, high cholesterol or low testosterone. Your GP may also ask you to fill in a short symptom questionnaire: BAUS names the two used most, the International Index of Erectile Function and the Sexual Health Inventory for Men (SHIM).

The five questions our consultation asks

Our consultation asks the five SHIM questions, each about the last six months:

1. How confident are you that you could get and keep an erection?
2. When you had erections with sexual stimulation, how often were they hard enough for penetration?
3. During sexual intercourse, how often were you able to maintain your erection after penetration?
4. During intercourse, how difficult was it to maintain your erection to completion?
5. When you attempted intercourse, how often was it satisfactory for you?

Each question has five answers, and a GPhC-registered pharmacist reviews the total. What the total means in our consultation:

• 8 to 21: mild to moderate erectile dysfunction, the range our online service treats, if the rest of your answers allow it.
• Below 8: Your answers point to severe erectile dysfunction, which sits outside what we can safely treat online. Please book a GP appointment to have this assessed.
• 22 or more: Your answers suggest you do not have erectile dysfunction, so you do not need treatment. If you are worried, please speak to your GP.

The questions are not a diagnosis on their own, and there is no self-scoring version on this page: they are part of a consultation the pharmacist reviews. The consultation also asks about risk factors for heart disease, such as:

• Uncontrolled high blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Physical inactivity
• Family history of cardiovascular disease

With three or more, we do not supply treatment online. Please book a GP appointment so your heart health can be assessed.

When should you see a GP about erection problems?

See a GP, or go to a sexual health clinic, if erection problems keep happening: it might be a sign of a health condition that can be treated (nhs.uk). NHS inform says to contact your GP practice if your symptoms have lasted more than a few months, the things you can do yourself have not helped, and you are bothered by them. Sexual health clinics can provide the same treatment as a GP surgery, and many offer a walk-in service (nhs.uk).

Get help sooner for heart symptoms. Chest pain, breathlessness, palpitations or faintness with everyday activity need to be checked by a doctor before erectile dysfunction treatment can be considered.

• If you have chest pain now, or feel very unwell, call 999
• If you need advice today, call NHS 111
• Otherwise, please make an appointment with your GP

Tell your GP, too, about any pain, problems with ejaculation or prostate symptoms alongside erection problems, which BAUS says a GP will ask about, or if your penis has started to curve: Peyronie's disease is one of the causes BAUS lists. Your GP may refer you on to a specialist, for example in cardiology, urology or endocrinology.

Can erectile dysfunction be cured?

It depends on the cause. When a cause can be treated, treating it may help: the NHS gives the examples of switching a medicine that is causing the problem, treating high blood pressure, high cholesterol or hormone problems, and counselling or therapy when the problem is linked to emotional or mental health (nhs.uk).

BAUS says most treatable causes can be found with a history, an examination and routine blood tests, and that lifestyle changes, such as a healthy diet, drinking less, losing weight and exercising more, can improve erectile dysfunction. It adds that testosterone treatment is only for men whose testosterone is low, and may be harmful if it is normal.

Tablets are different: they treat the symptom rather than the cause. A PDE5 inhibitor tablet helps you get an erection when you take it and are sexually aroused. These tablets only work with sexual stimulation. If no treatable cause is found, BAUS says tablets are the usual first treatment for most men.

How is erectile dysfunction treated?

Erectile dysfunction is usually treated with lifestyle changes, treatment of any cause that is found, and tablets called PDE5 inhibitors, which increase blood flow to the penis; if tablets do not help or are not suitable, there are devices, injections and surgery (nhs.uk, BAUS).

Exercise and lifestyle

The NHS advises losing weight if you are overweight, stopping smoking, eating a healthy diet, exercising daily and trying to reduce stress, and NHS inform notes that exercising too often or not enough can affect erectile dysfunction. Neither NHS page sets out specific exercises for erections.

Tablets

The NHS lists four PDE5 inhibitors: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). They work by increasing blood flow to the penis when you are sexually aroused.

We supply these after a consultation reviewed by a GPhC-registered pharmacist:

• Sildenafil: the medicine in Viagra, taken when needed
• Tadalafil: the medicine in Cialis, taken when needed
• Tadalafil Daily: a lower dose of tadalafil, taken once a day
• Vardenafil: the medicine in Levitra, taken when needed
• Avanafil (Spedra®): taken when needed

Two branded tablets are pharmacy medicines, which a pharmacy can supply without a prescription: Viagra Connect® (sildenafil 50mg) and Cialis Together® (tadalafil 10mg). We supply them after a pharmacist consultation to men aged 18 to 64 with erection problems. How they compare with prescription tablets is in Viagra Connect vs prescription sildenafil.

How the tablets differ is in sildenafil vs tadalafil, how sildenafil works on our sildenafil page, and timing in how long does sildenafil last. Each one has its own side effects, listed in its product information. Less common side effects are listed in the leaflet in your pack. Please read it before your first dose.

If tablets do not work or are not suitable

A tablet often needs several tries, so tell your pharmacist if it has not worked yet. When tablets do not help, cause side effects or cannot be used, BAUS says a GP can refer you to a specialist erectile dysfunction clinic, where the options include injections into the penis, a small pellet placed in the tip of the penis (MUSE), vacuum pumps and, when all other treatments have failed, an implant. The NHS says vacuum pumps are not always available on the NHS.

Can you get erectile dysfunction treatment on the NHS?

Yes. A GP or a sexual health clinic can assess erectile dysfunction and prescribe treatment on the NHS (nhs.uk). In England, generic sildenafil, tadalafil and vardenafil can be prescribed on the NHS for erectile dysfunction, while the brands Viagra, Cialis and Levitra, and avanafil and alprostadil, are restricted to men in certain groups (Drug Tariff, Part XVIIIB, October 2026).

Under those rules, the restricted medicines can be prescribed on the NHS for erectile dysfunction to men who, for example:

• have diabetes, multiple sclerosis, Parkinson's disease, prostate cancer, spina bifida or a spinal cord injury
• are having dialysis for kidney failure
• have had an operation to remove the prostate, radical pelvic surgery or a kidney transplant

So you can get the medicine in Viagra on the NHS as generic sildenafil, if your GP agrees it suits you. Vacuum pumps and constrictor rings are restricted on NHS prescriptions too (Drug Tariff).

Prescriptions in England cost £9.90 per item as of October 2026 (nhs.uk), unless you qualify for free prescriptions: the NHS has an online checker. Prescriptions are free in Scotland (NHS inform), and in Wales for people registered with a Welsh GP who collect from a pharmacy in Wales (Welsh Government).

You can also see a pharmacist or doctor privately, in person or online, and pay for the treatment. With us, a GPhC-registered pharmacist reviews your consultation, we tell your GP only if you agree (Will you tell my GP?), and orders come in plain packaging (Is the packaging discreet?). If you would rather use the NHS, your GP is the place to start.