Erectile Dysfunction
Treatment

Erectile dysfunction (ED), or impotence, is the ongoing difficulty in achieving or maintaining an erection firm enough for sexual intercourse. While most men experience occasional difficulties, ED is diagnosed when the issue is persistent and causes distress. It may be the result of underlying physical health conditions, psychological issues, or a combination of both. ED can affect your confidence, relationship, and overall quality of life — but it is treatable.

ED is extremely common. Studies show:

• Around 52% of men aged between 40 and 70 experience some form of ED.
• 40% of men at age 40 are affected; this increases to 70% by age 70.
• ED also affects younger men: around 2.3% of men at age 30 experience it.
• Globally, over 150 million men are affected.

Many men don’t speak up due to embarrassment, but ED is a medical condition — and help is available.

ED can result from physical, psychological, medicinal, or lifestyle-related causes:

Physical causes:

• Reduced blood flow (e.g. high blood pressure, diabetes, heart disease)
• Nerve damage (from surgery, spinal injury, or neurological diseases like MS or Parkinson’s)
• Hormonal imbalances (low testosterone, thyroid issues, high prolactin)
• Penile disorders (e.g. Peyronie’s disease)

Psychological causes:

• Performance anxiety, stress, or low self-esteem
• Depression, unresolved trauma, or relationship tension
• Loss of sexual attraction (though less common)

• Difficulty achieving or maintaining an erection
• Erections not firm enough for penetration
• Needing more stimulation than usual
• Erections that fade during intercourse
• Decrease in sexual desire (libido)

Some men notice a delayed response to arousal, or loss of firmness with specific partners. Others may have erections while asleep or during masturbation, but not during partnered sex — a key indicator of psychological ED.

Diagnosis typically starts with:

• A discussion of your symptoms and sexual history
• Review of medications and general health
• Blood pressure, glucose, cholesterol, and hormone testing (testosterone, prolactin)
• Optional home testing kits (e.g. testosterone, diabetes markers)

A GP may also perform a physical exam or refer you for further urology or cardiology checks depending on symptoms.

Oral ED medications (PDE5 inhibitors):

• Sildenafil (Viagra / generic) – 25mg, 50mg, 100mg
• Tadalafil (Cialis / generic) – 2.5mg (daily), 10mg, 20mg
• Vardenafil (Levitra / generic) – 10mg, 20mg
• Avanafil (Spedra) – 50mg, 100mg, 200mg

These increase blood flow to the penis but require sexual arousal to work.

Other treatment options:

• Vitaros (alprostadil cream): topical option for men who cannot take tablets
• Vacuum pumps: non-medicinal, draw blood into the penis using suction
• Counselling / CBT: helpful where stress, anxiety, or trauma is involved
• Hormone replacement: if ED is due to low testosterone
• Penile implants / surgery: rare, for complex cases only