Erectile dysfunction
WHAT IS ERECTILE DYSFUNCTION?
Erectile dysfunction (ED) is the term used to describe the difficulty of getting and maintaining an erection firm enough for sex. Although men are more likely to experience ED as they get older, most will experience it at some point in their lives. While this can be a short-term condition caused by things like alcohol, stress, or tiredness, some men will experience erectile dysfunction over a longer period of time. This can be due to a physical or emotional cause. If you’ve regularly been experiencing erectile dysfunction, please speak to a pharmacist or your GP.
Not all men experience the symptoms of erectile dysfunction in the same way. Some men can’t get an erection at all, some men lose their erection before sex, and others can’t get an erection hard enough for sex. If you can’t get or keep an erection long enough for sex, you’re experiencing erectile dysfunction. You aren’t alone; 4.3 million men in the UK have experienced erectile dysfunction symptoms.*
NOTE: This article/page uses the terms ‘male/man/men’ and/or ‘female/woman/women’. Please note, this is in reference to the sex assigned at birth.
CAUSES OF ED & WAYS TO MANAGE IT
Erectile dysfunction (ED) can be caused by a range of factors that may impact the ability to get an erection. Small blood vessels supply the penis, and when a man is sexually aroused, an increase in blood flow into the penis causes it to stiffen. ED can happen if these vessels are blocked in any way. Because the vessels are so thin, blockages can occur easily. This can happen due to things like smoking, high cholesterol and lack of exercise. ED symptoms could also be linked to emotional or psychological causes, such as anxiety or depression and, at times, may be a side effect of being on certain medication.
In order to keep an erection, blood needs to flow to your penis. If you have erectile dysfunction (ED), it could mean that the blood vessels in your penis are either narrow or blocked. This can be caused by atherosclerosis, the hardening of the arteries due to fats and cholesterol on the artery walls. Atherosclerosis does not tend to have any symptoms at first and many people may be unaware they have it, but it can eventually cause life-threatening problems, such as heart attacks and strokes. However, the condition is largely preventable with a healthy lifestyle and treatment can help reduce the risk of serious problems happening. If left to worsen, atherosclerosis can lead to a number of serious conditions, such as cardiovascular disease, and there will not usually be any symptoms if this develops. You should see your GP if you experience any cardiovascular disease symptoms, which may include:
- Chest pain
- Confusion, as a result of blood not flowing to your brain
- Difficulty breathing
- Feeling very tired
- Pain in any of your limbs, where there may be a blocked artery
- Weak muscles
High cholesterol
Cholesterol is a fatty substance made in the liver and is present in some foods. When you have too much of a fatty substance called cholesterol in your blood, it can block your blood vessels, including those in the penis. Having high cholesterol can be serious and makes you more likely to have heart problems or a stroke. High cholesterol can be caused by a diet that is too high in fatty food, a lack of exercise, being overweight and smoking or drinking too much alcohol.
There are often no symptoms of high cholesterol. It is diagnosed via a blood test. You should speak to your GP if you are worried about your cholesterol.
High blood pressure
High blood pressure (hypertension) is a leading cause of ED. Men with high blood pressure are nearly twice as likely to have erectile dysfunction and impaired penile blood flow compared to those with normal blood pressure.
If your blood pressure is too high it puts extra strain on your blood vessels, heart and other organs. If your high blood pressure is not controlled it can increase the risk of serious health conditions. High blood pressure can damage blood vessels, including those leading to the penis and may be a cause of ED. Treatment to lower blood pressure can help to reduce the risk of ED.
Lots of men have high blood pressure and aren't aware of it as there are often no obvious symptoms. If you are over 40, do not have a previous diagnosis of high blood pressure and live in England, you may be eligible for the free NHS Blood Pressure Check Service, which is available at selected Boots pharmacies.** Speak to a pharmacist in-store to check whether you are eligible.
Sexual performance anxiety is a type of anxiety which can affect everyone. It’s the fear that you won’t be able to perform sexually or enjoy sex which can lead to erectile dysfunction. Open communication with your partner can help to build trust and understanding in a relationship which can, in turn, support you to overcome worries, such as body confidence, fear of rejection and previous negative sexual experiences.
Other psychological factors
If you have ruled out other causes, stress and anxiety can be common causes of erectile dysfunction (ED). This can be psychological ED, often called performance anxiety, which is seen frequently in younger men and is usually short-lived. ED as a result of personal or professional stress is also very common. It's more likely that ED is related to an emotional problem if you only have erection problems some of the time. For example, you get an erection when waking in the morning but not during sexual activity. Although ED can have physical and psychological causes, in older men, physical causes are more common.
Identifying and managing your triggers of everyday stress, while talking to your partner can help. If you're experiencing everyday stress that is affecting your day to day life, speak to your GP, who, if appropriate, may be able to refer you to counselling and/or cognitive behavioural therapy, to treat anxiety and depression. Alternatively, you may choose to access a mental health service available via Boots Health Hub.***
Erectile dysfunction (ED) is very common in men who have diabetes, with up to 75% of men experiencing it to some degree over the course of their life. Causes of ED in diabetics are complex and linked to changes that occur within the body over time, affecting nerve, muscle and blood vessel functions. ED can also be linked to other conditions common in men with diabetes, such as high blood pressure and heart disease.
Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not have diabetes. While ED is very common, if it is a recurrent issue, it is really important to see a GP to rule out any underlying health problems. This may be your NHS GP or you could choose to access Livi GP.†
Erectile dysfunction (ED) may be caused by decreased levels of testosterone which could be due to an endocrine disorder. Low testosterone can be treated with hormone replacement. If ED persists, you should always speak to your GP to rule out an underlying cause.
Peyronie's disease causes the penis to become curved when it's erect. The condition mostly affects men over 40, but it can happen at any age.
The symptoms of Peyronie's disease include:
- A thickened area or hard lump in the shaft of the penis.
- A curve in the penis when it's erect (usually it curves upwards).
- Pain in the penis, usually during an erection (pain in the non-erect penis is rare).
- The penis looking misshapen, like an hourglass.
- Loss of length or girth of the penis.
- Some men with the condition get pain in their penis, while others get none. If you do get pain, it may get better over time.
Peyronie's disease may lead to erectile dysfunction. If you think you may have this condition or concerned about a lump or bend in your penis, or it's causing problems with sex, you should speak to your GP.
Most people occasionally fail to get or keep an erection and this may be due to stress, tiredness, anxiety or drinking too much alcohol, and it's nothing to worry about.
Drinking more than 14 units of alcohol (around six pints of beer) per week and/or increasing the frequency of alcohol drinking are thought to increase the risk of experiencing erectile dysfunction.
Pelvic floor muscles extend from your pubic bone at the front to your tailbone (coccyx) at the back of your body. Your pelvic floor supports your bladder and bowel, as well as having a role in erectile function during intercourse. It is very common for anyone to experience pelvic floor weakness. Men may experience a variety of symptoms including:
- Leaking urine during activity, for example when you sneeze, cough or laugh (known as stress urinary incontinence).
- A need to go to the toilet repeatedly during the day or night (known as frequency).
- An urgent need to visit the toilet and leaking before you get there (known as urgency incontinence).
- An inability to control the passing of wind or stool from your back passage.
- Erectile dysfunction (the pelvic floor helps you maintain erections).§
People will experience some form of erectile dysfunction (ED) at some point in their lives. While this can be a short-term condition caused by things like alcohol, stress, or tiredness, some men will experience ED over a longer period of time.
The symptoms of ED can be treated in different ways. Some people, for example, find that symptoms of ED improve or disappear when they change their diet or start an exercise regime. If there is no underlying cause, and lifestyle changes have not helped relieve the symptoms of ED, you may want to consider medicine.
There is a range of tablets including, Viagra Connect® and Sildenafil which can be used to treat ED, with the active ingredient in these treatments being sildenafil citrate. Sildenafil citrate is suitable for men over the age of 18 years who have difficulty getting and keeping an erection firm enough for sex.
The same medication won’t necessarily work for everyone. your GP may prescribe you a treatment, if it is appropriate for you. Alternatively, you may wish to buy your treatment over the counter from pharmacies either in-store or online, subject to a consultation to assess suitability.
Boots has a dedicated Erectile Dysfunction Service‡ via Boots Online Doctor, which provides access to advice and, if appropriate, treatment for ED.
As an alternative to taking tablets for ED, you may wish to consider a topical product. Speak with a GP to discuss the treatment options if you'd like to consider an alternative to taking tablets.
Compare Products
- Drug
- Find out more
- Strength
- When to take
- How long does it last?
- Subscription options available?
- Price
- Pack size and bundles available
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Cialis Together
- Tadalafil
- FIND OUT MORE
- 10mg tablet
- At least 30 minutes prior to sexual activity.
- Effective for up to 36 hours. This does not mean that you will maintain an erection for 36 hours.
- No
- From £4.75 per tablet
- 4 tablets, 8 tablets
-
Cialis
- Tadalafil
- ONLINE DOCTOR
- 10mg tablet, 20mg tablet
- At least 30 minutes prior to sexual activity.
- Effective for up to 36 hours. This does not mean that you will maintain an erection for 36 hours.
- No
- From £9.19 per tablet
- 4 tablets, 8 tablets, 16 tablets
-
Cialis Daily
- Tadalafil
- ONLINE DOCTOR
- 2.5mg tablet, 5mg tablet
- Tablet taken daily
- For daily use.
- No
- From £2.38 per tablet
- 28 tablets, 56 tablets, 84 tablets
-
Eroxon Gel
- N/A (treatment gel)
- FIND OUT MORE
- N/A
- At least 10 minutes prior to sexual activity.
- Eroxon lasts long enough for succesful intercourse to occur in up to 65% of people, and will naturally subside after intercourse.
- No
- From £6.25 per tube
- 4pack, 8pack, 12pack
-
Boots Sildenafil
- Sildenafil
- FIND OUT MORE
- 50mg tablet
- At least 1 hour prior to sexual activity.
- Effective for up to 4 hours
- No
- From £3.04 per tablet
- 4 tablets, 8 tablets, 12 tablets, 24 tablets
-
Sildenafil
- Sildenafil
- ONLINE DOCTOR
- 25mg tablet, 50mg tablet, 100mg tablet
- At least 1 hour prior to sexual activity.
- Effective for up to 4 hours
- Yes
- From £1.88 per tablet
- 4 tablets, 8 tablets, 16 tablets
-
Viagra Connect
- Sildenafil
- FIND OUT MORE
- 50mg tablet
- At least 1 hour prior to sexual activity.
- Effective for up to 4 hours
- No
- From £4.58 per tablet
- 2 tablets, 4 tablets, 8 tablets, 12 tablets, 24 tablets
-
Viagra
- Sildenafil
- ONLINE DOCTOR
- 25mg tablet, 50mg tablet, 100mg tablet
- At least 1 hour prior to sexual activity.
- Effective for up to 4 hours
- Yes
- From £3.44 per tablet
- 4 tablets, 8 tablets, 16 tablets
-
Tadalafil
- Tadalafil
- ONLINE DOCTOR
- 10mg tablet, 20mg tablet
- At least 30 minutes prior to sexual activity.
- Effective for up to 36 hours. This does not mean that you will maintain an erection for 36 hours.
- Yes
- From £2.50 per tablet
- 4 tablets, 8 tablets, 16 tablets
Erectile dysfunction (ED) is more common in people who are overweight, obese or have a waist measurement higher than 92cm (37 inches). Losing weight and/or reducing your waist size has been found helpful to reduce ED.
Following a healthy diet has been found to reduce ED. Eating a healthy diet, such as the Mediterranean diet, has been linked with having more flexible arteries and heart health, and can support healthy weight loss.
The most important factor though is to find a dietary pattern that you are happy to follow, that can help you lose weight. If you need some additional support with losing weight you may wish to speak to your GP. You may also consider accessing the Boots Online Doctor Weight Loss Service.‡
Smoking has been linked to an increased risk of developing erectile dysfunction (ED). Stopping smoking may improve the symptoms of ED and has many other health benefits too.
If you would like help quitting smoking, speak to a member of the pharmacy team who can advise whether the pharmacy offers a locally commissioned stop smoking service and advise on nicotine replacement therapy (NRT) products which may be suitable for you. You may consider the Boots Online Doctor Stop Smoking Treatment Service‡ which can help you get advice and treatment to help you stop smoking.
A vacuum pump is pump is a cylindrical device that is placed over the penis which encourages blood to flow into the penis by removing air from the cylinder. This is not a cure for erectile dysfunction, but can have a positive effect for most by helping increase your ability to have sexual intercourse.
Constriction rings are rings that go around the penis and/or scrotum. These help making erections harder and last longer by slowing the blood flow out of an erect penis.
If you can get an erection, you may use a constriction ring on its own. Alternatively, you may use a vacuum pump to help you reach an erection and place the constriction ring to enable it to last longer.
You may be able to access a vaccuum pump and/or constriction ring from your GP - this may be your NHS GP or you could choose to book an appointment via Livi GP.**
Men's health servies
Products for erectile dysfunction
LEARN MORE ABOUT ERECTILE DYSFUNCTION
FREQUENTLY ASKED QUESTIONS
There might be some occasions where you aren’t able to get or maintain an erection hard enough for sex. For example, if you’ve been tired or stressed at work for a few days, you might be able to get a suitable erection as soon as things have returned to a calmer state. However, if your erection problems don’t go away and become a regular issue, then it would be best to speak to your GP, to make sure it isn't linked to an underlying health condition.
The ‘blue pill’ or ‘little blue pill’ is the nickname for Viagra Connect®, which is a brand name for the drug sildenafil.
As well as Sildenafil, you can access other treatment options through Boots Online Doctor Erectile Dysfunction Service‡. There are medicines which contain different ingredients to Viagra Connect® and might be less or more suitable for you depending on factors such as how quickly you want the tablets to work, how often you have sex and your health and lifestyle choices.
Erectile dysfunction is also known as impotence, it is the difficulty in getting and maintaining an erection.
Erection problems are very common, particularly in people over 40. It is estimated that half of all people between the ages of 40 and 70 will have it to some degree and/or at some point in their life.
Sildenafil is the generic version of Viagra Connect®, containing the same active ingredient. Because both contain sildenafil citrate as their active ingredient, they work in exactly the same way.
1 Subject to availability. Eligibility criteria may apply. Charges may apply.
2Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
3Subject to availability. Eligibility criteria apply.
Reference: www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
*People reporting occasional and frequent difficulty getting and maintaining an erection (ref. Kantar TNS Omnibus Survey Dec 2010 - in a survey of 1,033 people).
***Eligibility criteria and charges apply.
‡Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
§Reference: https://www.nbt.nhs.uk/bristol-urological-institute/urology-patient-services/urology-patient-information/pelvic-floor-exercises-men
†You must be signed in & have an Advantage Card assigned to your account to be able to shop savings. Normal Advantage Card terms & conditions apply. Excludes in-store orders
The language surrounding sex, gender, and sexuality is always evolving, and different people have different views on the words that should be used. Therefore, we only mention sex, gender or sexuality when it's relevant, such as when providing our customers with the correct health information and treatment they need. We try to follow the NHS guidance for healthcare providers. You can find that here.
‖Estimated from reported Viagra Connect use since launch (Kantar 2019, Viagra Connect onlinebus survey, 1,499 men 35yrs+) & UK male population 35+ yrs VIAC-2022-0263 DOP November 2022
If you or someone you know is experiencing erectile dysfunction symptoms, there's no need to worry - Boots is here to help. By learning more about erectile dysfunction or impotence, you can start to understand the symptoms and causes, what you may be able to treat and when to see your GP. Explore all our advice right here, as well as the erectile dysfunction treatments we offer, available in a discreet and confidential way.
