Let’s talk about... erectile dysfunction

Two pairs of feet in bed

We explain what erectile dysfunction is, the causes of it, the links with heart and circulatory diseases and how to treat it.

Erectile dysfunction (ED), or impotence, is when a man has difficulty getting or maintaining a strong enough erection for sexual intercourse or other sexual activity. It can be caused by stress, anxiety or excessive alcohol consumption. But it can also be a symptom of an underlying condition such as atherosclerosis (narrowing of the arteries), diabetes or high blood pressure. Some medications can cause erectile dysfunction, for example beta-blockers and diuretics (commonly used to treat a variety of heart-related conditions such as high blood pressure and heart failure).

Why is erectile dysfunction as a warning sign for heart disease?

During an erection, the arteries carrying blood to the penis dilate and more blood flows into the penis, causing it to swell. 

If arteries in the body are affected by atherosclerosis, this causes a reduction in the blood flow, which can mean problems getting or maintaining an erection.

Atherosclerosis increases your risk of heart attack. Because the arteries in the penis are so narrow, erectile problems can be one of the first warning signs.

It’s crucial that any underlying medical condition, such as angina or diabetes, is detected. So if you’re experiencing problems with ED, book an appointment with your doctor. He or she will assess and examine you to try to establish the cause of the problem, and may refer you for tests. Don’t take any medicine for ED without first discussing it with your doctor.

What are the treatments for erectile dysfunction?

Man talking to a doctor

Medicines known as PDE5 inhibitors can help two-thirds of men with ED. These include Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil). You may need to take several doses over time before they work properly, and you may need to adjust the dose. National guidelines say you can be prescribed these drugs from six months after a heart attack, providing your condition is stable.

Another erectile dysfunction treatment is a hormone called alprostadil, which is applied as an injection or a pellet placed inside the man’s urethra (the tube that travels through the penis.

A non-drug treatment is a vacuum pump – these may take some practice, but are usually very effective.

    Is there anyone who shouldn't take Viagra and other PDE5 inhibitors?

    PDE5 inhibitors aren't recommended for people with low blood pressure, as they dilate the arteries, making the blood pressure even lower.

    If you suffer from angina or are waiting for treatment to relieve your symptoms, such as a stent or bypass surgery, your shouldn't take these drugs. That's because sexual activity may increase the likelihood of you experiencing chest pain (angina), and you shouldn't take nitrates (GTN) to treat your angina if you have taken PDE5 inhibitors.

    Can you take Viagra and PDE5 inhibitors if you are taking heart medications?

    They can be taken with most medicines for your heart, but not nitrates (GTN) or nicorandil, which are used to treat angina. You should leave at least 12 hours between taking a PDE5 inhibitor and using your GTN spray, or if you take nitrate tablets, allow at least 24 hours (48 hours for Cialis).

      What about side effects?

      Side effects of PDE5 inhibitors may include indigestion and headache, and sometimes muscle aches, flushing, low-back pain, and rhinitis (a runny nose).

        Do you need a prescription to get Viagra?

        Branded Viagra can now be bought over the counter in pharmacies, but please check with your GP first if you have a medical condition. It's important to use a reputable pharmacy, as there is a large market in counterfeit drugs for erectile dysfunction, especially over the internet. These contain varying amounts of the active ingredient and sometimes completely different drugs.

        Bear in mind that if you are over 60 or have one of a list of conditions that includes diabetes, you are entitled to free prescriptions on the NHS (in England - prescriptions are free for everyone in Wales, Scotland and Northern Ireland).

        More useful information