Erectile Dysfunction: Causes and the Steps of Treatment

Yes, it can, and that is the most important message on this page. The vessels supplying the penis are narrower than those feeding the heart, which is why hardening of the arteries often shows itself here first. For that reason, in a man with difficulty achieving erections, glucose, blood pressure, cholesterol and cardiovascular risk must all be assessed.

Whether the difficulty began suddenly or gradually, whether it varies with the situation and whether morning erections continue all give important clues. In most men, however, the two sit side by side; the attitude of "it is all in your head" is wrong and delays treatment.

Yes. Some blood pressure tablets, antidepressants and prostate medicines can affect erections. That is why every medicine you take is reviewed. Sometimes the answer is not to add a new drug but to change an existing one — do this with your doctor, never on your own.

You have. But first it is worth checking: was the dose adequate, was it taken at the right time and was there sexual stimulation? These tablets do not work without stimulation, and incorrect use is a common reason for an inadequate response. If there really is no response, a vacuum device, injection treatment and the prosthesis option are discussed.

It is only meaningful if testosterone is genuinely low and there are symptoms to match. Giving testosterone to a man whose level is normal does not resolve the difficulty; it also carries risks of its own and can affect fertility adversely. For this reason, treatment is not started without a morning testosterone measurement.

Studies of low-intensity shock wave therapy are continuing and it has been found promising in some groups of men. The level of evidence, however, is not yet settled; in whom, to what degree and for how long the effect appears has not been clearly defined. If this treatment is offered to you, it should be presented not as a standard and guaranteed solution but as an option whose evidence is still developing.

These applications are NOT established, proven treatments for erectile dysfunction. They are at the research stage. We would advise caution towards approaches that present them as a definitive solution and charge a high fee for them. The proven steps should be worked through first.

No. A significant proportion of products sold online are counterfeit; what they contain is unknown, the dose is uncontrolled and they pose a serious health hazard. If you take heart medication in particular, this carries a risk to life. Medication must be obtained following a doctor’s assessment and from a pharmacy.

Yes, and this is the most neglected step. Stopping smoking, losing weight, regular exercise and control of diabetes and blood pressure benefit both erectile function and the health of the blood vessels generally. If this step is skipped, the response to the other treatments is poorer as well.

Yes, it is the final step of the stepwise approach. For men who gain no benefit from the other treatments it offers a reliable and lasting solution. But because a device is placed in the place of the natural erectile tissue, it is irreversible; the decision is therefore not rushed and is discussed in detail.