Erectile Dysfunction

What is Erectile Dysfunction?

Erectile Dysfunction (ED, Male impotence) is a sexual dysfunction characterised by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.

Erectile dysfunction is a common problem which occurs more frequently with advancing age, diabetes and following radical prostatectomy.

Whatever the cause of it, effective treatments are available.

It is a common condition particularly in those over 40 or with certain medical conditions such as diabetes, or those patients who have had a radical prostatectomy.

Most men occasionally fail to get or keep an erection, this is usually due to stress, tiredness, anxiety or drinking too much alcohol and it is nothing to worry about. If it happens more often there may be underlying physical or emotional problems and it is important that a patient seeks medical advice rather than just buying medications over the internet.

This is because erection problems can be the first sign of underlying vascular disease for example due to high cholesterol, high blood pressure, undiagnosed diabetes or due to testosterone deficiency.



The Leger Clinic will obviously check for all these conditions and treat or refer as necessary.

Treatment for ED. Everyone has heard of Viagra, nowadays called by its generic name Sildenafil but there are other tablets available which may suit the patient better.

For patients with more severe Erectile Dysfunction or those that cannot take the tablets because they are on certain tablets for their heart condition, there are other treatments available: one to particularly mention is an injection which is self-administered by the patient or his partner, called Invicorp. It is highly effective and virtually painless. It is particularly useful for those patients who have severe Erectile Dysfunction following radical prostatectomy or those with type 2 diabetes where tablets are often ineffective.

For instructions on how to administer Invicorp please follow this link

Remember if you are a diabetic and have failed to get an adequate response to tablets then this may be due to testosterone deficiency and it will be suggested that you get a testosterone blood test.

Erection Difficulties

Difficulties with erections are incredibly common. It is estimated anywhere between 15 to 30% of men suffer from difficulties with erections. Erection difficulties become more common with age although in one study, 1 in 4 men seeking help with erections was under 40.  

The Definition of Erectile Dysfunction 

Erectile dysfunction is characterised by an inability or marked reduction in the ability to attain or sustain an erection which is hard enough or lasts long enough to allow for sexual activity. These difficulties happen despite a desire for sex and adequate sexual stimulation, and happen over a period of several months, and are associated with distress.  

Erectile Dysfunction and other problems 

Often erectile dysfunction is associated with other sexual problems such as loss of sexual desire, premature ejaculation or sexual difficulties in a partner. Being aware of and screening for these other difficulties is important as sometimes erectile difficulties happen as a consequence of premature ejaculation or a partner’s sexual difficulties, and treating the erectile dysfunction alone is missing the bigger picture. 


Psychological, social, relationship and situational factors 

Many men at some point have an episode where they have difficulty with erections, this can often be situational. Alcohol, stress, financial difficulties, anxiety and relationship difficulties can all have a significant impact on libido and erections. Social and cultural factors such as beliefs about erections and sex, religious and moral beliefs can also have a big impact on sexual desire and erections.  

With a resolution of situational factors – not drinking alcohol, or a reduction in stress or anxiety, a change in relationship dynamics, often erections return. However for some men, there are persistent difficulties with erections that don’t improve or gets worse over time. Sometimes this is still psychological in nature. There can be a loop of increasing stress and anxieties about erections leading to an avoidance of sexual activity, being less in the moment and a reduction in sexual pleasure which in turn makes erections less likely. But significant medical causes also need to be investigated. 

Medical causes 

There are many medical causes of erectile dysfunction and so it is important for men to see a physician to investigate possible causes, including: 

  • Cardiovascular disease, including high blood pressure, high cholesterol, coronary artery disease 
  • Diabetes 
  • Low testosterone 
  • Medication causing problems such as antidepressants, blood pressure medications, medications for hair loss, painkillers and antihistamines to name a few  
  • Hormone disorders involving the pituitary or thyroid 
  • Obesity and Sleep apnoea 
  • Cancer and treatments related to cancer 

Of crucial importance is that for men over 40, persistent erectile difficulties can be the first or only sign of cardiovascular disease, and predict a later risk of heart attack or stroke. With proper investigation and treatment, the risk of heart attack or stroke can be prevented.  


There are multiple treatments which can help with erectile difficulties, both for those with underlying medical conditions and those with stress, psychological or relationship related erectile dysfunction. 

Non-medical treatments: 

Lifestyle changes 

There is evidence that increasing aerobic activity (for example walking or running) decreases the risk of erectile dysfunction. Strength based exercise can increase your testosterone significantly, which can in turn improve erectile difficulties.   

Many causes of erectile difficulties such as high blood pressure, cholesterol, diabetes and low testosterone are related to obesity and so weight loss can significantly improve both erectile dysfunction and underlying medical conditions. 

Sex & Relationship Therapy 

For both those with and without underlying medical conditions exploring your difficulties with a sex and relationship therapist can be an important part of treatment. Beliefs we hold about sex, erections, your past and current experiences of sex and any relationship difficulties you might be having can have a big impact. You can find a list of psychosexual therapists as part of the Leger Clinic here (LINK) 

Medical Treatments 

Treatment of underlying disease, including high blood pressure, cholesterol & diabetes. 

Treatment of low testosterone (also known as hypogonadism).  

A large number of men with low testosterone are inadequately treated. Without treating the underlying low testosterone, men will struggle to regain sexual function.

Tablets such as PDE5 inhibitors.  

Examples are sildenafil (Viagra) and tadalafil (Cialis). These can be used an hour or two before sexual activity, or tadalafil can be used as a daily pill, taken once a day, which removes the need to predict timing of sex. There is increasing evidence that PDE5 inhibitors are helpful for a range of conditions, including Benign Prostatic Hypertrophy (BPH) as well as possibly improving the risk of cardiovascular disease.  

Penile injections such as Invicorp.  

For those who don’t respond to oral medication, there are other options available, usually for men with diabetes or severe cardiovascular disease or nerve damage.  

  1. Penile pumps also known as Vacuum Constriction Devices. These use a vacuum to pull blood into the penis. A band is then applied at the bottom of the penis to trap blood in the penis and maintain an erection 
  1. Penile Prosthesis. For men with extensive nerve damage, for example after radical prostatectomy for prostate cancer, surgical insertion of a penile prosthesis is an option to regain erectile function. 

In summary, there are lots of different causes of erectile dysfunction. Seeing a doctor who specialises in sexual medicine is important to help work through what the cause might be.  

The good news is that there are lots of different treatments available. Everyone has the right to a satisfying sexual life, whatever their medical history or age. At the Leger Clinic we have an expert team who can help you navigate what treatment is right for you whatever the cause.   

The Leger Clinic