Erectile dysfunction is very common, particularly in men over 40, and treatment can usually help. The NHS is direct about it: an occasional problem is usually nothing to worry about, but if it keeps happening it is worth seeing a doctor, because it can be a sign of a treatable health condition.

That last point is the one most worth carrying away. Persistent ED is not only a problem in itself. It can be the first visible sign of something in the circulation, which is why the sensible first step is a doctor who can check your blood pressure and general health, rather than a shortcut to a tablet.

Key takeaways

  • It is very common and usually treatable, and becomes more common with age.
  • An occasional off night is normal. It is the persistent pattern that warrants attention.
  • Persistent ED can point to another condition, including high blood pressure, high cholesterol or diabetes.
  • The main medicines are PDE-5 inhibitors: sildenafil, tadalafil, vardenafil and avanafil. They increase blood flow and they are prescription medicines.
  • Never combine a PDE-5 inhibitor with nitrates. The sildenafil label states that giving it to patients using organic nitrates in any form is contraindicated, because it potentiates their blood-pressure-lowering effect.
  • Some medicines cause ED as a side effect, and switching may be an option.
  • Find the medicine by active ingredient, since the brand on the shelf here may not be the one you know.
  • These are among the most counterfeited medicines in the world. Source matters as much as the molecule.

Is erectile dysfunction common, and can it be treated?

Yes to both. ED means being unable to get an erection, or unable to keep one long enough for sex. The NHS describes it as very common, particularly in men over 40, and states that treatment can usually help improve it.

Most men occasionally fail to get or keep an erection, and that is usually caused by stress, tiredness or drinking too much alcohol. It is not a medical problem and it does not need treating.

Depending on the cause, you may still get erections at other times, such as on waking. That detail is clinically useful, because it points towards a psychological rather than a physical cause, and it is worth mentioning to a doctor.

Why should I see a doctor rather than just buy a tablet?

Because persistent ED can be a sign of a health condition that can be treated, and because the assessment is quick.

The NHS lists conditions that can cause recurrent ED, and the list is cardiovascular and metabolic: high blood pressure, high cholesterol, diabetes. The blood vessels involved in an erection are small, so they can show a problem before larger arteries do.

The assessment is not invasive. A doctor will do basic health checks such as taking your blood pressure, and examine to rule out an obvious physical cause. If you have urinary symptoms such as needing to pee more often than usual, a prostate examination may be included.

There is a second reason. ED can be a side effect of some medicines, and a doctor may simply switch you to a different one. That possibility disappears entirely if you self-treat, and it is a common and easily missed cause.

Related note for this region: because high blood pressure is largely symptomless, some men find out about it at exactly this appointment. That is a good outcome, not a bad one. We cover the condition in high blood pressure in the UAE.

What are the treatments?

Mainly PDE-5 inhibitor tablets, with other options where those are unsuitable.

PDE-5 inhibitors. The NHS describes these as the main treatment: medicines that increase blood flow to the penis. They are sildenafil, tadalafil, vardenafil and avanafil. They differ in how quickly they act and how long they last, which is the main reason one may suit you better than another. They are prescription medicines, and which one fits is a clinical decision that takes account of your other medicines and conditions.

An important point about how they work: they support the normal response to arousal rather than replacing it. They are not an aphrodisiac, and expecting one leads people to conclude a correctly prescribed medicine has failed.

Alprostadil. A different mechanism, used where tablets are unsuitable or have not worked.

Vacuum pumps. These encourage blood flow mechanically. The NHS notes they work for most men and can be used where medicine is not suitable or does not work.

Treating the cause. Where ED is caused by another condition or by a medicine, addressing that is the more durable answer.

What is the one interaction I must know about?

Nitrates. Do not take a PDE-5 inhibitor if you take nitrates in any form.

This is the most important safety fact in the whole subject. The sildenafil label lists administration to patients using nitric oxide donors, such as organic nitrates or nitrites in any form, as a contraindication, and states that sildenafil was shown to potentiate the hypotensive effect of nitrates. The tadalafil label is equally explicit: administration to patients using any form of organic nitrate is contraindicated.

Nitrates are used for angina and chest pain, and they come in several forms including tablets, sprays and patches. Both labels also note that these medicines can potentiate the blood-pressure-lowering effects of alpha blockers and antihypertensives.

The practical rule: tell any doctor prescribing for ED about every medicine you take, including ones from another country, and never take a PDE-5 inhibitor that was prescribed for someone else. The person it was prescribed for was assessed. You were not.

Why can I not find the brand I know?

Because brand names are assigned market by market while the active ingredient does not change.

Someone arriving from the UK, Europe, India or the Philippines may look for a familiar name and not find it. The reliable habit is to read the active ingredient on the pack. Sildenafil is sildenafil under every brand that contains it.

Our erectile dysfunction category lists what is stocked here by ingredient, and the ingredients index maps ingredients to the brands containing them.

How do I avoid counterfeits?

Buy from a licensed source, and treat an unusually easy purchase as a warning rather than a convenience.

ED medicines are among the most counterfeited pharmaceutical products in the world, for obvious reasons: high demand, high price, and buyers who would often rather not have the conversation. That combination attracts fakes, and a counterfeit tablet may contain the wrong dose, a different drug, or nothing at all.

Practical checks:

  • Buy from a licensed pharmacy, not a market stall, a gym contact, a hotel supplier or a spam email.
  • A legitimate pharmacy, online or physical, should disclose who dispenses, where it is licensed, and whether a prescription is required.
  • Be sceptical of a seller who requires no prescription for a prescription-only medicine. That is not discretion, it is a signal about everything else.
  • Check the pack: the active ingredient and strength should be stated clearly, with a batch number and expiry date.
  • Distrust prices far below the market. There is a reason for them.

The discretion argument cuts the other way from how it is usually presented. A proper consultation is confidential. An informal purchase is the one where nobody knows what you actually took.

What can I change myself?

Weight, smoking, alcohol and, for some, cycling.

The NHS lists healthy lifestyle changes that can sometimes help: losing weight if you are overweight, stopping smoking, and reducing alcohol. It also suggests not cycling for a while if you cycle more than three hours a week, which is a specific and easily overlooked cause.

None of this replaces assessment where ED is persistent. It addresses contributing factors, which is worth doing regardless of what else is decided.

Do and don’t

Do:

  • See a doctor if erection problems keep happening.
  • Tell the prescriber every medicine you take, including from abroad.
  • Match medicines by active ingredient rather than by brand.
  • Buy only from a licensed pharmacy that discloses who dispenses.
  • Mention if you still get erections at other times, such as on waking.
  • Ask whether an existing medicine could be the cause.

Don’t:

  • Don’t take a PDE-5 inhibitor if you take nitrates in any form.
  • Don’t take a tablet prescribed for someone else.
  • Don’t buy from informal sellers or unusually cheap sources.
  • Don’t assume an occasional off night means anything.
  • Don’t ignore persistent ED as merely embarrassing, since it can be a signal.

Frequently asked questions

Do these medicines work immediately? They support the normal response to arousal rather than producing an erection on their own, and they differ in onset and duration. That difference is one of the main reasons a prescriber picks one over another, and it is worth asking how the one you are given is meant to be timed.

Is ED just part of getting older? It becomes more common with age, but common is not the same as inevitable or untreatable. The NHS position is that treatment can usually help.

Can I get treatment without an in-person examination? That depends on the service and on your medical history. What should not be skipped is a review of your other medicines and conditions, because that is where the nitrate contraindication and the blood-pressure question are caught.

Where to go next

The erectile dysfunction category is our second largest, and lists what is stocked here by active ingredient. The ingredients index is the place to start if you are matching a brand from another country.

MedicForce option: our ED listings are organised by active ingredient and strength, so you can identify exactly what you were prescribed elsewhere. See how to buy for what we require.