Key takeaways

  • See a doctor when erection problems keep happening. High blood pressure, high cholesterol, diabetes, hormone problems, depression and anxiety are among the possible causes. NHS
  • ED is common, particularly over 40, and treatment usually helps. An occasional episode linked to stress, tiredness or too much alcohol is usually nothing to worry about. NHS
  • The assessment includes medicines and general health. A doctor or nurse may ask about lifestyle and relationships, check blood pressure and examine the genitals. NHS
  • PDE-5 inhibitors increase blood flow to the penis. NHS examples are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). NHS
  • A vacuum pump may be an option when medicine is unsuitable or fails. The NHS says pumps work for most men. NHS
  • Online packs may vary in what they contain. The NHS warns about fake ED medicines and recommends discussing suitability with a doctor who knows your history. NHS

Nitrate tablets, sprays and patches must not be combined with sildenafil, tadalafil or another PDE-5 inhibitor. Bring every medicine name to the prescriber, including ones obtained abroad. Persistent ED can be an early circulation warning as well as a problem in itself.

Is erectile dysfunction common, and can it be treated?

ED is common and usually treatable. It 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. Becoming more common with age does not make it inevitable or untreatable.

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.

The NHS notes that some people also have low sex drive, while others can still get erections at times such as waking. Tell the clinician about that pattern, which points towards a psychological rather than physical cause. Expect questions about lifestyle and relationships as well as health checks. NHS

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 starts with basic checks such as blood pressure and examination for an obvious physical cause. The NHS names a genital examination and, if you are passing urine more often than usual, a possible rectal prostate examination. NHS

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.

High blood pressure is usually symptomless, so this appointment can uncover it. The NHS distinguishes readings of 140/90 or higher taken by a healthcare professional from 135/85 or higher at home, and describes repeated measurements or a 24-hour portable monitor to confirm a result. NHS blood-pressure guide See 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; ask the prescriber how to time the one you are given. 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 encourage blood flow and work for most men, according to the NHS. They can be used when medicine is unsuitable or has not worked. Its guide also describes treating high blood pressure, cholesterol or hormone problems, switching a medicine that causes ED, or counselling for emotional and mental-health problems. The cause still needs addressing. NHS

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. A proper consultation is confidential. With an informal purchase, nobody knows what you actually took.

The NHS warns that ingredients in online medicines can vary from one pack to another. It recommends a doctor who knows your history before buying online. For UK online services, its checks are separate: the pharmacy with the General Pharmaceutical Council, the doctor service with the Care Quality Commission, and the doctors with the General Medical Council. Those are UK checks, not UAE licences. NHS

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:

  • Arrange a review for persistent ED. Mention erections on waking, urinary symptoms and any medicine that might be causing it.
  • Bring every medicine name, including foreign brands. Match the active ingredient: sildenafil, tadalafil, vardenafil and avanafil are different choices, with different timing.
  • Check who dispenses, where they are licensed and whether a prescription is required. Read the ingredient, strength, batch number and expiry on the pack; unusually easy purchases that bypass prescription checks are a warning.
  • Work on weight, smoking, alcohol and stress alongside treatment. The NHS also recommends a healthy diet and daily exercise. NHS

Don’t:

  • Combine a PDE-5 inhibitor with nitrates, whether tablets, spray or patches. Tell the prescriber about alpha blockers and other blood-pressure medicines too.
  • Use somebody else’s prescription, or buy from a market stall, gym contact, hotel supplier or spam email. An unusually low price needs scrutiny.
  • Treat one off night as a diagnosis, or dismiss a persistent problem because discussing it feels embarrassing.
  • Assume a normal-feeling day rules out high blood pressure. NHS guidance uses 140/90 in a healthcare setting and 135/85 at home; a clinician interprets the readings. NHS

Frequently asked questions

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 can I match a medicine prescribed abroad?

Match the active ingredient and strength on the prescription.

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.