The bigger picture

ED – defined by the British Society for Sexual Medicine as “the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance” – is very common: around half of all men between the ages of 40 and 70 years will suffer it to some degree. It is considered a symptom rather than a condition in its own right, and as such is sometimes the first sign of a problem such as diabetes or hypertension.

Other causes include psychological or emotional issues such as relationship or mental health problems, conditions of the nervous system such as multiple sclerosis and Parkinson’s disease, structural abnormalities of the penis, and hormonal imbalances such as thyroid disorders. 

ED can also be the result of a medicine; as well as antihypertensives, drug classes that list the problem as a potential adverse effect include diuretics, fibrates, antipsychotics, antidepressants, lithium, H2-antagonists, hormones and hormone-modifying agents, statins, proton pump inhibitors, cytotoxics, anti-arrhythmics and anticonvulsants.

Lifestyle changes such as losing weight, stopping smoking, reducing alcohol consumption and increasing activity levels (except cycling, as more than three hours per week has been shown to be implicated in ED due to restriction of blood flow to the genital area) can make a difference, but drug treatment also has a place.

Phosphodiesterase-5 (PDE-5) inhibitors are usually first choice, except for men with unstable heart disease, heart rhythm problems or heart failure, or who have recently had a heart attack. Contrary to popular belief, most men with cardiovascular conditions can use medicines in this class to safely resume sexual activity.