When a man becomes sexually aroused, his brain sends nerve signals to his penis causing an erection (the nerves increase the blood flow to the penis and the tissue expands and hardens). Erectile dysfunction, sometimes referred to as ED or impotence, is when a man cannot get or keep a firm enough erection to have satisfactory sex. The term can also refer to a lack of sexual desire (a reduced libido). Erectile dysfunction treatment can help men achieve an erection and enjoy sex. Which treatment is best depends on what is causing the problem.
Erectile dysfunction is very common and is thought, in some way, to affect roughly 50% of all men aged 40-70. Erectile dysfunction is very different from issues with ejaculation (for example, premature ejaculation – where arousal, orgasm, and ejaculation happen quickly.)

Erectile dysfunction can be caused by both psychological and physical factors. These can include:
• Psychological: anxiety or stress, depression, relationship difficulties.
• Physical: any problem that relates to the nervous system or to circulation could cause erectile dysfunction, e.g. the narrowing of blood vessels leading to the penis (as a result of high blood pressure, high cholesterol, diabetes, or other factors), an injury or as a result of surgery. Changes in hormone levels can also cause ED.
It is also possible for some medicines to cause erectile dysfunction.
You might find that you sometimes experience difficulty getting an erection and other times find it very easy. For example, you might get an erection in the morning and when you masturbate, but not when you try to have sex with your partner. In this type of scenario, it is likely that the cause of your erectile dysfunction is psychological. It could be stress-related, for example. If you can’t ever get an erection, under any circumstances, the causes of your impotence are probably physical.

Furthermore, some medicines can cause ED in some men, for example:
• Diuretics – cause your body to increase the amount of urine it produces. Commonly used to treat high blood pressure, heart failure and kidney problems.
• Antihypertensives – used to treat high blood pressure, e.g. beta-blockers.
• Fibrates – prescribed to decrease cholesterol levels.
• Antipsychotics – used for some mental health conditions, like schizophrenia.
• Antidepressants – prescribed to tackle depression or sometimes pain
• Corticosteroids – contain steroids (these are a type of hormone)
• H2-antagonists – for stomach ulcers
• Anticonvulsants – prescribed to people with epilepsy
• Antihistamines – used to manage allergies, like hay fever
• Anti-androgens – suppress androgens (male sex hormones)
• Cytotoxics – used in chemotherapy

The six types of PDE-5 inhibitors available in England are:
• Viagra (active ingredient: sildenafil)
• Viagra Connect (available Spring 2018)
• Tadalafil
• Cialis (active ingredient: tadalafil)
• Levitra (active ingredient: vardenafil)
• Spedra (active ingredient: avanafil)