● Men's health · Erectile dysfunction
Safe, Effective Erectile Dysfunction Treatment
Discreet, clinician-led treatment for erectile dysfunction (ED)
Erectile dysfunction is common and can have physical, psychological or lifestyle-related causes. Treatment options may include prescription medicines, lifestyle changes and support for psychological or relationship factors. A clinical assessment can help identify possible causes and determine the most appropriate approach for you.
Medically reviewed by Danny Gian Hou Chu, HCPC-Registered Physician Associate (PA38670).
If this is something you’re dealing with, you are in good company — and reaching out is a sign of taking your health seriously, not a weakness.
52%
of men aged 40–70 experience some degree of erectile dysfunction.1
❤ ED can be one of the earliest signals of wider cardiovascular disease and risk factors, which is why persistent ED is worth discussing with a healthcare professional.
If this is something you’re dealing with, you are in good company — and reaching out is a sign of taking your health seriously, not a weakness.
● Understanding why
What causes erectile dysfunction?
Physical health
Conditions such as diabetes, high blood pressure, cardiovascular disease, high cholesterol and obesity can affect erectile function.
Blood flow
Vascular ED can occur when problems with blood vessels or circulation make it harder to get or maintain an erection.
Certain medications
Some prescription medicines can contribute to erection problems. Your clinician can review your medication and assess whether they may be a factor.
Lifestyle factors
Smoking, excessive alcohol consumption, being overweight and physical inactivity all increase the risk. The flip side is encouraging: changes here often help.
Psychological conditions
Stress, anxiety, low mood, depression and relationship pressures can all play a part, sometimes alongside a physical cause or on their own.
Hormonal causes
Low testosterone or thyroid problems can sometimes contribute to erectile dysfunction, particularly when other symptoms of testosterone deficiency are present.
Other possible causes
+ Read More
Erectile dysfunction can also be associated with neurological conditions, certain health conditions, or damage to the nerves and blood vessels involved in an erection. Pelvic or prostate surgery can also affect erectile function.
Some men have psychogenic ED, where psychological factors are a major contributor, while others have mixed causes, with both physical and psychological factors involved.
If low testosterone is suspected, a clinician may recommend an early-morning blood test.
● For information
Treatment for erectile dysfunction
The most appropriate treatment for erectile dysfunction depends on its cause, your general health, the medicines you take and your individual circumstances.
Treatment options may include:
Oral medications
Lifestyle changes
Treatment of underlying health conditions
Psychological or psychosexual support
Other medical treatments where appropriate
PDE5 inhibitors are a first-line medical treatment for erectile dysfunction and are suitable for many men following a clinical assessment.
The EAU recommends PDE5 inhibitors as first-line therapy for ED and also recommends addressing lifestyle and modifiable risk factors.
NICE also recommends PDE5 inhibitors for appropriate men with ED in specific conditions, including type 1 and type 2 diabetes, where there are no contraindications.
Common PDE5 inhibitor medicines used to treat ED include:
Sildenafil (Viagra)
Tadalafil (Cialis)
Avanafil (Spedra)
Vardenafil
These medicines help relax the blood vessels in the penis and increase blood flow when sexual stimulation is present.
UK product information for sildenafil, vardenafil, tadalafil and avanafil specifically states that sexual stimulation is required for these medicines to work.
| Treatment | Typical onset | How long it can last | Notes |
|---|---|---|---|
| Tadalafil | 30–60 minutes before sex | Up to 36 hours | Absorption is not affected by food. |
| Sildenafil | 30–60 minutes before sex | 4–6 hours | Works best on an empty stomach. |
| Vardenafil | 25–60 minutes before sex | 4–5 hours | Heavy or high-fat meals can delay its effect. |
| Avanafil | 15–30 minutes before sex | About 6+ hours | Less affected by food. |
During sexual arousal, signals from the nervous system help increase blood flow to the erectile tissue of the penis.
PDE5 inhibitors support this natural process by increasing the effect of nitric oxide-related signalling. This helps the blood vessels in the penis relax and increases blood flow, supporting the development and maintenance of an erection.
Important: Sexual stimulation is still required. ED medicines do not increase sexual desire and do not normally cause an erection without sexual arousal.
No single ED treatment is best for every man.
During your assessment, our clinical team may consider:
Your symptoms
Your medical history
Your sexual history
Your cardiovascular health
Your blood pressure
Other health conditions
Medicines and supplements you take
How often you have sex
How quickly you want treatment to work
How long you would like its effects to last
Any previous experience with ED treatment
The EAU notes that the choice of PDE5 inhibitor can take factors such as frequency of intercourse and personal experience into account.
Your consultation gives your prescriber the information needed to assess whether treatment is appropriate and, if so, which option and dose may be suitable.
No. PDE5 inhibitors are not suitable for everyone and can interact with some medicines. They must not be taken with nitrate medicines or nitric oxide donors because the combination can cause a potentially dangerous fall in blood pressure.
Some men with cardiovascular disease or other health conditions may also need additional assessment before treatment.
Tell your prescriber about all medicines and supplements you take so they can assess whether treatment is appropriate.
PDE5 inhibitors are generally well tolerated, but side effects can occur. Depending on the medicine, common side effects can include:
Headache
Flushing
Indigestion
Nasal congestion
Dizziness
Nausea
Muscle or back pain
Visual disturbances
Side effects and their frequency vary by medicine. Check the patient information leaflet supplied with your treatment and speak to your pharmacist or prescriber if you have concerns.
Seek urgent medical attention if you develop an erection that lasts more than four hours, known as priapism, or experience sudden loss of vision or hearing.
Oral medications are not the only treatment option.
Depending on the cause and individual circumstances, treatment may also include:
Psychological or psychosexual support
Vacuum erection devices
Topical or intra-urethral treatments
Intracavernosal injections
Treatment of an underlying health condition
Specialist treatments in selected cases
Vacuum erection devices use negative pressure to draw blood into the penis and can help produce an erection. They may be considered by men looking for a non-invasive, drug-free treatment option.
The EAU recognises vacuum erection devices, intracavernosal injections and topical or intra-urethral alprostadil among the treatment options for appropriately selected men.
● The bigger picture
You are far from alone
The numbers make one thing clear: ED is a common, widespread part of men’s health. Understanding how common it is — and the range of factors that can contribute to it — takes some of the worry out of seeking help.
experience erectile dysfunction to some degree — from mild and occasional to more persistent.1
2 Combined moderate-to-complete ED rises with age — but it affects younger men too (around 5–10% under 40).
An early signal worth heeding
Heart & circulationBecause the arteries supplying the penis are smaller than those around the heart, problems with blood flow often show up there first. For some men, ED is the earliest sign of wider cardiovascular health worth attention — on average appearing around three years before a related cardiac event.3 That makes it a genuine opportunity, not just a problem.
3 ED does not cause heart disease, but it can share the same underlying causes — which is why assessment is valuable for your overall health, not only your sex life.
● The part nobody talks about
Confidence, relationships and peace of mind
ED isn’t only physical. It can affect how you feel about yourself and add strain to relationships and performance anxiety. Lack of communication can often make the condition worse. Knowing that it’s common, understood and usually treatable can make it easier to take action.
It's treatable
For most men, effective options exist. The right one depends on your health and circumstances — which is what the assessment is for.
It's confidential
At Envigore, we handle each case with discretion. No waiting rooms, no awkward conversations. Our clinical team is focused on helping you.
It's a health step
Addressing ED can improve your relationship and your wider health, prompting attention to things that matter long-term.
● How it works
Discreet help for ED, in three simple steps
No in-person appointment, no awkwardness. Treatment is only ever supplied if a prescriber decides it’s clinically appropriate for you.
1. Complete your assessment
Answer a confidential set of clinical questions about your erectile dysfunction symptoms, history and any medicines you take.
2. A prescriber reviews
A UK-regulated prescriber reviews your answers personally and considers your wider health, not just the symptom.
3. Treatment if appropriate
If suitable, we’ll arrange your male erectile dysfunction treatment with discreet delivery. If it isn't, we'll explain why and suggest next steps.
Take the first step to treating
erectile dysfunction privately
A short, confidential online assessment, reviewed by a real prescriber. No waiting rooms, no judgement.
● FAQs
Erectile Dysfunction questions, answered
Common questions about erectile dysfunction, answered plainly and without judgement by our clinical team.
Erectile dysfunction is difficulty getting or maintaining an erection suitable for sexual activity.
You may find it difficult to:
Get your penis erect
Maintain an erection during sexual activity
Achieve an erection firm enough for sexual intercourse
ED can occasionally occur because of stress, tiredness or alcohol. When erection problems happen repeatedly, they can have physical or psychological causes and are worth discussing with a healthcare professional.
Erectile dysfunction is a form of male sexual dysfunction, but it does not necessarily mean there is a problem with sexual desire or attraction.
ED can have vascular, neurological, hormonal, psychological, medication-related and other physical causes, often with more than one factor involved.
Common physical causes include high blood pressure, diabetes, raised cholesterol and heart disease. Stress, anxiety and low mood are frequent psychological factors.
Lifestyle elements like smoking, alcohol and weight also play a role.
Identifying the cause is the key to treating it well.
Erectile dysfunction is very common and entirely normal. Erectile dysfunction becomes more common with age, although it can affect men of all ages. In the Cologne Male Survey of men aged 30–80, the overall prevalence of ED was 19.2%, increasing from 2.3% to 53.4% across the age groups.
Yes. A large UK study found that around 3 in 10 men under 40 report some degree of erectile dysfunction, and it becomes even more common after 40. In younger men, psychological factors and lifestyle habits often play a role. Because ED can sometimes point to an underlying health issue, it’s still worth getting checked rather than brushing it off.
It can be either, or both. A few clues can point one way or the other, but they aren’t definitive. For example, whether you still get erections at night or in the morning. A clinical assessment is the reliable way to understand what’s going on, which is why it’s the sensible starting point rather than guessing.
Low testosterone can contribute to sexual problems, including reduced sexual desire and erectile difficulties.
If a healthcare professional suspects testosterone deficiency, they may recommend blood tests and further assessment.
Testosterone replacement therapy may be appropriate when testosterone deficiency is clinically confirmed, but it is not a general treatment for ED in men with normal testosterone levels.
No single test diagnoses every case of ED. Assessment usually starts with your medical and sexual history, followed by appropriate health checks.
Your healthcare professional may ask about:
When your erection problems started
Whether you can get and maintain an erection
Morning or spontaneous erections
Sexual desire and arousal
Your sex life and sexual history
Stress, anxiety and mental health
Lifestyle factors
Existing health conditions
Previous pelvic or prostate surgery
Medicines and supplements you take
Your blood pressure, weight and general health may also be assessed.
Depending on your symptoms and medical history, blood tests may be appropriate. These can include tests relating to blood glucose, cholesterol and testosterone. Clinically indicated cases may also require additional tests.
The EAU recommends a comprehensive medical and sexual history, a focused examination and appropriate laboratory testing as part of the ED assessment.
The NHS also notes that assessment may include questions about lifestyle and relationships, blood pressure checks and examination to identify possible physical causes.
Yes, erectile dysfunction can sometimes be associated with cardiovascular disease or cardiovascular risk factors. ED and cardiovascular disease share several risk factors, including high blood pressure, diabetes, high cholesterol, obesity and smoking.
Persistent erection problems can therefore be a reason to assess your cardiovascular health and other underlying risk factors.
Read more about our heart health programme and the factors that can affect cardiovascular wellbeing.
Yes, they can. Depending on your circumstances, lifestyle changes may include:
Quitting smoking
Exercising regularly
Losing weight if you are overweight
Maintaining a healthy weight
Reducing excessive alcohol consumption
Managing stress
Addressing cardiovascular risk factors
Managing underlying health conditions
These changes can improve general health and may also improve erectile function.
Yes, some men taking blood pressure medicines can use PDE5 inhibitors, but this depends on the medicines involved and your individual health.
PDE5 inhibitors can cause a small additional reduction in blood pressure, so your prescriber should review your medicines and cardiovascular health before treatment.
Yes, losing weight may improve erectile function for some men who are overweight or living with obesity. Maintaining a healthy weight, becoming more active and addressing other lifestyle factors may also support cardiovascular and sexual health.
If weight management is relevant to your wider health, explore Envigore’s weight management support, weight loss support for men or dietitian-led nutrition support.
These services are not a treatment for erectile dysfunction, but may support wider health and lifestyle goals where appropriate.
The most common treatments are oral medicines that improve blood flow when you’re aroused. They mainly differ in how quickly they start working, how long the effect lasts, and whether food affects them. The right choice depends on your health and circumstances, which a prescriber will assess. Lifestyle changes and addressing any underlying condition matter too.
For many men, erectile dysfunction symptoms improve significantly once the underlying cause is addressed. A clinical assessment can help identify which approach is most likely to help in your case.
It varies by medicine. Some can work within 15–30 minutes, while others can take around 30–60 minutes depending on circumstances, and the duration of effect differs too. They work alongside arousal rather than instead of it. Your prescriber can explain what to expect from any treatment that’s suitable for you.
Yes, you can access erectile dysfunction treatment online in the UK following an appropriate clinical assessment. A UK-regulated prescriber can assess your symptoms, medical history and current medicines to determine whether treatment is suitable.
Prescription-only medicines should be supplied only when a prescriber considers them clinically appropriate. When buying ED medicines online, use a legitimate UK-regulated service, as unauthorised medicines may contain incorrect or harmful ingredients.
You can also explore Envigore’s erectile dysfunction treatments to see the treatment options available. We only supply treatment when a prescriber determines it is clinically appropriate for you.
+ References & Further Reading
Feldman HA, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Ageing Study. Journal of Urology. 1994;151(1):54–61. Via hopkinsmedicine.org
Boston University School of Medicine, Sexual Medicine. Epidemiology of ED. bumc.bu.edu/sexualmedicine
Cortese F, et al. Can we consider erectile dysfunction as an early marker of cardiovascular disease? Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men’s Health? J Clin Med. 2021 May 20;10(10):2221. ncbi.nlm.nih.gov/pmc/articles/PMC8161068
NHS. Erectile dysfunction (impotence). nhs.uk/conditions/erectile-dysfunction-impotence
Lui JL, Shaw NM, Abbasi B, Hakam N, Breyer BN. Adverse reactions of PDE5 inhibitors: An analysis of the World Health Organization pharmacovigilance database. Andrology. 2023; 11: 1408–1417. https://doi.org/10.1111/andr.13430
Braun, M., Wassmer, G., Klotz, T. et al. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 12, 305–311 (2000). https://doi.org/10.1038/sj.ijir.3900622
Li, Jim Z., Maguire, Terence A., Zou, Kelly H., Lee, Lauren J., Donde, Shaantanu S., Taylor, David G., Prevalence, Comorbidities, and Risk Factors of Erectile Dysfunction: Results from a Prospective Real-World Study in the United Kingdom, International Journal of Clinical Practice, 2022, 5229702, 10 pages, 2022. https://doi.org/10.1155/2022/5229702
S. Ayalasomayajula, E. K. Bajwa, A. G. Cornell, et al., “The Evolving Landscape of Pulmonary Hypertension Treatment: From Vasodilation to Disease Modification,” Clinical and Translational Science 19, no. 8 (2026): e70685, https://doi.org/10.1111/cts.70685.
About Your Clinical Team
Danny Gian Hou Chu, an HCPC-registered Physician Associate (PA38670), medically reviewed and approved this content and oversees all prescribing decisions at Envigore.
All prescriptions are dispensed by Right Medicine Pharmacy Group, a GPhC-Registered Pharmacy (No. 9012382).
Veronica Giudice, an HCPC-registered dietitian (DT26570) and British Dietetic Association member, provides nutritional guidance and lifestyle support.
Last medically reviewed: September 2026
Disclaimer: This page is for general information and education only and does not constitute medical advice, diagnosis or treatment. Prescription-only medicines are supplied only where a prescriber determines, following a clinical assessment, that they are appropriate for the individual. If you have chest pain or other concerning symptoms, seek urgent medical advice. Envigore is a UK-regulated online clinic.