About ED and its causes

The medical term for an erection problem is 'erectile dysfunction', or ED for short. You may have also heard it called impotence. ED happens when the penis doesn't get hard (erect) enough to allow a man to have sexual activity. This is because not enough blood can get into or stay in the penis long enough to allow an erection to happen.

An erection is a complex process that involves changes in the muscles, nerves and blood vessels in the penis. Blood is pumped into the penis to make it firm, which usually begins when we think about sex and/ or when we are stimulated. Sexual stimulation causes signals to travel down the nerves that lead from the spinal cord to the genitals. The blood vessels that supply the penis then open further, so the blood flows in and the penis enlarges.

About 40% of men over 40 may have suffered some degree of ED, so if you think you suffer from it, you're not alone. Some erection problems don't last long or happen often, but if they happen more often, it may be a sign that you are suffering from ED.

In many cases, ED is caused by a combination of both physical and psychological factors. A proper medical assessment is important as ED could be caused by an underlying physical illness, medication side effects, or be related to psychological issues (see examples below).

Physical causes

Vascular conditions:

• Diabetes
• Heart disease
• High blood pressure
• Kidney failure

Post-operative effects:

• Following prostate surgery

Other illnesses:

• Prostate cancer
• Nerve problems, e.g. multiple sclerosis and Parkinson's disease
• Trauma

Medication side effects

• A side effect of another drug

Psychological causes

• Stress
• Emotional problems

If you have ED, it is unlikely to go away by itself, so you should talk to your doctor as soon as possible. This could help your doctor to identify and treat your ED, as well as any underlying factors that may be causing it.

Talking about ED is the first step towards dealing with it, and the first stage of your 4t Action Plan. Read more about talking about ED in this section, complete the optional questions below, and then move on to stage 2 by clicking the 'next' button at the top or bottom of this page.

Talking to your doctor

ED is a common condition, so if you think you may be suffering from it, you're not alone. Unfortunately, most men wait for a year or more before doing something about it.

If you think you suffer from ED, please speak to your doctor, as it could be a sign of another condition. Although it can be daunting, ED often has an underlying physical cause, so it's important to take this step.

It can be a difficult subject to talk about, but remember that it's just another symptom to your doctor. ED is an issue your doctor deals with on a regular basis, so you shouldn't feel embarrassed talking about it. Please see the 'Conversation starter' tab above for suggestions of how to start a discussion with your doctor.

Be prepared to be asked some personal questions. Your doctor may ask you:

• "How long have you been having problems with your erection?"
• "When do you have erection problems?"
• "What do you think might be causing your erectile problems?"
• "Do you drink a lot?"
• "Are you a smoker?"

In addition to talking to you, your doctor will probably also conduct a proper medical ED test on you. You will find out more about what kinds of tests to expect in the next stage of the 4t Action Plan.

There are other specialists who you will be able to talk to, e.g. a relationship therapist or counsellor. Your doctor will be able to advise you about whom to contact in your area. Additionally in step 4 of the 4t action plan there is a list of some organisations that may be useful.

Talking about ED is the first step towards dealing with it, and the first stage of your 4t Action Plan. Read more about talking about ED in this section, complete the optional questions below, and then move on to stage 2 by clicking the 'next' button at the top or bottom of this page.

Talking to your partner

Talking about ED can be difficult, even with a partner, but it needn't be. Most couples would probably discuss other health concerns, so why should ED be any different?

If you're finding it difficult to get the conversation started, here are a few suggestions:

• Start by sharing your emotions
• Remind your partner that you love them
• Let your partner know that you miss making love, and say why you haven't been trying recently
• Tell your partner how common ED is - about 40% of men over 40 may have suffered some degree of ED
• Tell your partner that you think you may have ED, and that you'd like to talk about it

Your partner may also need advice and support. LoveLifeMatters.com is a free and confidential resource also sponsored and brought to you by Lilly UK, primarily aimed at female partners of men suffering from an erection problem. Let your loved one know that advice and support is available for them at this website, so that you can deal with the situation together.

Talking about ED is the first step towards dealing with it, and the first stage of your 4t Action Plan. Read more about talking about ED in this section, complete the optional questions below, and then move on to stage 2 by clicking the 'next' button at the top or bottom of this page.

Conversation starters

ED can be difficult to talk about, but it's a common condition that you shouldn't feel embarrassed discussing with your doctor. Why not try some of these suggestions to start the conversation?

• "Sex is becoming a problem for me and my partner"
• "I'm finding it difficult to have sex"
• "My sex life isn't what it used to be"
• "I'm slowly losing the ability to have sex"
• "I'm worried that I may not be able to get an erection anymore"
• "I'd like to talk about erectile dysfunction"

Talking about ED is the first step towards dealing with it, and the first stage of your 4t ActionPlan. Read more about talking about ED in this section, complete the optional questions below, and then move on to stage 2 by clicking the 'next' button at the top or bottom of this page.