Erectile dysfunction (ED) is incredibly common. The condition makes it difficult to get and keep an erection long enough to have sex and is experienced by millions of men across the country. We know this won’t necessarily make it any easier if it happens to you. The good news is that changing your lifestyle is often enough to improve ED. Reducing anxiety, getting more sleep and drinking less alcohol can all help to get your sex life back on track. However, as ED can also be a sign of an underlying issue, it’s important to speak to a doctor if the issue persists.
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Erectile dysfunction (ED) can also be referred to as impotence. ED is a condition that affects men and is the inability to achieve and maintain a satisfactory erection for sexual intercourse, or in response to sexual stimulation.
Erectile dysfunction is a very common condition that can affect any man at any age, although it becomes increasingly common with advancing years. It is estimated that around 50% of men between the ages of 40 and 70 will experience ED at some point.
Erections are caused when a man becomes sexually excited. This arousal causes the brain to send signals to the nerves in the penis. Upon receiving these signals the nerves increase the blood flow to the penis, causing it to enlarge and harden. If anything interrupts this process then erectile dysfunction can occur. This interruption may be physical, psychological or medicinal.
Physical causes of ED include:
Psychological causes of ED include:
Medicinal causes of ED include:
Erectile dysfunction will present itself as an inability to achieve or maintain a satisfactory erection during sexual intercourse. When dealing with ED it is very important to understand and identify the underlying cause. For example if you’re able to achieve and maintain an erection while you masturbate but find you are unable to get an erection with your sexual partner, this would suggest the cause is psychological. However, if achieving and/or maintaining an erection isn’t possible under any circumstance, it would be safe to assume the problem is primarily physical or potentially medicinal.
Erectile dysfunction is most commonly caused by reduced blood flow to the penis. In a large proportion of cases this can be due to narrowing of the blood vessels flowing into the penis, meaning that there is insufficient blood flow to produce an erection. Some causes of reduced blood flow are; weight gain, high blood pressure, high cholesterol, smoking and diabetes. For this reason erectile dysfunction can be an early indicator of heart disease and it is important to have a full health check with your GP.
In general, symptoms of erectile dysfunction that occur slowly are more likely to indicate a physical cause (e.g. narrowing of the blood vessels to the penis) whereas symptoms that are sudden in onset may suggest psychological causes.
Other causes of erectile dysfunction can include: injury to, or diseases that affect, the nerves going to the penis, hormonal causes (e.g. low testosterone), side effects of medicines, excess alcohol, drug abuse, and psychological causes such as anxiety, depression, stress or relationship issues.
If you feel like you have the symptoms, our guide can help you learn how to complete a discreet online ED consultation.
In general, erectile dysfunction can be self-diagnosed from the obvious symptoms of struggling to achieve or maintain a satisfactory erection. Although ED can be self-diagnosed, it is always recommended that any new symptoms should be discussed with your GP. If you do not wish to discuss ED with your GP, you should book an appointment for a check-up. Erectile dysfunction can be a sign of underlying health conditions, such as heart and circulatory problems, that should be addressed.
When consulting your doctor about erectile dysfunction it will be necessary to answer some questions about your sexual history. It’s important to answer these questions honestly as it may affect the diagnosis. This may include questions about:
Other more general lines of enquiry will likely include:
The doctor may wish to perform a series of simple tests, as ED can be caused by a more serious underlying condition such as cardiovascular disease or diabetes. These tests may include:
There may be the need to perform a physical examination of the penis. This way the doctor can rule out any physical abnormality or anatomical reason for why ED is occurring. If over the age of 50 then the GP may wish to perform a rectal (prostate) exam where they will insert a gloved finger into the anus. This exam will help the doctor rule out underlying conditions, such as prostate cancer.
In some cases a blood sample may be taken for analysis. This sample will show the hormone levels in the blood. This analyses will help identify or rule-out any hormonal conditions like hypogonadism, which is low levels of testosterone in the blood.
Erectile dysfunction is somewhat rare in men under the age of 40 (if due to physical problems), so for a small number of cases further testing may be required. If this is the case then your GP may wish to refer you to a specialist, though this is rarely necessary.
Treatment for erectile dysfunction has improved significantly in recent years with most sufferers being able to resume normal sexual activity as a result. Treatment is normally a combination of medicines, lifestyle changes and resolving any psychological causes.
There are four main tablets for erectile dysfunction, these are Sildenafil (Viagra & generic sildenafil), Tadalafil (Cialis & generic Cialis), Avanafil (Spedra) and Vardenafil (Levitra & generic Vardenafil).
Ultimately, these treatment options all do the same job, however there are small but important differences between them that we will summarise. Choosing the one that is right for you will depend on a variety of factors, like your health and whether you are taking any other medicines. It also comes down to personal preference.
Vitaros is a new cream treatment for ED that is applied directly to the penis. It offers an additional option to men who cannot take, or do not respond to, traditional ED tablets. It offers easy application and a fast onset of action, however it is less discreet.
Just to note, Viagra and Sildenafil are the same drug. Look closely on a packet of Viagra and you will see it states ‘contains Sildenafil’. Viagra is simply a branded name given by one manufacturer to this particular drug. So for all intents and purposes, they are exactly the same in all but name.
Read more about Tadalafil vs Cialis.
As with all four types of ED tablets, Viagra (Sildenafil), Cialis, Spedra and Levitra, the right strength for you won’t relate to the size of an individual or their blood pressure. It is recommended that new patients start on the middle strength so in the case of Sildenafil and Viagra, 50mg. For Levitra, the starting dose is 10mg, Spedra is 100mg and Cialis, the lower strength of the 'when required' dose is 10mg, which will be the entry-level dose.
This initial trial should be attempted at least four times before it is judged whether that dose is effective or whether it needs to be altered to a higher or lower strength. In some cases, if one drug is proving completely ineffective then trying one of the other drugs may be a more prudent option rather than attempting a higher strength.
Viagra, Sildenafil, Cialis, Spedra and Levitra all need to be taken before sexual intercourse. Their effect should remain viable for several hours after taking. There is a slight variation between them with regards to how long before and for how long these effects last.
For clarity, stating ‘effects last for 4-5 hours’, does not mean the erection will remain constant for this time. The penis will still require stimulation or sexual arousal to maintain an erection.
Headaches and flushing are the most common side effects of Sildenafil (Viagra), Cialis and Levitra.
As with all prescription medicines it is very important to remember that you only take these medicines after having the proper medical consultation such as with your GP or through our Online Pharmacy. Buying them without a consultation with a medical practitioner can be dangerous and leave you susceptible to ineffective, fake or even dangerous medicines.
If you are unsure of the legitimacy of a site you are thinking of buying from, then make sure you understand how to recognise a regulated online pharmacy.
| TREATMENT | INFORMATION | BEST FOR | PRESCRIPTION-ONLY | STRENGTH | ACTIVE INGREDIENT | HOW IT WORKS | DURATION | PRICE | MANUFACTURER |
|---|---|---|---|---|---|---|---|---|---|
| Cialis |
A popular, long-acting treatment for erectile dysfunction, often dubbed ‘the weekend pill’. | Men seeking a long-lasting ED treatment | Yes | 10mg, 20mg | Tadalafil | Opens the blood vessels to the penis and helps to produce and maintain an erection. | 36 hours | From £9.12 per tablet | Lilly |
| Levitra | More effective than other ED treatments at treating men over 50, as well as those with health risks such as high blood pressure, high cholesterol or diabetes. | Men over 50 and men with diabetes | Yes | 10mg, 20mg |
Vardenafil | Increases blood flow to the penis. Together with sexual stimulation, the increased blood flow will help achieve and maintain an erection. | 10 hours | From £5.50 per tablet | Bayer |
| Sildenafil | A generic, cheaper version of Viagra. Sildenafil is available at a much lower price, with the same effect and quality you would expect from branded Viagra. | Men seeking a cheaper alternative to Viagra | Yes | 25mg, 50mg, 100mg | Sildenafil citrate | Increases blood flow to the penis, helping to achieve and maintain an erection. Will only produce an erection if you are sexually aroused. | 4-5 hours | From £2.00 per tablet | Various |
| Spedra | One of the fastest solutions for ED available - takes effect as soon as 20 minutes after use. Can last for up to 4 or 5 hours. | Men seeking a fast acting ED treatment | Yes | 50mg, 100mg, 200mg | Avanafil | Increases blood flow to the penis. Together with sexual stimulation, the increased blood flow will help achieve and maintain an erection. | 4-5 hours | From £4.50 per tablet | Menarini |
| Tadalafil |
Cheaper than the popular branded Cialis, Tadalafil has been recently made available in the UK thanks to the expiration of the Cialis patent. | Men seeking a long-lasting ED treatment | Yes | 10mg, 20mg | Tadalafil | Opens the blood vessels to the penis and helps to produce and maintain an erection. | 36 hours | From £2.00 per tablet | Various |
| Viagra | The iconic ‘blue pill’ from Pfizer, launched back in 1998. Very prone to counterfeiting - never buy it from a retailer who isn’t fully licensed and reputable. | Men seeking to achieve and sustain an erection for 4-5 hours | Yes | 25mg, 50mg, 100mg | Sildenafil citrate | Increases blood flow to the penis, helping to achieve and maintain an erection. Will only produce an erection if you are sexually aroused. | 4-5 hours | From £5.62 per tablet | Pfizer |
| Viagra Connect | The only over the counter ED treatment available in the UK. Works in the same way as 'regular' Viagra. | Men who don't have a prescription | No | 50mg | Sildenafil citrate | Helps blood flow to the penis, allowing men to achieve and maintain an erection. Will only produce an erection if sexual stimulus is present. | 4-5 hours | From £4.00 per tablet | Pfizer |
| Vitaros | A fast-acting topical treatment for ED where tablets have not been effective or are not a good solution. Can help to produce an erection in as little as 5 minutes. | Men who want a fast acting ED treatment, and/or who have found tablets to be ineffective | Yes | 300mcg | Alprostadil | When administered to the tip of the penis, it helps to create an erection by increasing blood flow to the area. | 1-2 hours | ~£15 per application | Ferring |
Learn more about the price of ED treatment and what the best option for you is.
Often there are underlying psychological factors that cause erectile dysfunction, and it may be that group psychotherapy, cognitive behaviour therapy, counselling or sex therapy will be helpful for treating the causes. These are thought to be most successful when combined with physical therapy.
Other treatments available for erectile dysfunction that does not respond to drug treatment or counselling include:
These should only be considered for severe cases of erectile dysfunction that are unresponsive to first-line treatments.
As you can see, there are a wide variety of treatments for erectile dysfunction, and even if it means trying a few different types, it’s still reassuring to know that there are solutions to a medical condition that causes much disruption in your life.
There are many lifestyle changes that you can make that could help reduce the effects or risk of erectile dysfunction. These include:
Ultimately, a major cause of erectile dysfunction is cardiovascular disease, and changes you would make to improve your health for a heart attack, are actually going to be the same changes that will help your ED.
Amongst younger men with erectile dysfunction, being checked by a medical professional is a recommendation from the British Heart Foundation, due to it being an early indicator of heart disease.
Oral medications for erectile dysfunction vary in their speed depending on which one you use, and how long you have been taking it for.
Usually, you will find them effective between 15 - 60 minutes after taking them. Some of the oral medications, like tadalafil, can begin to work more quickly after you have been taking it for a while.
As you can see from our comparison above, the correct treatment for you will be impacted by your own sex life, lifestyle choices, sex drive and whether or not you have existing health issues.
For many men, they will benefit from prescription medications (or Viagra connect), you can see here more about the best pills to take for erectile dysfunction.
ED can be caused, or contritubed to, by lifestyle factors, such as smoking, being overweight and feelings of stress and anxiety. It’s easy to reduce the risk of developing erectile dysfunction by making simple changes, for example:
These simple lifestyle changes will vastly improve your physical and general health, which will decrease your chances of developing conditions such as diabetes or cardiovascular disease, both of which can cause ED. Having a good level of general health will also reduce the risk of needing any prescription medicine. The less medicine you are taking the lower the risk of suffering an erectile dysfunction inducing side-effect.
When it comes to erectile dysfunction there are a few common misconceptions and associated stigmas that surround this condition.
Erectile Dysfunction is linked to sexual attraction
A variant of the above myth is the notion that if a man needs to take a treatment such as Viagra that means he isn’t sexually attracted his partner. This is simply not the case. Just to reiterate, even with erectile dysfunction medication a man can only achieve an erection if he is properly stimulated.
If there is difficulty achieving and maintaining an erection with your partner because you find her physically unattractive, or if the reason is an unresolved psychological issue then taking erectile dysfunction tablets isn’t likely to resolve this.
Erectile Dysfunction is when you can NEVER get an erection
Another common misconception stems from the belief, ‘I don’t have erection problems all the time and therefore it cannot be erectile dysfunction.’ This belief is false. Men with erectile dysfunction can suffer many different kinds of symptoms, including any of the following:
Erectile Dysfunction only occurs in old men
Erectile dysfunction can be seen as something that only happens to older men and it’s just a normal part of aging that you simply have to live with. Erectile dysfunction can happen at any age. It simply becomes increasingly more common the older we get. It’s estimated that half of men between the ages of 40 and 70 suffer with erectile dysfunction. This statistic increases as we look beyond the age of 70, with 7 in every 10 men believed to be sufferers.
Taking Viagra will mean you will have an erection until it wears off
The biggest myth that stalks erectile dysfunction, especially in pop-culture, is that treatments such as Viagra cause an erection. In truth, this is not the case. Without the necessary arousal or sexual stimulation an erection cannot be achieved or maintained. The active ingredients in the three main treatments (Sildenafil, Tadalafil and Vardenafil) don’t automatically provide you with an erection. What they actually do is open the veins allowing blood to flow to the penis more freely and effectively when properly stimulated. Essentially, you could take Sildenafil or Tadalafil and still not achieve an erection if lacking the necessary sexual arousal.
Where do these myths come from?
It’s unsurprising these myths and stigmas regarding erectile dysfunction exist when you look at how pop-culture continually perpetuates these notions through film, television and comedy acts. It may provide us a quick laugh but as a consequence it’s reinforcing stigmas such as:
As we age the likelihood of our bodies malfunctioning increases and so with it does the chances of developing erectile dysfunction. Our eyesight can suffer similarly with age. The difference being there is no stigma attached to wearing glasses, contact lenses or receiving laser eye surgery to treat the latter. So why does a stigma still exist in our culture that shames a man into thinking he can’t enjoy a fuller, more pleasurable sex life should erectile dysfunction strike?
Read our dedicated resource to stay properly informed about ED, with genuine UK statistics.
There are a number of non-prescription alternatives for the treatment of Erectile Dysfunction such as;
You should not take Viagra or Spedra in a 24-hour period. You should not take more than one Cialis 10mg or 20mg tablet in a 36-hour period and more than two ‘as required’ Cialis tablets in a week. Do not take more than one Cialis Daily in a 24-hour period.
Cialis, Spedra, and Viagra (sildenafil) work in a similar way to produce an erection but there are subtle differences in length of duration and speed of onset.
Cialis generally has the fastest onset, sometimes within as little as 15 minutes. It also produces the longest effect, up to 36 hours. Is not affected by food and can be taken as little as 30 minutes or up to 12 hours before it is needed.
Spedra works as quickly as 15 minutes and last up to 6 hours.
Viagra takes on average 30 minutes to kick in and continues for around 4 hours. This also applies to Sildenafil tablets.
We are all different and one type of tablet may work better for you than another. In addition, factors like the amount of alcohol consumed and when and what you ate can alter the effects of the individual treatments. You may wish to try different tablets and see which suits you best. Each treatment should be tried at least 4 - 8 times before deciding if it is effective for you before changing strength or drug.
We are all different and one type of tablets may work better for you than another. You may want to try different tablets and see which suits you the best. Remember to try each treatment multiple times before trying a different strength or drug.
You should never take different treatments at the same time; leave at least 24 hours between taking any erectile dysfunction treatments (leave 36 hours for Cialis).
Viagra and the other erectile dysfunction treatments in the same family, are very well tolerated. Any adverse effects that do occur are mostly mild, including:
For a full list of side effects, see each individual treatment page.
Grapefruit and grapefruit juice can reduce the elimination of certain medicines from the body. This may lead to a build up drug in your system. For this reason we advise you avoid grapefruit and grapefruit juice whilst taking erectile dysfunction medication.
The usual starting dose for erectile dysfunction tablets is? Viagra 50mg, Sildenafil 50mg, Cialis 10mg, Spedra 100mg. If it has not had the desired effect or didn't last 4 hours then it is important to try again for another 3 separate occasions before moving up to the higher strength. It can take a few attempts at first before you get the desired effect for your treatment.
If the starting dose was more effective than anticipated then reduce the dose to the lower strength treatment.
With all the ED treatments arousal is necessary, the tablets will not work without it and the medication will then simply wear off after 4 hours.
Avoid taking ED medication with a heavy meal/high fat meal. This may delay the onset/ take longer to start working.
Drinking excessive amounts of alcohol is not recommended as it will impair your ability to achieve an erection and you will not receive the maximum benefits form the medication.?
Both The Independent Pharmacy and the manufacturers of ED treatments do not recommend cutting or breaking any of the ED treatments.
An erection that lasts for more than 4 hours (known as priapism) needs urgent medical attention. If left untreated, it can cause long-term damage to the penis. It is important to understand that this condition is rare, if you use erectile dysfunction treatments sensibly and as directed there is only a very small risk of this occurring.
Viagra and the other erectile dysfunction treatments are not addictive but it is important to bear in mind that by taking this medication you are treating the symptoms and not the underlying cause of the condition. Therefore in the future you may need a higher strength tablet if the underlying condition was to get worse. If the erection difficulties are due to performance anxiety then men may feel unable to perform without them and become psychologically reliant on them as a back up.
The amount of time you need to take erectile dysfunction medications for will depend on the cause of your condition. If it is due to another medical condition such as diabetes, high blood pressure or obesity by changing your lifestyle and getting effective treatment for this condition, you may see a slow improvement in your symptoms of erectile dysfunction.
Alternatively, if your ED is caused by psychological reasons like anxiety, you may need counseling to overcome the issues at the heart of your condition. Remember that erectile dysfunction treatments treat the symptoms of ED but not the underlying causes.
Erectile Dysfunction (ED) is the condition when sufficient erection cannot be attained or maintained long enough for normal sexual function. It is commonly referred to as male impotence.
Not necessarily. However, one in five men will experience it at some stage in their lives, even though only 10% of those who have it ever seek treatment. It is commonly perceived as lack of virility and loss of manliness, therefore men tend to keep the incidence to themselves and suffer in silence unnecessarily.
This is one of the most damaging misconceptions about erectile dysfunction. According to a University of Maryland Medical Centre report, only 15% of the cases are purely psychological in nature. The causes of the remaining 85% can be traced to some physical problem. Anxiety, unresolved anger and other emotional issues between partners are the usual psychological causes. Depression also may cause impotence.
Whilst all causes of erectile dysfunction may not be preventable, maintaining a healthy lifestyle goes a long way in preventing the physical causes such as hypertension, diabetes, atherosclerosis and heart disease. Smoking, as well as alcohol and drug abuse, are some examples of the other preventable causes. Effective communication between partners also helps.
Most cases of erectile dysfunction respond to medication. Viagra, or other treatments such as Sildenafil, Cialis help those with ED to achieve erection and maintain it. They are normally taken around and hour before sex and will only work when you become aroused. For most people they are not available from the NHS and must be paid for privately from your local GP or an Online Pharmacy.
Not in most cases of ED. To identify and resolve psychological causes of ED, sex counselling can help. Surgical correction of physical defects, if any, can resolve ED in some cases. When non-surgical treatment measures are exhausted, surgery to implant a penile prosthesis can be considered to manage the condition.
Yes, you can buy all available erectile dysfunction treatments online from The Independent Pharmacy. By filling in a consultation for one of our UK prescribers to check and, if appropriate, they can issue with a prescription for the ED treatment of your choice. This prescription is then dispensed by our NHS pharmacy and dispatched to a location of your choice.
You should always check that if you are buying medicines online, including erectile dysfunction tablets, the website you are buying from is legitimate. To provide prescription medicines online, the website must be registered with the Care Quality Commission (CQC) in the UK as well as the medicines coming from a GPhC-registered pharmacy.
At The Independent Pharmacy, we display all of our regulating bodies clearly on the website including the CQC & GPhC. We are an NHS pharmacy and have a clickable link to Trustpilot, the independent review site, on every page to allow customers to check out what real people are saying about us.
We will always ensure any consultation through The Independent Pharmacy is safe, completely confidential and follows all the best practice & legal requirements from all UK regulatory bodies.
All the ED treatments we supply are sourced from the same UK wholesalers used by your local high street pharmacy. We always ensure that the products we supply are of the highest quality and have a UK product licence. Being a registered NHS pharmacy we use the same medicines for our Online Pharmacy service as we supply to our NHS patients.
Erectile dysfunction can indeed come and go, either with improvements in blood flow following treatment, which then deteriorate again, or with the psychological effects such as stress easing off but later worsening. ED can also strike when you least expect it, or when you overthink it, which can be very frustrating.
The main symptom of ED is being unable to sustain an erection. Despite this, a man may still have sexual desire and be able to have an orgasm and to ejaculate.
Erectile dysfunction can cause male infertility because it can interrupt or prevent intercourse. In order to conceive, sperm must travel to a partner's egg during intercourse. Thus, problems that prevent or interrupt intercourse cause an inability to deliver sperm to the egg and lead to infertility.
In some (but not all) cases, ED may be linked to a low sperm count, low levels of testosterone or difficulty with conception.
ED and premature ejaculation can occur at the same time, though they are not directly related.
Bodybuilders sometimes regularly use steroids, DMAA (dimethylamylamine) or hormone treatments that can cause or worsen the symptoms of ED.
Cancers and liver conditions, such as Hepatitis C, are often linked with ED online, however no formal trials have been completed.
Many men claim that ED is caused directly by using condoms. While condoms can, in some cases, interfere with arousal and therefore erections, there is no direct link between the two. Erectile dysfunction occurs when an erection is not possible, rather than being caused by a condom. Ensuring that your condoms are the correct fit for you could fix the problem.
Authored by
Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.
Reviewed by
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.
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