Erectile dysfunction (ED) is common, treatable, and frequently the first warning sign of underlying cardiovascular disease. Most men wait years before getting help. We see ED as an opportunity — not just to treat the immediate problem, but to spot and address what might be driving it, before it shows up as something more serious.
Educational information — not a substitute for clinical assessment
This page describes erectile dysfunction in general terms to help you decide whether assessment may be helpful. It is not a diagnostic tool. If you recognise yourself in what follows, please book a consultation.
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. The key word is persistent — occasional difficulty is universal and not a clinical concern. ED becomes a clinical issue when it happens regularly or starts to affect confidence, relationships, or wellbeing.
ED is not a problem of masculinity, performance, or character. It is a medical condition, almost always with identifiable contributing factors, and almost always treatable. The reason many men avoid getting help has more to do with stigma and the perceived awkwardness of the conversation than with the medical complexity of the problem itself.
of men aged 40–70 experience some degree of ED. Prevalence rises with age but ED is not "normal ageing" — underlying causes can usually be identified and addressed.
ED is one of the most common men’s health concerns and one of the least talked about. Population data suggests:
You are not unusual. The clinician who sees you has seen many men with the same concern. The conversation, once started, is much easier than imagined.
ED almost always has multiple contributing factors. Identifying which factors apply to you is the first step in effective treatment.
Erections require healthy blood flow into the penis. Conditions that affect blood vessels — high blood pressure, high cholesterol, diabetes, smoking, atherosclerosis — commonly affect the small arteries supplying the penis before larger arteries. This is why ED is an early warning sign for heart disease (see below).
Conditions affecting nerve function: diabetes, multiple sclerosis, Parkinson’s disease, spinal injury, stroke, or pelvic surgery (prostate, bladder, bowel).
Low testosterone (hypogonadism) is a less common cause but worth checking, particularly with reduced libido, fatigue, low mood, or loss of body hair. Thyroid disorders also contribute occasionally.
Many commonly prescribed medications can affect erectile function, including some blood pressure medications, antidepressants, anti-androgens, and others. We review your full medication list as part of assessment.
Performance anxiety, depression, work stress, relationship difficulties, and past sexual trauma can all contribute. In younger men, psychological factors are often the predominant cause. Importantly, ED with any cause becomes self-perpetuating — performance anxiety builds on top of an initial physical or situational issue.
The arteries supplying the penis are smaller than those supplying the heart. Atherosclerosis often shows up as ED 3–5 years before it shows up as a heart attack. Treating ED without checking cardiovascular risk is a missed opportunity that we don’t take.
For any new ED in a man under 70, particularly if onset has been gradual, we routinely assess cardiovascular risk — blood pressure, cholesterol, glucose, smoking, exercise, family history. For many men, the ED consultation becomes the start of broader cardiovascular protection that benefits them for decades.
An unhurried, discreet conversation about your symptoms, history, and what matters to you. We’ll cover onset, pattern (situational, with partner only, morning erections, masturbation), medication, lifestyle, and any other symptoms. This conversation is what most men dread and what almost all men find easier than expected.
A focused physical examination may be appropriate — assessing blood pressure, pulse, general fitness, and sometimes a brief genital examination. We follow GMC guidance on examinations and a chaperone is always offered (see our Chaperone Policy).
Tests we commonly arrange:
Results are typically available within 24–48 hours.
A clear, written plan covering treatment options, lifestyle changes, and follow-up. Many men leave the first consultation with reassurance, an action plan, and a sense that the problem is finally being addressed.
Treatment is individualised based on cause, severity, your overall health, and your preferences. The discussion happens in consultation, after assessment.
The most important step. Improving cardiovascular health, controlling diabetes, reducing alcohol, stopping smoking, and addressing untreated sleep apnoea all directly improve erectile function in most men. For some, these changes alone resolve the problem.
A class of medications is widely used as first-line treatment for ED. These are prescription-only and discussed in detail in consultation — including how they work, who they suit, who should avoid them, and what to expect. Under UK law we don’t name specific medications on this website; this conversation belongs in clinic.
For men who can’t use or don’t respond to first-line medication, other treatments are available: vacuum devices, injectable treatments, and (rarely) surgical options. We discuss what fits your situation.
Where testosterone is genuinely low and ED is partly hormonal, replacement may help. Testosterone replacement is a long-term commitment with monitoring requirements, and is not a routine treatment for ED in men with normal testosterone levels.
Where performance anxiety, depression, relationship difficulties, or past trauma play a role, psychological therapy (alone or alongside medication) is often the most effective long-term treatment. We can refer to a psychologist or sexologist within MHW.
The boring advice is the most effective. Men who improve the following see meaningful improvement in ED:
Even when ED has a physical cause, psychological factors usually develop on top. Performance anxiety after the first few failures becomes a self-fulfilling cycle. Other psychological factors:
These are addressable. Talking to a clinician or psychologist who has worked with this many times is the start.
Consider booking if:
The earlier you come, the simpler the conversation and the better the outcome typically is.
Absolutely. Medical confidentiality applies. You can choose whether we write to your NHS GP — many men prefer we don’t initially, and that’s fine. Records are held in line with UK GDPR. See our Privacy Policy.
30 minutes for the initial consultation. Long enough to have the full conversation without rushing, short enough to fit a lunchtime.
Sometimes a brief examination is appropriate, but not always. If examination is suggested, you’ll be told what’s involved, asked for consent, and offered a chaperone. You can decline any examination.
Often yes. For many men, after assessment we can prescribe at the first visit. For others, we wait for blood test results before deciding the best approach.
Many men with heart conditions can still be treated for ED, but some medications interact with cardiac medications. We assess this carefully and where needed liaise with your cardiologist.
Many online services are reputable but some sell medication without proper assessment. The risk is that you miss treatable underlying conditions (especially cardiovascular). A proper one-off in-person assessment, then potentially ongoing online repeat prescription, is a sensible approach.
Current consultation prices are on our Fees page. Blood tests are quoted before they’re done. Medication costs vary by treatment chosen and are discussed in consultation.
Your decision. Many men come for an initial consultation alone before deciding what to share with their partner. Others bring their partner from the start. Both approaches work.
Care at MHW Clinic is delivered by a small clinical team, with Dr Haydar Bolat as Clinical Director. The specific clinicians involved in your care depend on the plan agreed with you at consultation.
UK-registered GP and Clinical Director at MHW. Provides confidential men’s health consultations including ED assessment, cardiovascular screening, and treatment discussion. All consultations are private and discreet.
View profileLanguages spoken across the team: English, Turkish, Bulgarian, Bengali, Hindi, Albanian, Azerbaijani, German, Romanian. We can also arrange professional telephone interpreters in most other languages at no extra cost. More on languages and interpreters →
This page was reviewed by Dr Haydar Bolat, Clinical Director at MHW Clinic. Content is based on NICE Clinical Knowledge Summaries (CKS) for Erectile Dysfunction, British Society for Sexual Medicine (BSSM) guidance, and current UK clinical practice and current UK clinical practice. It is updated when guidance changes. Educational information only — not a substitute for clinical assessment.
Book a confidential consultation with a GP who has seen this many times before. No judgement, no awkwardness, no rush.