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In Brief
Erectile dysfunction (ED) is persistent difficulty getting or maintaining an erection firm enough for sexual activity. It is common and usually treatable. It may be related to blood-vessel health, diabetes, hormones, certain medicines, smoking, alcohol, anxiety or stress.
A medical assessment may include a sexual and medical history, blood pressure measurement, glucose and cholesterol testing, testosterone measurement and cardiovascular risk assessment.
ED does not automatically mean a man has a sperm problem. It mainly affects conception when it makes intercourse during the fertile period difficult.
You Are Not Alone in Experiencing Erectile Dysfunction
Trying to conceive can bring pressure into a relationship. For some couples, intercourse begins to feel like something that must happen at a particular time. When erections become unreliable, the experience can become stressful, and many men hesitate to discuss it.
Erectile dysfunction is also known by the older term impotence. It refers to persistent difficulty achieving or maintaining an erection suitable for sexual activity. An occasional difficulty, particularly during a stressful period, does not necessarily mean someone has ED.
Rather than relying on products advertised online as erection boosters, it is worth understanding the possible cause and discussing it with a qualified doctor.
You can learn more about the specialists and services available at Renew Healthcare.
What Causes Erectile Dysfunction?
An erection involves several systems working together. Blood flow, nerves, hormones and psychological factors all contribute. Problems affecting any of these systems can lead to erectile difficulties.
The causes can be grouped into four broad categories.
1. Blood-vessel and circulation problems
An erection depends on adequate blood flow. Conditions that affect blood vessels can therefore contribute to ED, including:
High blood pressure
High cholesterol
Diabetes
Smoking
Excess body weight
2. Nerve and hormonal factors
Nerve damage or hormonal changes may also affect erectile function. Possible factors include:
Long-standing diabetes
Low testosterone
Certain surgeries
Pelvic injuries
3. Medicines and substances
Some medicines used for blood pressure or mood conditions may affect sexual function. Alcohol, tobacco and anabolic steroids may also contribute.
Do not stop prescribed medication on your own. Discuss possible side effects and alternatives with your doctor.
4. Psychological factors
Anxiety, depression, work-related stress and pressure associated with trying to conceive can contribute to erection difficulties. Physical and psychological causes can also occur together.
Erectile Dysfunction Can Be an Early Cardiovascular Warning Sign
One important aspect of ED is its association with cardiovascular health.
The blood vessels supplying the penis are relatively narrow. Changes in blood-vessel health may therefore become noticeable through erectile difficulties.
A meta-analysis of 14 follow-up studies involving 92,757 men found that erectile dysfunction was associated with a higher risk of cardiovascular events. Across the 13 studies reporting total cardiovascular events, the pooled relative risk was 1.44.
This means an association was observed; it does not prove that ED causes heart disease, and it does not mean that every man with ED will develop a heart problem.
However, persistent ED is a reasonable reason to review blood pressure, blood sugar, cholesterol and overall cardiovascular risk with a doctor.
Which Tests Are Worth Doing for Erectile Dysfunction?
A useful assessment starts with understanding the symptoms and medical history. Not every person needs every available test.
| Assessment or test | Why it may be useful |
|---|---|
| Medical and sexual history | Helps distinguish erection difficulties from low sexual desire or ejaculation problems |
| Validated questionnaire | Helps assess the nature and severity of symptoms |
| Blood pressure and weight | Helps identify relevant cardiovascular and metabolic risk factors |
| Physical examination | May identify hormonal, vascular or local causes |
| Blood glucose | Checks for diabetes or problems with blood sugar |
| Lipid profile | Assesses cholesterol and related cardiovascular risk |
| Total testosterone | Helps identify a possible hormonal contribution |
| Cardiovascular risk assessment | Helps determine whether further heart-health evaluation is appropriate |
Are Penile Doppler and Other Special Tests Always Necessary?
No. Penile Doppler scans and nerve tests are not automatically required for every man experiencing ED. They may be considered when the medical history or examination suggests a specific cause.
Similarly, broad screening packages and repeated hormone panels are not necessarily useful for everyone.
If testosterone is found to be low, the result should be repeated and the underlying reason investigated before treatment is considered. Testosterone therapy can suppress sperm production, which is particularly important for men who are trying to conceive.
Treatment Options for Erectile Dysfunction
Treatment depends on the underlying cause, overall health, symptoms and personal circumstances. The European Association of Urology's 2026 guideline describes a personalised approach rather than a single treatment ladder.
1. Address the underlying health factors
Managing contributing conditions is an important part of treatment. This may involve:
Improving blood-sugar control
Managing blood pressure and cholesterol
Working towards a healthier weight
Reducing alcohol consumption
Stopping tobacco use
Reviewing medicines with a doctor
Lifestyle changes should not be dismissed as a minor step. In a two-year clinical trial involving 110 obese men with ED, the group receiving lifestyle intervention showed improvement in erectile-function scores compared with the control group.
2. Prescription medicines
PDE5 inhibitors are commonly used as a first-line treatment option in clinical guidelines.
However, a doctor should first assess cardiovascular health and review other medicines. These medicines are not suitable for everyone.
Important safety warning: Combining PDE5 inhibitors with nitrate medicines or recreational substances known as "poppers" is an absolute contraindication. Anyone taking these substances or medicines must discuss their situation with a doctor before considering ED medication.
Avoid buying erection tablets from unverified online sellers or taking medication without an appropriate medical assessment.
3. Psychological support and talking therapy
Anxiety, depression, relationship difficulties and performance pressure may contribute to ED. Cognitive behavioural therapy and partner-inclusive support may be appropriate alongside medical treatment when indicated.
4. Other medical options
Depending on the individual situation, a urologist may discuss options such as penile injections, vacuum erection devices or penile implants.
These options have different levels of supporting evidence and are not suitable for everyone.
Do Shockwave Therapy, PRP and Stem Cells Work?
Treatments advertised for ED sometimes include low-intensity shockwave therapy, platelet-rich plasma (PRP) injections and stem-cell procedures.
The evidence needs to be considered carefully.
Low-intensity shockwave therapy: A 2025 Cochrane review found that it may produce some improvement in erectile-function scores. However, the evidence was of low certainty, and the clinical importance of the improvement remains uncertain. Guidelines give it a weak recommendation for selected men.
PRP injections: Current guideline recommendations restrict PRP for ED to clinical-trial settings.
Stem-cell treatment: Available evidence is insufficient to establish it as a standard treatment.
Ginseng: A Cochrane review found only a trivial benefit supported by low-certainty evidence.
Online herbal capsules: The source material did not identify trial evidence supporting these products.
Be cautious of claims promising guaranteed results or presenting experimental treatments as established solutions.
Does Erectile Dysfunction Affect Getting Pregnant?
This is an important question for couples trying to conceive.
Erection and sperm production are two different biological processes. A man may experience erectile dysfunction and still have a normal semen analysis. Similarly, a man may have a low sperm count while having normal erections.
However, the two issues can overlap. Research has found that sexual dysfunction is more common among infertile men, although the studies cannot establish which condition came first.
When Can ED Affect Conception?
ED can make conception difficult when a man cannot maintain an erection or have intercourse during the fertile period.
If intercourse is not possible at the appropriate time, discussing ED treatment with a doctor may be an important first step. A fertility specialist can also explain medical options for sperm delivery when appropriate.
Ejaculation problems are different from erection problems. For example, retrograde ejaculation involves semen entering the bladder rather than travelling out through the penis.
When Should You Consider a Semen Analysis?
According to the ASRM guidance cited in the source document, a semen analysis should be considered when a couple has been trying to conceive for:
12 months if the woman is under 35.
6 months if the woman is 35 or older.
A semen analysis helps assess sperm-related factors and answers a different question from an ED assessment.
When Should You See a Doctor?
Consider a medical consultation if:
Erection difficulties continue beyond a temporary stressful period.
Symptoms are becoming more frequent or severe.
You have diabetes, high blood pressure or high cholesterol.
You smoke or have other cardiovascular risk factors.
The problem began after starting a new medicine.
You are trying to conceive and the difficulty is affecting intercourse.
If you experience chest pain or breathlessness on exertion, seek medical attention promptly, whether or not you also have erectile dysfunction.
Before your appointment, it can help to note when the symptoms began, how frequently they occur, any medicines you take and any relevant health conditions.
One useful question to ask your doctor is:
"Could my erection problem be an early sign of diabetes or heart disease, and which test should come first?"
Frequently Asked Questions
1. Is erectile dysfunction a sign of heart disease or diabetes?
Sometimes. ED can be associated with diabetes, high blood pressure, cholesterol problems and cardiovascular disease. Persistent symptoms are a good reason to review blood pressure, glucose, lipids and cardiovascular risk with a doctor. The association does not mean that every man with ED has heart disease.
2. What is the first-line treatment for erectile dysfunction?
Lifestyle and risk-factor management and prescription PDE5 inhibitors are first-line options in the European guideline. Talking therapy may also be appropriate when anxiety or psychological factors contribute. A doctor should assess heart health and other medicines before treatment.
3. Does erectile dysfunction cause infertility?
Not directly. Sperm production and erections are separate processes. ED can affect conception when intercourse is not possible during the fertile period. A semen analysis can help assess sperm-related factors.
4. Can erectile dysfunction be cured?
The outcome depends on the cause. ED associated with lifestyle factors, certain medicines or anxiety may improve when the contributing factors are addressed. Vascular or nerve-related problems may require ongoing management. No treatment can honestly guarantee the same result for everyone.
5. Do shockwave therapy, PRP or stem cells work for erectile dysfunction?
The evidence is limited. Low-intensity shockwave therapy may offer some improvement in selected men, but the certainty of evidence is low. PRP is restricted to clinical trials in the cited guideline, and evidence for stem-cell treatment remains insufficient.
6. Is it safe to buy erection tablets online?
It is safer to seek medical assessment before taking ED medication. A doctor needs to review cardiovascular health and other medicines. Combining PDE5 inhibitors with nitrate medicines or poppers is an absolute contraindication. Products from unverified sellers may also have uncertain contents.
The Bottom Line
Erectile dysfunction is common and usually treatable, but it should not be viewed only as a sexual-performance issue. It can sometimes be an early indication of problems involving blood sugar, blood pressure, cholesterol or cardiovascular health.
A focused medical assessment can help identify possible causes and determine which tests are appropriate. Lifestyle changes and prescription medicines are established treatment options, while some advertised therapies still have limited or insufficient evidence.
For couples trying to conceive, it is equally important to understand that erectile function and sperm production are different. Addressing erection difficulties and arranging a semen analysis when appropriate can help clarify the next steps.
For information about Renew Healthcare and its specialists, visit the Renew Healthcare website. You can also read the Dr. Arnab Kundu profile.
About the Doctor
Dr. Arnab Kundu
Read more about Dr. Arnab Kundu at Renew Healthcare.
For information about the clinic's services, visit Renew Healthcare.
Medical Disclaimer
This article is intended for general educational purposes and does not replace an individual medical consultation, diagnosis or treatment plan. Erectile dysfunction can have several causes, and appropriate evaluation depends on each person's medical history and symptoms. Consult a qualified healthcare professional for advice about your situation.
AI disclosure: This article was drafted with AI assistance and must be reviewed, edited and approved by the named medical reviewer before publication. Add the doctor's verified qualifications and NMR/SMR registration details before publishing.
References
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