Erectile Dysfunction | Causes, Symptoms, and Treatments 

Erectile Dysfunction or ED is classified as a medical condition in which a man cannot get an erection firm enough for intercourse.  

In the UK, around 50-55% of men aged 40 to 70 have some degree of ED. This makes about 1 out of every 2 males in this age range, which is quite an alarming figure.   

If you are concerned about having ED, Dr Giulio Garaffa can help. Let us take a closer look at what erectile dysfunction is and how it can be treated. 

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What is Erectile Dysfunction?

Erectile dysfunction is a type of penile disorder that affects a man’s ability to achieve and maintain an erection firm enough for intercourse. Other erectile dysfunction symptoms include: 

  • Occasionally achieving an erection but not consistently. 
  • Getting an erection before intercourse but losing it too soon. 
  • Being unable to achieve an erection at all. 
  • Needing excessive stimulation to maintain firmness. 

 

Whilst it is normal to sometimes have erection issues, if this condition becomes prolonged, it can affect your confidence, stress levels, and overall quality of life. 

What is Normal Erection?

During sexual arousal, blood flow fills the penis into two erection chambers made of spongy muscle tissue. These chambers are called the corpus cavernosum. The pressure of the blood within these chambers makes the penis firm, hence leading to an erection. When you are not aroused, the penis is soft and limp.  

As a man, you must have noticed that the size of the penis changes in response to temperature fluctuations, stress, or anxiety. This is a natural process that reflects the body’s regulation of blood flow into and out of the penile tissue. Erectile dysfunction, however, happens due to different reasons. 

What’s Causing Your Erectile Dysfunction?

Erectile dysfunction isn’t just a normal part of aging. Sometimes, it is a sign that something bigger is going on. Let us take a look at the most common erectile dysfunction causes. 

Physical Causes

Your body needs healthy blood flow, balanced hormones, and proper nerve function for an erection. Certain medical conditions can interfere with this process, such as: 

  • High blood pressure (Hypertension) 
  • Diabetes 
  • Obesity 
  • Heart disease 
  • Atherosclerosis (clogged arteries) 
  • Low testosterone (testosterone deficiency) 
  • Neurological disorders like multiple sclerosis or Parkinson’s disease 
  • Past surgeries affecting the pelvic region, such as prostate surgery or radiation therapy 

  

Have you noticed any issues with blood pressure or energy levels lately? Talk to Dr Garaffa today.

Erectile Dysfunction Treatment

Psychological Causes

Your mind is just as important as your body when it comes to intimacy. Stress, anxiety, depression, or relationship problems can create a mental barrier that prevents you from achieving or maintaining an erection.  

Have you been feeling overwhelmed lately? Even performance anxiety alone can make ED worse.

Lifestyle Factors

Your daily habits play a big role in sexual health. Lack of exercise and poor sleep habits are also important factors to assess. Check the list below and identify lifestyle factors that may be contributing to this condition: 

  1. Smoking – Damages blood vessels and reduces circulation 
  2. Excessive alcohol consumption – Weakens nerve function and blood flow 
  3. Lack of exercise – Affects cardiovascular health and hormone levels 
  4. Poor sleep habits – Can lower testosterone and increase stress 
  5. Certain medications, like: 
  • Antidepressants 
  • Blood pressure medications 
  • Diuretics 
  • Antihistamines 
  • Muscle relaxers 

Types of Erectile Dysfunction

Doctors classify erectile dysfunction (ED) into four major types i.e organic, psychological, mixed, and situational. These categories help pinpoint the root cause and guide the most effective treatment approach. By identifying which type of ED you’re experiencing, we can take the right steps toward restoring your confidence and sexual health.  

1. Organic Type

Organic ED happens when something in your body is not working the way it should. This could be due to hormonal imbalances, nerve damage, or circulation issues that limit blood flow that we have talked about above.  

If you are noticing ongoing difficulties, even when you’re in the mood, an underlying health condition might be the reason. The good news? Identifying and managing the root cause can help you regain control.

2. Psychological Type

This type stems from emotional and mental factors rather than a physical problem. Your brain is just as important as your body when it comes to arousal, and stress, anxiety, or depression can disrupt the signals needed for an erection. 

Situational ED

This form of psychological ED happens only in specific situations. Maybe when you are with a new partner, under stress, or in certain environments. You might experience normal function in private or during self-stimulation but struggle during intimacy. This suggests the issue is more mental than physical. 

Note: If the cause of ED is psychological, you might still get morning erections or function fine when alone, but struggle in intimate situations. Therapy, stress management, and open communication often make a big difference in the treatment for this type. 

3. Mixed Type

Sometimes, ED isn’t just physical or psychological; it’s both. Maybe an underlying health issue started the problem, but now the stress of it happening makes things worse. Or perhaps anxiety triggered ED initially, but over time, it led to changes in blood flow or nerve function.  

Because mixed ED has multiple causes, a combination of medical treatment and lifestyle changes often works best to restore confidence and function. 

4. Medication-Induced ED

Certain medications can interfere with your body’s ability to get an erection. Blood pressure drugs, antidepressants, and even some allergy meds may be the cause. If you started having ED after beginning a new medication, it’s a good sign to get your medicines revised. Sometimes, switching to a different prescription or adjusting the dosage can solve the problem without compromising your overall health. 

How is Erectile Dysfunction Diagnosed?

Since ED can have different causes, your doctor may use a mix of questions, physical exams, and medical tests to pinpoint the issue. At Dr Garaffa’s andrology clinic, we will start by asking you a few questions related to your sexual health and lifestyle: 

  • How long have you been experiencing ED? 
  • Is it consistent or only in certain situations? 
  • Do you wake up with morning erections?  
  • Are you on any medications? 
  • Do you smoke, drink, or use recreational drugs?  

 

It is important to be open about these details so we can decide together on the best treatment approach. 

Physical Examination

At Dr Garaffa’s andrology clinic in London, we may check your blood pressure, heart rate, and testicles and penis for any abnormalities. This can reveal underlying conditions like poor circulation, hormonal imbalances, or nerve issues. Also, we will assess prostate health, especially if you’re older or have urinary symptoms. 

Blood Tests and Lab Work

To rule out medical causes, you may be asked for your blood samples to check: 

  • Testosterone levels – Low testosterone can affect libido and erection strength. 
  • Blood sugar levels – Diabetes is a major cause of ED. 
  • Cholesterol levels – High cholesterol can lead to clogged arteries and restricted blood flow. 
  • Thyroid function – Since your thyroid regulates hormones, imbalances can affect sexual function. 

Nocturnal Penile Tumescence (NPT) Test

If the cause of your ED isn’t clear, an NPT test will be suggested to check if you get normal erections whilst you sleep. Since men typically have 3–5 erections per night, a lack of these suggests a physical cause, whilst normal nighttime erections indicate a psychological factor. 

Ultrasound and Advanced Testing

For some cases, a penile Doppler ultrasound is used to check blood flow in the penile arteries. If we suspect nerve damage, we may also do advanced tests to assess how well your nerves respond to stimulation. 

Erectile Dysfunction Treatment

The right treatment for ED depends on what’s causing it. Dr Garaffa offers a range of medications, lifestyle changes, medical devices, and surgical procedures to help you regain confidence and restore normal sexual function. 

Medications and Drug Therapy

When ED stems from hormonal imbalances or circulatory issues, medication can provide an effective solution: 

  • ICI: Penile Injections – These injections help increase blood flow directly to the penis, leading to a firm and lasting erection. 
  • Testosterone Replacement Therapy (TRT) – If low testosterone is contributing to your ED, TRT can restore hormone levels and improve sexual function. 

Lifestyle and Natural Remedies

If your ED is linked to stress, poor circulation, or unhealthy habits, certain lifestyle changes can make a big difference. Regular exercise, a balanced diet, quitting smoking, and stress management can naturally boost blood flow and testosterone levels. Addressing mental health factors like performance anxiety or depression has also been clinically proven to improve erectile function. 

Devices and Medical Procedures

For those who don’t respond well to medication, medical devices and surgical treatments can offer long-term solutions: 

  • Vacuum Pump Device – Creates an erection by drawing blood into the penis and maintaining it with a constriction ring. 
  • External Shock Wave Therapy – A non-invasive treatment that stimulates new blood vessel growth for better circulation. 
  • Microsurgical Varicocele Repair – Corrects varicoceles (enlarged veins) that can affect testosterone levels and erectile function. 
  • Corporoplasty (Nesbit Procedure) – Straightens a curved penis caused by Peyronie’s disease, improving both appearance and function. 
  • Repair of Penile Rupture – Fixes injuries that impact erectile function and penile structure. 
  • Adult Circumcision & Frenuloplasty – Can relieve pain or tightness that affects sexual activity. 
  • Meatoplasty – Helps improve urinary and sexual function by widening the urethral opening. 

Emerging and Alternative Treatments

For those exploring non-traditional options, alternative therapies may provide relief: 

  • External Shock Wave Therapy – A cutting-edge treatment that enhances blood flow by stimulating tissue regeneration. 
  • Penile Injections & TRT – Whilst commonly used, these treatments are continuously evolving to become even more effective and tailored to individual needs. 

FAQs About Erectile Dysfunction

Can ED be reversed naturally?

In some cases, yes. Lifestyle changes like maintaining a healthy weight, exercising regularly, managing stress, quitting smoking, and limiting alcohol can improve erectile function. However, the effectiveness depends on the underlying cause. If ED persists, medical evaluation is necessary. 

The best treatment varies for each individual. Options include oral medications, penile injections, vacuum devices, lifestyle changes, shockwave therapy, and surgery. A thorough assessment helps determine the most effective solution. 

Not always. Whilst low testosterone can contribute to ED, other factors like poor blood flow, nerve damage, and psychological stress are often involved. A blood test can determine if testosterone replacement therapy is needed.

ED can sometimes be an early warning sign of cardiovascular issues. Both conditions involve restricted blood flow. If ED occurs suddenly or alongside other heart-related symptoms, a cardiovascular checkup is essential. 

How Dr Garaffa Can Help

No matter what’s causing your ED, there’s a solution with Dr Garaffa that fits your needsAs a leading andrological surgeon, he provides expert, compassionate care tailored to each patient’s needs. With cutting-edge treatments ranging from non-invasive therapies to advanced surgical procedures, he has helped hundreds of men regain control over their sexual health. 

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DR. GIULIO GARAFFA

LONDON’S TOP UROLOGIST

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