Erectile dysfunction (ED) is a condition where a man is unable to achieve or maintain an erection that is firm enough for sexual intercourse.


ED is a common condition. While it can be a frustrating and embarrassing condition, it is also treatable, and many men are able to resume a satisfying sex life with the help of medical treatment.

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Causes and risk factors:

ED can have many causes, both physical and psychological.

  • Physical causes include:
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Smoking
  • Obesity
  • Chronic kidney disease
  • Diabetes
  • Hormonal imbalances (e.g., low testosterone or low thyroid hormone)
  • Nerve damage (e.g., spinal cord injuries or damage to nerves due to trauma or surgery)
  • Certain medications (e.g., antidepressants and blood pressure medications) can also cause ED as a side effect 2.

Psychological causes of ED include:

  • Depression
  • Stress
  • Relationship issues
  • Anxiety, incl. “performance anxiety”
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The primary symptom of ED is the inability to achieve or maintain an erection that is firm enough for sexual intercourse. ED may be the only complaint, but it can be associated with other symptoms including a reduced sex drive, difficulty achieving orgasm, and premature ejaculation.

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To diagnose ED, a doctor will typically ask about symptoms and medical history, perform a physical exam, and may order blood tests to check your blood sugar, hormone levels, cholesterol, thyroid hormone and other factors that can contribute to ED. Often, a referral to a specialist in male health is warranted for an accurate diagnosis.

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Treatment for ED will depend on the underlying cause of the problem. For physical causes, such as heart disease or diabetes, treating the underlying condition may help improve ED symptoms.

It is essential to review chronic medication use with your doctor. Certain antihypertensives (medication used to treat blood pressure) and anti-depressants are known to cause ED, and if this is an unacceptable side effect, an alternative should be prescribed.

Medications (known as Phosphodiesterase-5 inhibitors) such as Viagra, Cialis, and Levitra can also be used to improve blood flow to the penis and help men achieve and maintain an erection. If the cause of the ED is found to be a low testosterone level, this can be administered to help manage the condition.

In some cases, an injection directly into the penis is used to improve penile firmness. Whilst this is may seem daunting, it is often hugely effective to improve ED.

Other treatment options include the use of penile vacuum/suction devices and less commonly, penile prostheses.

For psychological causes of ED, therapy and counselling can be helpful in addressing underlying issues such as anxiety or depression. Couples therapy can also be beneficial for those experiencing relationship issues 1.

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Prevention and lifestyle changes:

There are several lifestyle changes that can help prevent or improve ED symptoms. Maintaining a healthy weight, exercising regularly, getting enough sleep, reducing alcohol intake and quitting smoking can all help improve blood flow and reduce the risk of developing ED. Effective stress management is also essential in terms of sexual health

A healthy diet can help improve overall health and reduce the risk of developing conditions such as heart disease and diabetes that can contribute to ED 1.

Overall, ED is a common and treatable condition that can be caused by a variety of factors. If you are experiencing symptoms of ED, it is important to speak with your doctor to determine the underlying cause and develop an appropriate treatment plan.

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This referenced content has been reviewed by Dr Cilliers, who is a qualified medical doctor with extensive experience in the private healthcare sector of South Africa, particularly in the disciplines of emergency medicine, general practice, geriatrics, healthcare leadership, sub-acute care and physical rehabilitation.

  1. Mayo Clinic Staff. (2021). Erectile Dysfunction. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
  2. National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Erectile Dysfunction.

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