Erectile Dysfunction Clinic London

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Erectile dysfunction is a symptom rather than a single disease. Explore what may be contributing to it:

What Is Erectile Dysfunction?

Erectile dysfunction means regularly having difficulty getting or maintaining an erection sufficient for sexual activity.

ED can occur occasionally, particularly during periods of stress, tiredness or increased alcohol consumption. However, persistent or worsening erectile difficulties may warrant medical assessment.

The important point is that ED is a symptom rather than a single disease.

Possible contributing factors can include:

• Reduced penile blood flow
• Cardiovascular and metabolic health
• Diabetes
• High blood pressure
• High cholesterol
• Low testosterone or other hormonal abnormalities
• Certain medications
• Smoking
• Obesity
• Stress and anxiety
• Psychological or relationship factors
• Neurological conditions
• Previous pelvic or prostate surgery

For this reason, treatment should not necessarily begin with simply choosing an ED treatment. Understanding what may be contributing to the problem can help determine the appropriate next step.

Why Can I Get an Erection but Not Maintain It?

This is one of the most common concerns men have about erectile function.

Being able to achieve an erection but repeatedly losing it can have several possible explanations.

Blood flow plays an important role because an erection requires sufficient arterial blood to enter the penis and remain there.

However, erection difficulties can also be associated with hormonal, metabolic, medication-related or psychological factors.

If this happens repeatedly, an ED assessment can help determine whether further investigation is appropriate.

Why Are My Erections Weaker Than Before?

Changes in erection firmness can occur gradually.

Age can play a role, but weaker erections should not automatically be dismissed as simply getting older.

Factors worth considering can include:

• Testosterone levels
• Blood pressure
• Cholesterol
• Blood glucose and diabetes risk
• Weight and metabolic health
• Smoking
• Alcohol consumption
• Medication
• Cardiovascular health
• Stress and sleep

A medical assessment can help identify potentially modifiable factors.

Why Have My Morning Erections Reduced?

Morning erections are influenced by several physiological factors, including sleep, hormones, neurological function and blood flow.

A reduction does not automatically mean that something is medically wrong.

However, a persistent change alongside difficulty achieving or maintaining erections may be worth discussing with a healthcare professional.

Depending on your history and symptoms, investigations may include hormone and metabolic blood testing.

Can Erectile Dysfunction Be Caused by Poor Blood Flow?

Yes.

Vascular erectile dysfunction occurs when blood flow involved in producing and maintaining an erection is impaired.

Factors associated with vascular problems can include:

• High cholesterol
• High blood pressure
• Diabetes
• Smoking
• Obesity
• Cardiovascular disease
• Reduced physical activity

Low-intensity shockwave therapy has been studied particularly in men with vasculogenic erectile dysfunction. At MDC, shockwave therapy is considered as one potential treatment option for appropriately selected patients rather than a treatment for every cause of ED. Read about Shockwave Therapy for ED in London →

Can Low Testosterone Cause Erectile Dysfunction?

Testosterone can influence libido, sexual function, energy, mood and general wellbeing.

Low testosterone may contribute to sexual symptoms in some men, although ED is not always caused by testosterone deficiency. This is why simply assuming that ED means low testosterone can be misleading.

Where clinically appropriate, MDC can investigate testosterone alongside other relevant hormones and health markers.

Can Diabetes Cause Erectile Dysfunction?

Yes.

Diabetes is an important risk factor for erectile dysfunction because persistently elevated blood glucose can affect blood vessels and nerves involved in erectile function.

Men experiencing ED may therefore benefit from assessment of metabolic health, particularly where there are other risk factors for diabetes.

Can High Cholesterol Cause Erectile Dysfunction?

High cholesterol can contribute to atherosclerosis, narrowing and damage within blood vessels.

Because erections depend heavily on healthy vascular function, cardiovascular risk factors can affect erectile function.

This is another reason why persistent ED can sometimes warrant broader health assessment rather than simply treating the erection itself.

Can Stress or Anxiety Cause Erectile Dysfunction?

Yes.

Not all ED is primarily physical.

Stress, performance anxiety, depression, relationship difficulties and other psychological factors can contribute to erection problems.

For some men, physical and psychological factors occur together.

Identifying the likely contributors helps determine which treatment pathway may be most appropriate.

Why Isn't Viagra Working Anymore?

Medications such as sildenafil (Viagra) and tadalafil (Cialis) can be effective ED treatments, but response differs between individuals.

If medication is becoming less effective, the answer is not necessarily to simply increase the dose. It may be appropriate to reassess:

• Cardiovascular risk factors
• Hormones
• Metabolic health
• Medication use
• Lifestyle factors
• The underlying cause of ED

Men who respond poorly to PDE5 inhibitor medication are also one of the groups in whom other treatment approaches may sometimes be considered. Do not stop or change prescribed medication without discussing this with an appropriate healthcare professional.

What Is Shockwave Therapy for Erectile Dysfunction?

Low-intensity extracorporeal shockwave therapy uses acoustic energy applied externally to penile tissue. It has been studied as a non-invasive treatment option for erectile dysfunction, particularly vasculogenic ED.

Unlike tablets that are generally taken around sexual activity, shockwave therapy is being investigated and used with the aim of influencing underlying vascular mechanisms involved in erectile function.

However, results vary and shockwave therapy is not appropriate for every patient or every cause of erectile dysfunction. MDC therefore recommends appropriate assessment and discussion of suitability.

Suitability should be assessed individually. Evidence has particularly examined men with vasculogenic ED, including some men with mild-to-moderate ED. A clinical assessment is important because ED caused predominantly by another mechanism may require a different approach.

Shockwave is one treatment option, not the entire ED pathway. Depending on the underlying problem, management may involve:

• Lifestyle and cardiovascular risk management
• Treatment of underlying health conditions
• PDE5 inhibitor medication
• Hormonal investigation and treatment where appropriate
• Psychological or psychosexual support
• Specialist urological assessment
• Other established ED treatments

This is why MDC focuses on assessment first and treatment selection second. For full information on how ED shockwave therapy works, who may be suitable, sessions and pricing, visit MDC's dedicated Shockwave Therapy for Erectile Dysfunction in London page →

When Should I See a Doctor About Erectile Dysfunction?

Consider seeking medical advice if:

• ED happens regularly
• Your erections have become progressively weaker
• You repeatedly lose erections during sexual activity
• ED medication has become less effective
• Morning erections have significantly changed
• You have diabetes, hypertension or cardiovascular risk factors
• You have symptoms suggesting low testosterone
• ED is affecting your confidence, wellbeing or relationship

Sudden erectile dysfunction associated with other concerning symptoms should be medically assessed promptly.

Specialist ED Care with Mr Giulio Garaffa

MDC's erectile dysfunction pathway is supported by Mr Giulio Garaffa, Consultant Urological Surgeon, with specialist expertise in andrology, male sexual medicine and erectile dysfunction.

Rather than treating ED as an isolated symptom, our pathway can combine specialist assessment with appropriate investigations including hormone testing, metabolic and cardiovascular risk markers, sexual health testing and other diagnostic assessment where clinically indicated.