ED has a variety of causes. For example, it can be a sign of more serious problems with your heart or blood vessels, diabetes or hormone levels, particularly if you are over 40 years old. Choosing the right treatment depends on the cause. If you haven’t previously seen a doctor about your ED, or it is a new problem, we recommend you book an appointment with your GP as a physical examination and tests may be required. The earlier any issues are detected, the more opportunity there is to improve your health for the future. During sexual arousal, nerves carry messages from the brain to the penis which causes blood vessels in the penis to relax (widen). This in turn causes more blood to flow into the penis and creates an erection. Causes of ED include: Problems with the blood vessels – factors which increase the risk of heart disease (obesity, smoking, high cholesterol, age, diabetes) also contribute to ED, however the blood vessels of the penis are smaller than those in the heart, so ED may be an early warning sign of heart disease. Problems with the nerves – diseases that affect the transmission of nerve signals from the brain to the penis can cause erectile dysfunction. For example: multiple sclerosis, spinal cord injury, damage due to diabetes. Cycling for more than 3 hours per week has been associated with ED due to pressure on the nerves. This is usually reversible (the nerves recover) over a few weeks after stopping cycling. Problems with the penis itself – deformities of the penis such as a very tight foreskin, or a condition called Peyronie’s disease can cause ED Psychological problems and relationship issues – anxiety, depression and stress can all cause ED. Relationship issues – performance anxiety with an unfamiliar partner, no longer being attracted to your partner, tiredness can all affect sexual desire, performance and the ability to get an erection. If a man is getting early morning erections as normal and is able to get an erection for masturbation, psychological or relationship issues are a more likely cause of the ED. For more advice on psychological or relationship issues leading to problems with sex, see here (link to sexual advice association). Sometimes, even when performance anxiety or stress is the root cause of the ED, it may be appropriate to use medication to achieve an erection as this can allow men to regain their confidence and feel better about themselves. Hormonal problems – low levels of the male hormone testosterone along with other hormone imbalances can cause ED, often along with other symptoms such as a reduced sex-drive. Drugs – Some medications affect sex drive and the ability to get an erection. For a list, see here. If you are experiencing ED while taking any of these medications, we recommend speaking to your doctor. The consumption of alcohol can cause difficulty getting an erection v. This may be a one-off related to a bout of heavy drinking. However, regular consumption of high levels of alcohol has a range of affects on the body that includes altering hormone levels. This can cause persistent ED