Why does erectile dysfunction (ED) occur?

For a multitude of reasons. It can be purely anxiety-based; or it maybe more of a physical problem, such as diabetes, neurological disease or specific abnormalities of the penis. The most important thing to say is that ED may be a sign of an underlying vascular problem. That's why middle-aged and elderly patients with this problem need to be taken seriously by their GPs.

Are there lifestyle changes that can help ED?

Yes. If you are obese, lose some weight. If you have high cholesterol, get it under control. If you have diabetes, the better the condition is controlled, the better the quality of your erections long-term. And exercise, which improves vascular tone. Plus, there is psycho-sexual therapy.

Are tablets available to treat ED?

There are four different types of tablets available — and although they are from the same family, and you would expect all to have the same efficacy, it doesn't always work like that. Side-effects vary, but these can include headache, a flushed face, indigestion and sinusitis. They can be a short-term or a long-term solution.

What about other treatments?

There are injections of a drug called prostaglandin into the penis; a vacuum device; a prostaglandin pellet that can be inserted into the urethra; or a cream which you pop into the tip of the penis. There is shockwave therapy, too, applied to areas of the penis, to encourage new blood vessel growth.

What about surgery?

Penile implants can inflate up and down to reflect a normal erection and satisfaction rates are very high. But it requires an operation and tends to be reserved for people who don't respond to tablets.