Erectile dysfunction treatment (management of erectile dysfunction (impotence))
A step-by-step way of helping men get and keep an erection firm enough for sex, starting with lifestyle and tablets and checking for any underlying cause.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- ED treatment is a stepladder: lifestyle changes first, then tablets, then other options if needed — not just a prescription.
- ED can be an early sign of heart, circulation or diabetes problems, so a proper check matters as much as the erection itself.
- PDE5 inhibitor tablets help most men, but they need the right dose, correct timing, and sometimes a few attempts; they are not safe with certain heart medicines.
- Be cautious about online tablets and 'instant fix' clinics that skip the health check or push expensive treatments.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can restore erections firm enough for satisfying sex in most men
PDE5 inhibitor tablets are not suitable if you take nitrate medicines for angina, and need caution with some prostate and blood-pressure medicines.
Assessment, examination and blood tests, with an agreed plan. You may leave with a prescription and instructions, but no procedure to recover from.
A clear, written plan including how and when to take treatment and what to avoid
Assessment, examination and blood tests, with an agreed plan. You may leave with a prescription and instructions...
You try lifestyle changes and any tablets. Tablets may need several attempts and a dose adjustment before you know...
Underlying causes (such as blood pressure, blood sugar or low testosterone) are treated, which can gradually...
The clinician checks whether treatment is working, side effects, and whether to change dose or try another option.
What is erectile dysfunction treatment?
Erectile dysfunction (ED) means trouble getting or keeping an erection firm enough for sex. It is very common, especially as men get older, and it usually has a physical cause, a psychological cause, or both. Treatment is about helping you have erections again and, just as importantly, finding and treating anything underlying.
The first steps are not a tablet. A good clinician asks about your general health, your mood and relationships, your medicines, and your heart and circulation, because ED can be an early warning sign of heart or blood-vessel disease and of diabetes. Lifestyle changes — losing extra weight, stopping smoking, drinking less alcohol, moving more, and easing stress — can improve erections and your overall health.
If you need more, tablets called PDE5 inhibitors (such as sildenafil and tadalafil) are usually the first medicine tried, and they help most men. If tablets do not suit you or do not work, there are other options: vacuum pumps, medicine put into or onto the penis, hormone treatment if your testosterone is low, talking therapy, and, rarely, an operation to fit an implant.
This guide explains the options so you can ask better questions. It is not personal medical advice, and ED should be assessed by a clinician rather than self-treated with tablets bought online.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Comparing common ED treatments
| Option | How used | Good to know |
|---|---|---|
| PDE5 tablets | Taken before sex, or low-dose daily | First choice for most; needs arousal; avoid with nitrates |
| Vacuum pump | Pump plus ring at the base | Drug-free; can feel cumbersome |
| Alprostadil | Self-injection or pellet/cream | Reliable when tablets fail; risk of prolonged erection |
| Implant surgery | One-off operation | For severe, treatment-resistant ED; surgical risks |
Most men start with lifestyle and tablets. Other options are added if these are unsuitable or do not work, after discussion with a clinician.
Preparing for your treatment
- Be ready to discuss your general health, mood, relationship and any recent life stress, as well as the erection problem itself.
- Bring a list of all your medicines and supplements; some (and some recreational drugs) can cause or worsen ED.
- Expect questions and possibly tests about your heart and circulation, blood pressure, cholesterol, blood sugar (diabetes) and sometimes a morning testosterone blood test.
- Tell the clinician if you take nitrate medicines for angina or chest pain, or medicines for an enlarged prostate, as these affect which ED treatments are safe.
- Think about what 'success' means for you and your partner, and whether your partner can be involved in the discussion.
- Avoid buying erection tablets online before assessment; counterfeit and unsupervised tablets can be dangerous, especially with heart conditions.
What happens
Treatment usually starts in a GP surgery, sexual health clinic or urology/andrology clinic with a conversation and examination rather than a procedure. The clinician asks how the problem started, whether you still get morning erections, and about your mood, relationship and lifestyle. They may examine you and arrange blood tests for diabetes, cholesterol and sometimes testosterone, and check your blood pressure and heart risk.
Together you agree a plan. This often begins with lifestyle changes and treating any underlying condition, plus a trial of PDE5 inhibitor tablets at a suitable dose. You will be told how and when to take them and that they need sexual arousal to work. If tablets do not suit you, the clinician may teach you to use a vacuum pump or alprostadil, or refer you to a specialist. Penile implant surgery, if ever needed, is arranged through a specialist andrology service.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- PDE5 inhibitor tablets are not suitable if you take nitrate medicines for angina, and need caution with some prostate and blood-pressure medicines.
- Tablets may be unsafe shortly after a heart attack or stroke, or with very low or unstable blood pressure — a clinician must assess this.
- Testosterone treatment is not appropriate when testosterone levels are normal, and is avoided in some prostate and fertility situations.
- Treatment that ignores a sudden onset of ED in a younger man may miss an important psychological or hormonal cause.
- An online prescription with no health check is not a safe substitute for assessment.
Delay or rearrange if…
- You have unstable chest pain, recent heart attack or stroke, or uncontrolled blood pressure until reviewed.
- Your medicines have not yet been reviewed for ones that may be causing the problem.
- Heart and circulation risk has not been assessed and your symptoms suggest possible heart disease.
- There is a sudden, complete loss of erections with other symptoms (such as pelvic injury) needing urgent assessment.
- Low mood, severe stress or relationship crisis means psychological support should come first or alongside.
Alternatives to discuss
- No active treatment, if the problem is mild and not troubling you
- Lifestyle changes alone (weight, smoking, alcohol, activity, stress) as a first step
- Psychological or couples therapy where the cause is largely emotional or relational
- Treating an underlying condition (diabetes, blood pressure, low testosterone) rather than only the erection
- Switching a medicine that may be causing ED, where safe to do so
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can restore erections firm enough for satisfying sex in most men
- Finds and treats underlying causes such as diabetes, high blood pressure or low testosterone
- Can pick up early heart or circulation disease before it causes more serious problems
- Offers several options, so something usually works even if the first choice does not
- Can improve confidence, mood and relationships
Risks & complications
- Tablet side effects: headache, facial flushing, indigestion, a blocked or runny nose
- Treatment not working first time, needing a dose change or a different option
- Bruising or discomfort at the site if you use penile injections
- Feeling embarrassed or anxious discussing the problem
- Dizziness or low blood pressure with tablets, especially with other blood-pressure medicines
- Visual changes or temporary blue-tinged vision with some tablets
- Pain in the penis with alprostadil
- Vacuum pump causing bruising, numbness or a cold-feeling erection
- A painful erection lasting more than a few hours (priapism), which is an emergency
- Sudden change in vision or hearing with tablets — stop and seek urgent advice
- Serious heart-related events if tablets are taken with nitrate medicines
- Infection or mechanical failure of a penile implant (surgical option only)
The most important safety point is that PDE5 inhibitor tablets must not be combined with nitrate medicines (for angina) and need care with some prostate and blood-pressure medicines — always be honest about every medicine you take. Because ED can be an early sign of heart disease, ask your clinician whether your heart and circulation have been properly assessed, not just your erections.
Published figures to discuss
Outcomes vary widely between men because ED has many causes and different treatments suit different people. PDE5 inhibitor tablets help the majority of men, but reported response depends on the underlying cause (for example, ED after some prostate surgery or in advanced diabetes responds less well). Exact figures from clinic marketing should be treated with caution; published estimates below are broad and depend heavily on patient selection.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Response to PDE5 inhibitor tablets | Roughly two-thirds to around 80% of men respond, depending on the cause | Lower in advanced diabetes or after some pelvic/prostate surgery; needs correct dose and several attempts. | Long-term effects of PDE5 inhibitors on cardiovascular outcomes — PMC reviewncbi.nlm.nih.govPublished figure |
| Prolonged erection (priapism) with penile injection | Uncommon, but an emergency if it lasts more than a few hours | Risk is higher with injectable alprostadil than with tablets; patients must know what to do. | Long-term effects of PDE5 inhibitors on cardiovascular outcomes — PMC reviewncbi.nlm.nih.govSource-linked context |
| Penile implant satisfaction and complications | Satisfaction often reported around 90% at one year, with uncommon infection or mechanical failure | Reserved for severe, treatment-resistant ED; figures come from specialist series and vary. | Long-term effects of PDE5 inhibitors on cardiovascular outcomes — PMC reviewncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually no physical recovery from ED treatment, because most options are tablets or self-used devices. 'Recovery' here means how quickly treatment starts to help and how it is reviewed.
- Tablets not working perfectly on the first attempt before the dose or timing is adjusted
- Mild headache or flushing for a short time after taking a tablet
- Needing arousal and foreplay for tablets to work — they are not automatic
- Taking a few weeks to feel the benefit of lifestyle changes or treating an underlying cause
Aftercare
- Take tablets exactly as advised, including how long before sex and how often, and do not exceed the dose.
- Keep working on lifestyle changes, as these improve both erections and general health.
- Attend any blood-pressure, diabetes, cholesterol or testosterone follow-up the clinician arranges.
- If you use injections or pellets, follow the technique you were taught and store medicines correctly.
- Tell your clinician about side effects rather than simply stopping treatment.
- Never combine erection tablets with nitrate medicines or recreational 'poppers'.
- Seek urgent help for an erection lasting more than four hours, or sudden vision or hearing changes.
- List of all current medicines and supplements ready
- Recent blood pressure, blood sugar and cholesterol results if you have them
- Notes on when the problem started and whether morning erections still happen
- Questions about heart and circulation risk written down
- Partner involved in the discussion if you wish
- Clinic or GP contact details for follow-up saved
⚠ Get urgent help if…
- An erection that is painful or lasts more than four hours (priapism) — seek emergency care
- Sudden loss or change of vision after taking a tablet
- Sudden hearing loss or ringing in the ears after taking a tablet
- Chest pain, breathlessness or collapse, especially during or after sex — call 999
- Signs of infection (fever, spreading redness, severe pain) after penile injection or implant surgery
- Severe dizziness or fainting after taking a tablet with other blood-pressure medicines
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is reliable erections firm enough for satisfying sex, with side effects you can live with — and, just as importantly, any underlying health problem found and treated. Most men respond to tablets, but the right dose and a few attempts may be needed.
No treatment is guaranteed to work for everyone, and ED treatment does not change libido (sex drive) unless low testosterone is the cause. If one option does not help, another often will, so it is worth going back rather than giving up.
ED is often a long-term condition, so treatment usually continues rather than curing the problem once and for all. Erections may improve permanently if a reversible cause (such as a medicine side effect, heavy drinking or low testosterone) is corrected. Because the underlying causes can progress, your treatment and heart-health checks may need reviewing over time.
Related tests, treatments or support
ED treatment is often combined with managing related conditions such as diabetes, high blood pressure, high cholesterol or low testosterone, and with stopping smoking and reducing alcohol. Where stress, anxiety, depression or relationship difficulties play a part, talking therapy or couples support can be combined with physical treatments.
Follow-up & long-term care
Follow-up is usually a review with your GP or clinic to check whether treatment is working, adjust the dose, manage side effects and review your heart, blood pressure, blood sugar and (if relevant) testosterone. If symptoms started suddenly, are getting worse, or there are heart concerns, you may be referred to a urologist, andrologist or cardiologist.
- Repeat blood-pressure, blood sugar and cholesterol checks as advised
- Periodic review of testosterone if you are on hormone treatment
- Ongoing lifestyle measures (weight, smoking, alcohol, activity)
- Dose reviews of tablets and checks for new medicines that may interact
- Maintenance and eventual replacement of a penile implant, if fitted
Repeat, follow-on and what comes next
- Treatment is often adjusted: the dose of tablets may be changed, or a switch made to a different option if the first does not work.
- Men frequently move up the 'ladder' over time as ED or its causes progress.
- A penile implant can fail mechanically or become infected and may need further surgery or replacement.
- Underlying conditions may need re-treating, so ED management is rarely a one-off.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, written plan including how and when to take treatment and what to avoid
- A named route to review the dose, manage side effects and change option if needed
- Assessment and follow-up of heart, blood pressure, diabetes and (if relevant) testosterone
- Clear emergency instructions for prolonged erection or sudden vision or hearing change
- Access to psychological or relationship support where this is part of the cause
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Type of clinician seen (GP, sexual health clinic, urologist or andrologist) and length of appointment
- Investigations arranged, such as blood tests for diabetes, cholesterol and testosterone, and heart-risk assessment
- Which treatment is used — tablets, vacuum device, injectable or pellet medicine, or surgery
- Number of follow-up reviews and dose adjustments needed
- Whether talking therapy or couples support is added
- For implant surgery: surgeon and anaesthetic fees, theatre, the device itself and aftercare
- The consultation fee and what assessment and tests are included
- Which treatment is being recommended and the ongoing cost of medicines or devices
- Whether heart, diabetes and hormone checks are part of the package
- How many follow-up reviews are included and the cost of further visits
- What happens, and what it costs, if the first treatment does not work
- For surgery: the device, surgeon, anaesthetist, facility and aftercare costs, and the policy if a complication occurs
On the NHS? ED is assessed and treated on the NHS by GPs and sexual health clinics when clinically indicated; some tablets are also available from pharmacies, and private clinics are used mainly for speed, choice or a specialist opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Prescribing tablets without checking heart health, other medicines or possible underlying disease
- Not warning that tablets are dangerous with nitrate medicines or recreational 'poppers'
- Implying tablets give an automatic erection without arousal
- Skipping the option of treating the cause, lifestyle change or psychological help
- For surgery, not explaining infection, mechanical failure and that an implant is irreversible
Marketing red flags
- 'Instant cure' or 'guaranteed results' for erectile dysfunction
- Selling tablets online with no proper health assessment
- Pushing expensive 'shockwave', stem-cell or 'P-shot' treatments as proven when evidence is limited
- Promoting testosterone for ED when levels are normal
- No discussion of heart-disease risk or of safer, cheaper first-line options
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Could my erection problem be a sign of heart, circulation or diabetes problems, and have these been checked?
- Which treatment do you suggest first for me, and why?
- Are any of my current medicines causing or worsening this?
- Is it safe for me to take PDE5 inhibitor tablets given my heart health and other medicines?
- What should I do if the first treatment does not work?
- Could stress, mood or my relationship be playing a part, and would talking therapy help?
- What are the warning signs that mean I should seek urgent help?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I get ED treatment on the NHS?
Should I just buy erection tablets online?
Do the tablets give you an automatic erection?
Is ED a sign of something more serious?
What if tablets do not work for me?
Will treating my testosterone fix ED?
Can stress or relationship problems cause ED?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Erection problems (erectile dysfunction) NICE CKS — Erectile dysfunction BAUS — Penile injections for erectile dysfunction (Caverject) NHS England — Penile prostheses for end-stage erectile dysfunction Long-term effects of PDE5 inhibitors on cardiovascular outcomes — PMC review
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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