Erectile Dysfunction: Causes, Treatment and Safe Use of ED Tablets

It is one of the most common men’s health problems, and one of the least discussed. Erectile dysfunction (ED) affects millions of men, and many suffer in silence for years out of embarrassment, or turn to roadside hakeems and secret pills sold in the bazaar. It is not a character flaw and not a normal part of ageing that you must accept. It is a medical condition with identifiable causes, and often it is the first warning of a more serious health problem.

What is erectile dysfunction?

ED means being repeatedly unable to get, or keep, an erection firm enough for satisfying sex, for three months or more. Having trouble now and then, because of stress, tiredness or alcohol, is normal and not ED. It becomes more common after 40, but can affect younger men too.

Causes

Physical causes are behind most cases:

• Diabetes, which damages blood vessels and nerves
• High blood pressure and high cholesterol, which narrow the arteries
• Heart disease and obesity
• Smoking, including shisha, and heavy alcohol use
• Low testosterone, thyroid problems and kidney disease
• Prostate problems and their treatments, and spine or nerve injury
• Medicines such as some blood pressure tablets, antidepressants and others. Never stop them on your own, but speak to your doctor.
• Poor sleep, including sleep apnoea

Psychological causes are common too, alone or together with physical ones:

• Stress, performance anxiety and fear of failure, see anxiety
• Depression
• Relationship difficulties, guilt and worry about money or work

If you still get firm erections on waking, or while masturbating, the cause is more likely to be psychological. If these have disappeared, a physical cause is more likely.

Why you should not ignore it

The arteries in the penis are very small, so artery disease often shows there first, years before it causes chest pain. ED can be an early sign of hardening of the arteries and a warning of future heart attack or stroke. A man with ED who has never had his blood pressure, sugar and cholesterol checked should do so.

What the doctor will do

You will be asked, privately and respectfully, about your symptoms, health and medicines. The checks usually include blood pressure, weight, blood sugar or HbA1c, cholesterol, and sometimes testosterone and other hormone tests. You are not being judged. Doctors see this every day.

Treatment

• Lifestyle: exercise regularly, lose excess weight, stop smoking, limit alcohol and sleep well. These improve erections as well as overall health.
• Treat the underlying cause: control diabetes, blood pressure and cholesterol, and review medicines that may be contributing.
• Counselling: helpful for anxiety, depression, stress and relationship problems, alone or together with a partner.
• Tablets (PDE5 inhibitors): sildenafil and tadalafil are the common prescription medicines. They improve blood flow to the penis, but work only with sexual stimulation and do not increase desire. Tadalafil lasts longer than sildenafil. Doctors choose the right one and the right dose for you.
• Other options for those who cannot take tablets or do not respond are vacuum devices, injections or implants, prescribed by a specialist. Testosterone is only for men with proven low levels.

Safety with ED tablets

• Never take them if you use nitrate medicines such as glyceryl trinitrate (GTN) or isosorbide for chest pain, because the combination can cause a dangerous drop in blood pressure.
• Tell your doctor if you have heart disease, low blood pressure, liver or kidney disease, or take blood pressure tablets or prostate medicines such as alpha-blockers.
• Common side effects are headache, flushing, indigestion, blocked nose and dizziness.
• An erection lasting more than four hours is an emergency. Go to hospital at once.
• Stop and seek help if you have sudden loss of vision or hearing, or chest pain.
• Avoid counterfeit and unregulated products. Many “herbal” or “power” capsules, sold in markets and online, secretly contain unlisted drugs in unknown amounts and can be dangerous. Buy only prescribed medicines from a licensed pharmacy.
• Do not share tablets, and do not combine them with alcohol or recreational drugs.

Things that do not work

• Roadside advertisements, lotions, oils and miracle cures
• High-dose supplements without evidence
• Delaying a doctor’s visit out of embarrassment

When to see a doctor

• Erection problems lasting more than a few weeks or three months
• ED that begins suddenly, or after a medicine change or injury
• You have diabetes, heart disease or high blood pressure
• You have chest pain, shortness of breath or leg pain on walking
• Low mood, anxiety or relationship stress is affecting you

Key takeaways

• ED is a common, treatable medical condition and not a personal failure.
• It can be an early warning of diabetes, high blood pressure, high cholesterol or heart disease, so get a check-up.
• Lifestyle changes, treating the cause, counselling and prescription tablets help most men.
• Never use ED tablets with nitrate medicines, and avoid unregulated herbal products.

Related medicines on Medimart

These are prescribed by doctors for erectile dysfunction, only after a medical check:

• Sildenafil: a PDE5 inhibitor taken before sexual activity
• Tadalafil: a longer-acting PDE5 inhibitor

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse sexual wellness products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. Please speak to a doctor in confidence about erection problems.