There are many euphemisms for erectile dysfunction - ‘I can’t get it up, doc’, or ‘it’s stopped working down there’ - this is because the problem is both difficult to talk about and extremely common.

So what exactly is Erectile Dysfunction? And perhaps more importantly, what causes it?

As the name suggests, it’s an issue of either achieving or maintaining an erection. It's difficult to know exactly how many people are affected by ED - unsurprisingly not everyone seeks medical attention for it - but it’s thought that approximately half of men between 40 and 70 years of age have at some point experienced the problem in some form. It’s even more common in men older than this.

In the first instance it can be useful to define the extent of the problem. A lot of men will find it difficult to achieve an erection from time to time, and this is usually a result of being stressed, tired, distracted, or having drunk too much alcohol.

For some men, though, the issue is more than a temporary inconvenience. It's a common misconception that ED is solely a psychological issue. While emotional factors can certainly play a role, the truth is that the majority of cases - thought to be as high as 80% - stem from underlying physical causes. By considering the various physical causes of ED, we can better understand how best to address it.

A blood test can be a valuable investigation in the first instance.

Testosterone, the hormone primarily produced in the testicles, plays a pivotal role in male sexual function. Inadequate levels of testosterone can directly contribute to erectile difficulties, and a simple blood test, best performed in the morning when levels peak, can accurately assess this. If low testosterone is identified, addressing this deficiency can lead to significant improvements in erectile function.

Reduced blood flow to the penis, a common side effect of aging, is another physical cause. As men age, blood vessels tend to narrow and become less flexible, impeding the vital flow of blood to the erectile tissues and this is why ED becomes more common in older men. However, it's important to note that other factors beyond age contribute to impaired blood flow, such as diabetes, high blood pressure, and even certain medications.

A blood test can also assess your cholesterol level, and screen for early signs of diabetes. These are important risk factors for cardiovascular disease. The cardiovascular disease that causes impaired blood flow to organs such as the heart and brain may also underlie the blood flow problems to the penis in erectile dysfunction. This is why doctors see ED as a possible sign of cardiovascular disease elsewhere in the body. 

Doctors will also usually check a Prostate Specific Antigen (PSA) level. PSA is a blood test used to help screen for prostate cancer which can occasionally be a cause of erectile problems. 

There are treatments available for erectile issues, many of which can be purchased from your local pharmacy, but having an understanding of what is causing the problem is vital when considering how best to deal with it.

Whilst ED is not a reason to panic - the anxiety related to the condition often serves only to exacerbate it - it’s also important not to ignore the symptom if it is happening on a regular basis.

So what would be my takeaway messages when it comes to Erectile Dysfunction? Firstly, that it’s common, even if it’s unlikely to be top of anyone’s list of conversation topics. Secondly, whilst there is without doubt a significant psychological element to the condition, it’s worth considering whether there may be an underlying cause that warrants investigation.

Contrary to what men are often advised, this may be one situation where it may, in fact, be worth listening to your penis.