Erectile dysfunction is difficulty getting or keeping an erection firm enough for sex. It affects around half of men over 40 to some degree, it is almost always treatable, and it can be an early sign of heart or circulation problems, which is why it deserves a proper check rather than a prescription alone.
Erectile dysfunction is one of the most common reasons a man ends up in a urologist’s clinic, and one of the least talked about. Around half of men over 40 have some degree of it. Almost every case can be improved, and many can be resolved. Mr Vinod Nargund has treated erectile dysfunction for the whole of his career, and the first thing he will tell you is that there is nothing unusual about it.
What causes erectile dysfunction?
Erections depend on blood flow, nerves, hormones and the mind, and a problem in any one of them can cause erectile dysfunction. The most common causes are narrowed blood vessels, diabetes, high blood pressure, low testosterone, some medications, smoking, heavy drinking, and stress or anxiety. Usually more than one factor is involved, which is why a proper assessment matters more than a tablet on its own.
Why erectile dysfunction is worth taking seriously
The blood vessels in the penis are small, so they show the effects of circulation problems years before the heart does. Erectile dysfunction is now recognised as an early warning sign of cardiovascular disease, often appearing three to five years before a heart problem. A man who gets his erectile dysfunction properly assessed is also getting his heart checked, which is one of the best reasons to stop putting it off.
What happens at the consultation?
Mr Nargund will take a frank, unembarrassed history: when it started, whether it is every time or occasional, whether morning erections still happen, and what else is going on in your health and your life. He will check your blood pressure and examine you, and arrange blood tests for testosterone, blood sugar and cholesterol. In some cases an ultrasound of blood flow to the penis is useful. You will leave with a clear picture of what is causing the problem, not just a prescription.
What treatments are available?
- Tablets such as sildenafil and tadalafil work well for most men and are the usual first step, once it is confirmed they are safe for you.
- Treating the cause, which may mean adjusting another medication, correcting low testosterone, or improving blood pressure, weight and fitness. These changes often work better than men expect.
- Vacuum devices and injections for men who cannot take or do not respond to tablets.
- Penile implants, a very effective surgical option when other treatments have failed.
- Psychological support where anxiety, relationship strain or low mood are part of the picture, often alongside medical treatment.
Related problems Mr Nargund also treats
- Peyronie’s disease, where a curve or bend in the penis makes erections painful or difficult.
- Low testosterone, which causes tiredness and low sex drive as well as erectile dysfunction.
- Premature or delayed ejaculation.
Sources
British Society for Sexual Medicine guidelines on erectile dysfunction, NICE clinical knowledge summaries, and NHS patient information.
Reviewed by Mr Vinod Nargund, MBBS, PhD, FRCS(Urol), FEBU. Last updated 12 September 2026.