ED “is common, whether it starts later in life or has been present for years”, says Dr Ben Davis.
Half of all men will experience ED at some point in their lives. GP and clinical sexologist Dr Ben Davis outlines the treatments that can help.
Erectile dysfunction: it’s a fact of getting old, along with sagging skin and achy knees, we’ve been led to believe. But that’s false, says Dr Ben Davis, a GP and clinical sexologist at Central Health London. Erectile dysfunction (ED) “is not necessarily inevitable”, Davis says. “Plenty of men in their 70s and 80s continue to have satisfying sex lives, including good erections. Ageing doesn’t have to mean the end of sexual pleasure.”
After 10 years spent helping men to improve their sex lives at his clinical practice on Harley Street, he would know.
Davis wants to be clear that ED “is common, whether it starts later in life or has been present for years”. Half of all men will experience it at some point in their lives, and it’s a condition that is on the rise in Britain. Superdrug Online Doctor, which provides prescriptions to help with ED through online pharmacists, saw a 68% rise in demand for its services here last year. That came with a 46% increase in men aged 18-29, the age group least likely to experience ED for reasons strictly related to physical health.
While “it doesn’t mean there’s necessarily something wrong with you”, ED can be an important indicator of your overall well-being. Erection problems “can predict a heart attack or stroke by five years”, as well as being “a possible sign of testosterone deficiency and diabetes”, says Davis.
It works the other way round, too. “There has been an increase in things like metabolic disease and obesity in the past decade, both of which can make erectile dysfunction more likely,” Davis says. “But it’s just as true that life has become more stressful. I see more anxiety generally in patients, and there’s less work security, a part of life that lots of men draw validation from.”
Then there is the precarious British housing market, which has led to a third of men aged under 35 living with their parents, and a number more with their in-laws. Whether you’re the returning child or the loving but frustrated parent, “it’s very hard to be sexual when you don’t have real privacy”.
If any of this sounds familiar, the good news is that ED can be reversed with the right treatments. Here is what you need to know, from the man who really has seen it all.
Men’s testosterone levels tend to decrease as they age, at a rate of about 1% every year after 30, according to the NHS. “Testosterone is a key hormone for sexual desire and arousal. It influences key brain areas linked to sexual stimuli, as well as being important for the erections and erectile health,” Davis says. “Key symptoms of testosterone deficiency are low sexual desire, loss of morning erection, and other erection difficulties.”
While testosterone does tail off with age, there is a difference between this gradual decrease and actual testosterone deficiency. “It’s both hugely under- and over-diagnosed,” says Davis. “About one in four men have the symptoms associated with testosterone deficiency” – fatigue, low mood and low sex drive, as well as erectile problems – “but this doesn’t necessarily mean that their symptoms are caused by testosterone deficiency”.
Only 2% to 5% of men actually have abnormally low testosterone levels, recent research from private UK healthcare provider Bupa suggests, and this natural decline isn’t enough to cause erectile dysfunction on its own (though if you’re having trouble for other reasons, it may be a contributing factor – more on which below).
Despite this, “testosterone is sold as a cure-all for a whole range of men’s sexual difficulties”, Davis says. “But if you have normal levels of testosterone, then your ED is being caused by something else, and increasing your testosterone levels is unlikely to solve the problem.” You might be prescribed testosterone therapy by a doctor after a full blood test, taken on more than one occasion. It’s important to see a professional to explore all of the options first, especially if you’re planning to pay for treatment yourself.
“Some online clinics label men’s testosterone levels as being suboptimal if they’re less than 18 nanomoles per litre [nmol/L], which is well above average and unlikely to be causing symptoms,” Davis explains. “Many online clinics are focused on turning initial consultations with patients into regular testosterone subscriptions. Testosterone also has a significant placebo effect, and so men may feel better injecting testosterone, even if testosterone is really not the cause of the issue.”
The key message: don’t buy testosterone through online pharmacists alone. “The risk is that men spend money on something that doesn’t address the root causes of their problems, which can also make them feel more desperate if things don’t improve.”
Viagra was a wonder when it was approved for use in the UK in 1998. It’s now commonplace in bathroom cabinets and much less stigma-laden than it was 30 years ago. Viagra, Cialis and other similar medications improve blood flow to the penis and, therefore, “can be very helpful, particularly where the problem is being caused by damage to blood vessels”, Davis says. This is something that midlife men may well face, as it’s an issue often caused by poor cardiovascular health over a course of years or decades.
However, if you’re taking Viagra to patch over relationship problems or a lack of attraction to your partner, expect its effects to wane. These medications can help by “improving erection strength, giving you more confidence and reducing the anxiety you might have around your erections, but in the long term, if there are other underlying issues then Viagra won’t solve them”.
Although it can be helpful, Viagra on its own isn’t enough to stop heart disease. “I’ve previously had patients who have started taking Viagra in their 40s or 50s, but didn’t have a full work-up from a doctor, who went on to have a heart attack 10 years later – not because of the Viagra but because they had underlying cardiovascular disease affecting the arteries in the heart as well as the penis,” Davis says. “The blood vessels in the penis are smaller and the effects are noticeable earlier than in those around the heart. A man with erection problems is in a key window of time to prevent future heart attacks, but too often men are too ashamed to seek help.”
The little blue pill does also come with side effects when taken in the long term. Regular headaches can cause nausea, dizziness and stomach cramps. If vascular disease is your main problem when it comes to your erections, “there are other treatments like shockwave therapy which can help to stimulate the blood vessels, as well as new home devices like the Vertica, which can improve things in the medium term”, Davis says.
Erectile dysfunction can be managed through diet and exercise. “In some cases, changes here might be enough to rectify the problem,” says Davis. “Becoming more active and improving your diet can improve your cardiovascular, metabolic and pelvic health, which in turn can improve the blood flow to your penis.”
The best foods to eat to prevent or reduce erectile dysfunction are the ones that make up the Mediterranean diet, being rich in fibre, nitrates and omega 3: fatty fish, oil, nuts and seeds.
“There’s also some evidence that lycopene, found in tomatoes, can be helpful for prostate health, while we know that ultra-processed and high-sugar foods can worsen metabolic health,” Davis says.
Exercise can also give you a much-needed boost by benefiting overall circulation, improving your confidence and supporting your mental health.
That said, if the damage to your blood vessels from cardiovascular disease is extensive, then diet and exercise alone are unlikely to be enough. “Here, Viagra, or those alternatives to, it really do come in handy,” Davis says.
Some men struggle with erections even when they are alone and want to masturbate. Others struggle only in the presence of a partner. This is often a stressful and upsetting situation for both parties.
It might sound counterintuitive, but Davis suggests “pressing pause on penetrative sex for a while”. When facing sexual difficulties, many men find that masturbation can feel more relaxed and less pressured than partnered sex.
“This can be a way to reconnect with your own pleasure without performance anxiety,” but porn can “reinforce social scripts around sex that often make men feel pressured or inadequate, and make it much harder to get an erection in the moment”. It is something to be consumed with caution.
Sexual difficulties “can actually give more room to explore what really excites you and turns you on”, says Davis. While a lot of men believe that penetrative sex is really important to women, “most women don’t orgasm from penetrative sex and it’s often not as important to them as many men believe”. This is the perfect time to “experiment with different kinds of sex other than penetrative sex, as well as different kinds of touch”, for heterosexual and same-sex couples alike.
“For some men, their sexual drive is good, they’ve just lost desire for their partner, which is very common,” Davis says. This can be even tougher, and sometimes it’s down to the “doublepause”, with women going through menopause and men dealing with declining testosterone at the same time inside of a relationship.
“Maintaining sexual desire in long-term monogamous relationships can be a challenge, but there are lots of great resources out there,” says Davis, who recommends the books Mating in Captivity by psychologist Esther Perel, and Mind The Gap: The Truth about Desire and How To Futureproof Your Sex Life, by Dr Karen Gurney.
Sexual difficulties don’t have to mean the end of a relationship. “This is a really good time to have open conversations about both of your fantasies and erotic worlds, and to see which overlaps you have that you haven’t yet explored,” Davis says.
“It’s likely that there are some remaining even when you’ve been together for decades, if you are open to being curious about your and your partner’s sexual selves. A new level of intimacy can often emerge.”