Erectile concerns: causes, assessment and GP guidance

Erectile concerns, sometimes called erectile dysfunction (ED), are common and affect men of all ages. They can be occasional or persistent and may have physical, psychological, or mixed causes.

Erection problems are often an early sign of wider health issues rather than a condition in isolation. This page explains how GPs assess erectile concerns, common causes, appropriate investigations, and when further review is important.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What counts as erectile dysfunction?

Erectile dysfunction refers to:

Difficulty achieving an erection
Difficulty maintaining an erection
Erections that are insufficient for satisfactory sexual activity

Occasional difficulties are normal. Ongoing or worsening problems usually warrant assessment.

How erections work (brief overview)

Erections depend on:

Healthy blood flow to the penis
Proper nerve signalling
Adequate hormone levels
Psychological arousal

Disruption at any of these stages can lead to erectile problems.

Common causes of erectile concerns and dysfunction

Cardiovascular and circulation-related causes

Reduced blood flow is one of the most common physical causes.

High blood pressure
High cholesterol
Diabetes
Smoking
Obesity

Erectile concerns can sometimes appear before other cardiovascular symptoms.

Psychological and emotional factors

These include:

Stress
Performance anxiety
Depression
Relationship difficulties

Psychological factors can cause erectile concerns even in physically healthy men and often interact with physical causes.

Hormonal factors

Hormones may play a role, particularly:

Low testosterone

Hormonal causes are less common than lifestyle or vascular causes and are assessed in clinical context rather than by symptoms alone.

Learn more about Testosterone blood testing here.

Neurological and medical causes

Less commonly:

Nerve damage
Pelvic surgery
Neurological conditions

Medication and substance-related causes

Certain medications can contribute, including:

Blood pressure medicines
Antidepressants
Opioids

Alcohol and recreational drug use can also worsen erectile function.

Erectile concerns as a health marker

Erectile dysfunction is sometimes described as a barometer of men’s health.

Because penile blood vessels are small, circulation problems may show up as erectile issues before heart disease becomes apparent. This is why GPs take erectile symptoms seriously, even in younger men.

Seek urgent medical advice if erectile concerns are accompanied by:

Chest pain or breathlessness
New neurological symptoms
Sudden loss of erections with other acute symptoms
Severe testicular or pelvic pain

How GPs assess erectile concerns

Assessment usually includes:

Onset and pattern of symptoms
Morning erections and libido
Relationship and psychological context
Lifestyle factors including smoking, alcohol and exercise
Medical history and medications
Cardiovascular risk assessment

This helps distinguish likely physical, psychological or mixed causes.

Blood tests that may be considered

Blood tests are not always needed but may include:

Blood glucose or HbA1c
Lipid profile
Testosterone, when clinically indicated
Thyroid function tests

Testing is targeted rather than routine and should be discussed with a GP for a full assessment.

Treatment and management options

Management depends on the underlying cause and may include:

Lifestyle changes

Improving physical activity
Weight management
Smoking cessation
Reducing alcohol intake

These changes improve erectile function and overall health.

Psychological support

Addressing anxiety, stress or relationship factors can be crucial and may involve:

Talking therapies
Couples counselling

Medication

Medication may be appropriate in some cases and is prescribed after assessment, considering:

Cardiovascular safety
Drug interactions
Underlying causes

Medication works best when combined with broader health optimisation.

Erectile difficulties are often misunderstood. They are not an inevitable part of ageing, and they are not always caused by low testosterone or psychological factors alone. In many men, erection problems reflect a combination of physical health, circulation, mental wellbeing and lifestyle factors. For this reason, erectile symptoms should not be treated in isolation or without proper assessment, as doing so risks missing underlying health issues that may benefit from earlier intervention.