Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. ED is also known as impotence.

ED can have a range of causes that can be both physical and psychological (mental). Physical causes include:

• narrowing of the blood vessels going to the penis - commonly associated with high blood pressure (hypertension), high cholesterol or diabetes (a condition caused by too much glucose in the blood)
• hormonal problems

Psychological causes of ED include:

• anxiety 
• depression 
• relationship problems

How common is erectile dysfunction?

ED is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 to 70 will have some degree of ED.

Outlook

ED can have a significant impact on both your quality of life and your partner’s. However, in many cases, ED can be treated. Although you may be embarrassed, it is important that a healthcare professional diagnoses ED so that the cause can be identified.

ED is often an early sign that your blood vessels are narrowing. This can happen because they are clogged with fatty substances, such as cholesterol. As the blood vessels in your penis are a lot smaller than the blood vessels elsewhere in your body, they are often affected first.

Having narrowed blood vessels is a risk factor for cardiovascular disease (conditions that affect the heart and blood flow). Examples include:

• coronary heart disease - where the main arteries that supply your heart (the coronary arteries) become clogged 
• stroke - a very serious condition where the blood supply to your brain is interrupted 
• heart attack - a very serious condition where the blood supply to your heart is blocked

If you have ED, your GP will assess your risk of cardiovascular disease and may suggest lifestyle changes, such as losing weight, to try to reduce your risk. Making these changes is an important part of treatment for ED and may help to relieve your symptoms as well as improving your general health.

There are several other treatment options that have proved very successful for ED. Medication can be used to successfully manage it in at least two-thirds of men. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.

See Erectile dysfunction - Treatment for more information. 

Inability to get an erection

Erectile dysfunction (ED) is the inability to get and maintain an erection. Sometimes ED only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to obtain an erection with your sexual partner.

In these circumstances, it is likely that the underlying cause of ED is primarily psychological (mental). However, if you are unable to obtain an erection under any circumstances, it is likely that the underlying cause is primarily physical.

Seek medical advice

You should see your GP if ED persists for more than several weeks. They will be able to assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).

Many websites offer treatments for ED but their use is not recommended. The medications that are offered by these sites could be fake and may be dangerous. Even if the medications are genuine, they may not be suitable for you.

It is important that you only take medication for ED that your GP has prescribed for you. See Erectile dysfunction – Treatment for more information about the treatment options available.

To understand more about the possible causes of erectile dysfunction (ED) it is useful to understand how erections occur.

Erections

When you become sexually aroused, your brain sends signals to the nerves in your penis. The nerves increase the blood flow to your penis, causing the tissue to expand and harden. Therefore, anything that interferes with your nervous system or your blood circulation could lead to ED.

Anything that affects your libido (level of sexual desire) can also cause ED because a reduced libido makes it more difficult for your brain to trigger an erection. Psychological (mental) factors, such as depression, can reduce your libido, as can changes in your hormone levels (chemicals that are produced by the body).

Physical causes

There are four main types of health conditions that can cause physical problems resulting in ED. These are:

• vasculogenic - conditions that affect the flow of blood to your penis 
• neurogenic - conditions that affect your nervous system, which is made up of your brain, nerves and spinal cord
• hormonal - conditions that affect your hormone levels 
• anatomical - conditions that affect the physical structure of your penis

Vasculogenic conditions

Examples of vasuclogenic conditions that can cause ED include:

• cardiovascular disease - a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) 
• high blood pressure (hypertension)
• diabetes - a condition that is caused by too much glucose (sugar) in the blood. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition

ED is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes that your GP considers when making your diagnosis and planning your treatment.

Neurogenic conditions

Examples of neurogenic conditions that can cause ED include:

• multiple sclerosis - a condition that affects the body's actions and activities, such as movement and balance 
• Parkinson’s disease - a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
• a spinal injury or disorder
• tumours (growths)
• a stroke - a serious medical condition that occurs when the blood supply to the brain is interrupted

Hormonal conditions

Examples of hormonal conditions that can cause ED include:

• hypogonadism - a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels 
• an overactive thyroid gland (hyperthyroidism) - where too much thyroid hormone is produced
• an underactive thyroid gland (hypothyroidism) - where not enough thyroid hormone is produced 
• Cushing's syndrome - a condition that affects the production of a hormone called cortisol

Anatomical conditions

Examples of anatomical conditions that can cause ED include:

• Peyronie's disease - a condition that affects the tissue of the penis
• hypospadias - a condition that causes the urethra (the tube that carries urine from the bladder to the tip of the penis) to develop abnormally on the underside of the penis

Medicinal causes

In some men, certain medicines can cause ED, including:

• diuretics - medicines that increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease 
• antihypertensives - medicines, such as beta-blockers, that are used to treat high blood pressure
• fibrates - medicines that are used to lower cholesterol levels
• antipsychotics - medicines that are used to treat some mental health conditions, such as schizophrenia 
• antidepressants - medicines that are used to treat depression and some types of pain
• corticosteroids - medication that contains steroids, which are a type of hormone
• H2-antagonists - medicines that are used to treat stomach ulcers
• anticonvulsants - medicines that are used to treat epilepsy
• antihistamines - medicines that are used to treat allergic health conditions, such as hay fever
• anti-androgens - medication that suppresses androgens (male sex hormones) 
• cytotoxics - medication used in chemotherapy to prevent cancer cells from dividing and growing

Speak to your GP if you are concerned that a prescribed medication is causing ED. An alternative medication may be available. However, it is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional who is responsible for your care.

Psychological causes

Possible psychological causes of ED include:

• depression - feelings of extreme sadness that last for a long time
• anxiety - a feeling of unease, such as worry or fear

ED can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of ED.

There are a number of emotional issues that may also affect your physical ability to get or maintain an erection. These include:

• relationship problems, such as being unable to talk openly about any problems that you have
• lack of sexual knowledge
• past sexual problems
• past sexual abuse
• being in a new relationship 

Other causes

Other possible causes of ED include:

• excessive alcohol intake 
• tiredness
• using illegal drugs, such as cannabis, heroin or cocaine

Blood vessels

Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Cholesterol

Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Hormones

Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Testosterone

Testosterone is a male sex hormone, which is involved in making sperm and sexual characteristics such as the voice getting deeper. Testosterone is also found in small amounts in women.

Before diagnosing erectile dysfunction (ED) your GP will ask you about:

• your symptoms
• your overall physical and mental health
• your alcohol consumption
• whether you take drugs
• whether you are currently taking any medication

Sexual history

Your GP will also need to ask you detailed questions about your sexual history. Try not to be embarrassed because ED is a common problem. It should be possible to request a male GP at your doctor’s surgery if you prefer.

Your GP may ask about:

• your previous and current sexual relationships 
• what your sexual orientation is 
• how long you have been experiencing ED
• whether you can get any degree of erection with your partner, on your own or when you wake up in the morning 
• whether you have been able to ejaculate or orgasm
• your libido (your level of sexual desire)

ED that occurs all the time may suggest an underlying physical cause. If ED only occurs when you are attempting to have sex with your partner it may suggest that there is an underlying psychological (mental) cause.

Assessing your cardiovascular health

An important cause of ED is narrowed blood vessels. These are also a risk factor for cardiovascular disease (conditions that affect the heart and blood flow). Your GP may therefore assess your cardiovascular health by seeing if you have any of the risk factors for cardiovascular disease. If you do, it is likely that this is what is causing your ED.

Your GP may:

• measure your blood pressure to see if you have high blood pressure (hypertension)
• listen to your heart rate to check for any abnormalities
• measure your height, weight and waist circumference to see if you are a healthy weight for your height 
• ask you about your diet and lifestyle, for example, how much exercise you do
• test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels

If you are at risk of developing cardiovascular diseases, further tests for ED will not usually be necessary. 

Physical examinations and tests

Your GP may carry out a physical examination of your penis to rule out anatomical causes (conditions that affect the physical structure of your penis).

If you are over the age of 50, your GP may suggest that you have a digital rectal examination (DRE). This involves your GP wearing gloves and inserting a finger into your anus (back passage). A DRE can be useful for diagnosing problems with the prostate (the small gland between the penis and the bladder), such as prostate cancer.

Blood tests may also be used to check for possible underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).

Further testing

Further testing for ED is usually only required if you are unusually young to be experiencing ED. This is because ED is relatively rare in men who are under 40. Your GP may also recommend further testing to identify the exact cause of your erectile dysfunction, for example, in case of an abnormality in the blood vessels in your penis.

If it is thought that your ED is related to cardiovascular disease, these tests are rarely necessary.

Nocturnal penile tumescence and rigidity (NPTR)

A nocturnal penile tumescence and rigidity (NPTR) test involves monitoring you over two nights in hospital to see if you get an erection during the night. Most healthy men have erections when sleeping. During the test, a piece of perforated tape will be tied to the base of your penis. If you have an erection during the night, the tape will break.

A NPTR test is a useful way of determining whether ED is due to physical or psychological causes.

Intracavernous injection test

An intracavernous injection test involves injecting a synthetic (man-made) hormone into your penis to increase the blood flow to your penis. This may be used to assess any abnormalities in your penis to help plan surgery. 

If the injection fails to produce an erection it may indicate that there is a problem with the blood supply to your penis. If you do get an erection during an intracavernous injection test, it is still possible that there is a problem with your blood vessels. You may therefore need an ultrasound scan as well.

Duplex utrasound scan

A duplex ultrasound scan uses high frequency sound waves to create an image of part of the inside of your body. It can be used to measure blood flow inside your penis. See the Health A-Z topic about Ultrasound scans for more information about how they work.

Arteriography and dynamic infusion cavernosometry or cavernosography

These are specialised tests that involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are only likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.

Psychological assessment

If there may be an underlying psychological cause for your ED, your GP may refer you for a psychological assessment. This could be with:

• a psychologist - a healthcare professional who specialises in the assessment and treatment of mental health conditions
• a psychiatrist - a qualified medical doctor who has received further training in treating mental health conditions

Blood vessel

Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Cholesterol

Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Hormones

Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Testosterone

Testosterone is a male sex hormone, which is involved in making sperm and sexual characteristics such as the voice getting deeper. Testosterone is also found in small amounts in women.

If you have erectile dysfunction (ED) the treatment that you will receive will depend on the underlying cause of the condition (see Erectile dysfunction - Causes). The treatment options for ED are explained below.

Treating underlying conditions

If your ED is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first before treatment for ED can begin. In some cases, treating the underlying cause may also resolve the problem of ED.

See the Health A-Z index to find out more about the condition that you have been diagnosed with and how it will be treated.

Hormone therapy

If a hormonal condition is causing ED, you may be referred to an endocrinologist. An endocrinologist is a healthcare professional who specialises in the treatment of hormonal conditions.

Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels.

Lifestyle changes

The symptoms of ED can often be improved by making changes to your lifestyle to reduce the impact of known risk factors for ED. These include:

• losing weight if you are overweight - see the Live Well section of the website for advice about healthy food swaps and weight loss motivation  
• giving up smoking if you smoke - see the Health A-Z topic about Quitting smoking for information and advice 
• moderating your alcohol consumption - see the Health A-Z topic about Alcohol misuse for advice
• not taking illegal drugs - see the Health A-Z topic about Drug misuse for advice 
• exercising regularly - see Live Well section for advice about exercise basics and how much exercise you should be doing 
• reducing stress - see the Live Well section of the website for advice about stress management 

As well as helping to improve your ED, these types of changes can also improve your general health. For example, losing weight may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels). See the Health A-Z topic about Cardiovascular disease – Prevention for more information.  

If you are taking a medication that can cause ED and there is an alternative medicine available, your GP will discuss this with you. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional who is responsible for your care.

Phosphodiesterase-5 (PDE-5) inhibitors

Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating ED. They work by temporally increasing the blood flow to your penis.

In England, three PDE-5 inhibitors are available for treating ED. They are:

• sildenafil - sold under the brand name Viagra 
• tadalafil - sold under the brand name Cialis
• vardenafil - sold under the brand name Levitra

Sildenafil, tadalafil and vardenafil

Sildenafil and vardenafil work for about eight hours and they are designed to work "on demand". Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.

Depending on the type of PDE-5 inhibitor you are taking and the dose, you may need to take the tablet 30 minutes to an hour before sexual activity. With sildenafil and vardenafil, you should be able to have sex from one hour after taking the medicine up to eight hours later. After taking tadalafil, the effects will last for up to 36 hours.

It may take longer to notice the effects of the tablet if it is taken with food, so you should take your PDE-5 inhibitor on an empty stomach. You can then eat after an hour without affecting the medicine.

Only take one tablet within a 24-hour period.

You may have the choice of which PDE-5 inhibitor to take as sildenafil, tadalafil and vardenafil are likely to be equally effective. Your GP should explain the benefits of each medication and how it works. The choice may depend on:

• how often you are sexually active 
• whether you have tried any of the medications before

There have been many studies to test the effectiveness of sildenafil, tadalafil and vardenafil. In general, at least two-thirds of men report having improved erections after taking one of these medicines.

If you do not find that PDE-5 inhibitors are effective it may be because:

• you have not waited long enough after taking the dose
• you have waited too long after taking the dose
• the dose is not high enough
• you have not had enough sexual stimulation

These medications are triggered by sexual stimulation, so you also need to be aroused for the medication work.

Warnings

PDE-5 inhibitors should be used in caution in people who have cardiovascular disease, such as coronary heart disease (when your heart's blood supply is blocked or interrupted). However, sexual activity is also likely to be beneficial for your cardiovascular health. Your GP should discuss the risks and benefits with you and will prescribe PDE-5 inhibitors if it is safe to do so.

PDE-5 inhibitors should also be used in caution in people who have anatomical problems with their penis, such as Peyronie's disease (a condition that affects the tissue of the penis). However, this will also depend on your individual circumstances and in some cases PDE-5 inhibitors will be safe to use.

PDE-5 inhibitors should also be used with caution in people who:

• are at risk of priapism - a painful erection that lasts for several hours; for example, people who have sickle cell anaemia which causes abnormal red blood cells 
• are also taking alpha-blockers - a medication that is used to treat a number of conditions, such as high blood pressure (hypertension)

Do not take PDE-5 inhibitors if you are also taking medicines or drugs that contain nitrates. The combination of the two substances can put your heart in danger.

Organic nitrates are often used to treat angina and amyl nitrate is a recreational drug that is more commonly known as "poppers".

You are also warned not to take PDE-5 inhibitors if you:

• have been advised not to take part in sexual activity or in activities that widen your blood vessels 
• have low blood pressure (hypotension) 
• have recently had a stroke - a medical emergency that occurs when the blood supply to the brain is interrupted
• have unstable angina - an underlying heart condition that causes symptoms such as chest pain
• have had a heart attack - a medical emergency where the blood supply to the heart is suddenly blocked
• have a history of non-arteritic anterior ischaemic optic neuropathy - an eye condition that causes a sudden loss of vision

In some cases, PDE-5 inhibitors can still be used even if you are affected by one of these conditions. For example, your GP may advise that PDE-5 inhibitors are safe three to six months after a heart attack.

Side effects

PDE-5 inhibitors can cause some side effects, including:

• headaches and migraines
• flushing (redness) 
• indigestion
• nausea (feeling sick)
• vomiting (being sick)
• a blocked or runny nose
• back pain
• vision disturbances
• muscle pain

See the Medicines information tab above for more information about your medication.

NHS prescriptions

Your GP can prescribe PDE-5 inhibitors to anyone as long as it is safe to do so (see warnings above). However, in some cases you may need to pay the full cost of the medication. The exact price will depend on the dosage and your local pharmacy but, on average, four PDE-5 tablets cost around £17 to £30.

Some people are entitled to PDE-5 inhibitors on NHS prescriptions (see below). This means that you will only need to pay the prescription charge, which is around £7.20. If you are entitled to free NHS prescriptions, then it will not cost you anything. See Help with costs – Prescriptions for more information about prescription charges.

People with the following medical conditions are entitled to NHS prescriptions for PDE-5 inhibitors:

• diabetes -  a condition that is caused by too much glucose (sugar) in the blood 
• multiple sclerosis - a condition that affects the body's actions and activities, such as movement and balance 
• Parkinson’s disease - a condition that affects the way the brain co-ordinates body movements, including walking, talking and writing
• polio - a condition that can cause severe muscle paralysis (lack of movement) 
• prostate cancer - the prostate is a small gland between the penis and the bladder 
• a severe pelvic or spinal injury
• spina bifida - a series of birth defects that affect the development of the spine and nervous system
• certain genetic conditions, such as Huntington's disease

People who are receiving or who have received certain medical treatments may also be entitled to NHS prescriptions for PDE-5 inhibitors. These treatments include:

• pelvic surgery - which is often used to remove tumours (growths) or to treat conditions such as incontinence
• surgical removal of the prostate gland (prostatectomy) - which is often used to treat prostate cancer
• dialysis for kidney failure - where a machine is used to filter your blood because your kidneys can no longer perform this function
• kidney transplant - where a healthy kidney is surgically implanted into the body of someone with little or no kidney activity

You may also be entitled to a NHS prescription if you were receiving some types of ED medication on 14 September 1998 which was paid for by the NHS. This is because the availability of ED medications on the NHS was changed in 1999. However, those who had been on ED medication for some time were allowed to continue receiving it on the NHS.

In certain circumstances, some specialist centres may provide a NHS prescription for PDE-5 inhibitors - for example, if ED is causing you severe distress. The healthcare professional who is treating you will consider whether ED is:

• disrupting your daily life
• affecting your mood or behaviour
• affecting your relationships

Vacuum pumps

A vacuum pump is another treatment method for ED. It consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.

You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis in order to keep the blood in place, allowing you to maintain an erection for around 30 minutes.

It may take several attempts to learn how to use the pump correctly, but they are usually very successful. After using a vacuum pump, 9 out of 10 men are able to have sex, regardless of what causes their ED.

Considerations 

You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.

Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of people.

People who qualify for NHS prescriptions for ED treatments may be able to get a vacuum pump on the NHS (see above for more details). However, most people will need to buy one. The Sexual Advice Association produces a number of factsheets, including one on vacuum pumps that provides details of companies that supply them.

Alprostadil

If your ED does not respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.

Alprostadil is available as:

• an injection directly into your penis - this is called an intracavernosal injection
• a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) - this is called urethral application

You may to be trained in how to correctly inject or insert alprostadil. If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra.

Alprostadil will usually produce an erection after five to15 minutes. How long the erection lasts for will depend on the dose.

In men who did not respond to PDE-5 inhibitors, alprostadil intracavernosous injections were successful in 85 out of 100 men. Alprostadil that is inserted into the urethra is successful for up to two-thirds of men.

Warnings

Alprostadil should not be used:

• in people at risk of priapism (a painful erection that lasts for several hours) - for example, those with sickle cell anaemia
• alongside other ED medications 
• if you have a penile implant or if you have been advised to avoid sexual activity 

Urethral application may also not be used in:

• some people who have anatomical problems with their penis (conditions that affect the physical structure of the penis) 
• people who have infections of their penis, such as balanitis (inflammation of the head of the penis)

Side effects

Alprostadil can cause some side effects including:

• changes in your blood pressure
• dizziness
• headache
• pain in your penis 
• urethral burning or bleeding
• reactions at the site of the injection, such as swelling

See the Alprostadil medicines information for more information about this medicine.

NHS prescriptions

As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available for people with particular health conditions or those receiving some types of medical treatments. If you need to pay the full prescription cost, a single injection of alprostadil costs around £8 to £22, depending on the dose. A single dose of alprostadil for urethral application is around £10. 

Surgery

Surgery for ED is usually only recommended if all other treatment methods have failed. It may also be considered in:

• younger men who have experienced trauma (serious injury) to their pelvic area - for example, in a car accident
• men with a significant anatomical problem with their penis

In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so it is unlikely to be used.

Penile implants

Penile implants are a type of surgery that may be considered. These can be:

• semi-rigid implants - which may be suitable for older men who do not have sex regularly
• inflatable implants - which consist of two or three parts that can be inflated to give a more natural erection

Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery.

Complications

As with all types of surgery, having penile implants inserted does carry a risk of infection. If you take preventative antibiotics (medicines to treat bacterial infections), the rate of infection is around two or three in 100. Mechanical problems with the implants may occur within five years in five per cent of cases. 

Psychological treatments

If your ED has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.

If conditions such as anxiety or depression are causing your ED, you may benefit from counselling (a talking therapy).

Sensate focus

Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts).

Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. The idea is to explore your bodies knowing that you will not have sex.

After the agreed period of time has passed, you can begin touching each other’s genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex.

You can find out more about sensate focus from the British Association for Sexual and Relationship Therapy (BASRT).

Psychosexual counselling

Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your ED. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your ED.

The counsellor can also provide you with some practical advice about sex, such as foreplay techniques and how to make effective use of other treatments for ED in order to improve your sex life. See our Live Well section for information and advice about sexual arousal and good sex.

Psychosexual counselling may take time to work and the results achieved have been mixed.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have ED. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your ED - for example, to do with:

• your self-esteem (the way you feel about yourself) 
• your sexuality 
• your personal relationships

Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.

See the Health A-Z topic about Cognitive behavioural therapy for more information about this type of treatment.

Blood vessels

Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Cholesterol

Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Hormones

Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Testosterone

Testosterone is a male sex hormone, which is involved in making sperm and sexual characteristics such as the voice getting deeper. Testosterone is also found in small amounts in women.