Do aspirin help erectile dysfunction? This is a question many men ask when seeking solutions for erectile problems. Whilst aspirin is widely used for cardiovascular protection due to its blood-thinning properties, there is no robust clinical evidence supporting its use as a treatment for erectile dysfunction (ED). Current NICE guidance does not recommend aspirin for managing ED. Effective, evidence-based treatments are available, including phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, lifestyle modifications, and psychological interventions. Understanding the difference between theoretical mechanisms and proven treatments is essential for safe, effective management of erectile difficulties.

Understanding Erectile Dysfunction and Its Causes

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is a common condition, particularly in men over 40, with prevalence increasing with age. Whilst occasional difficulty with erections is normal, consistent problems warrant medical attention as ED can be an early indicator of underlying cardiovascular disease.

The causes of erectile dysfunction are multifactorial and can be broadly categorised into physical, psychological, and lifestyle-related factors. Physical causes include:

• Vascular conditions – atherosclerosis, hypertension, and high cholesterol can impair blood flow to the penis

• Diabetes mellitus – damages blood vessels and nerves essential for erectile function

• Neurological disorders – multiple sclerosis, Parkinson's disease, or spinal cord injuries

• Hormonal imbalances – low testosterone, thyroid disorders, or hyperprolactinaemia

• Medications – certain antihypertensives, antidepressants (particularly SSRIs/SNRIs), antipsychotics, opioids, and 5-alpha-reductase inhibitors

• Structural abnormalities – such as Peyronie's disease (penile curvature)

Psychological factors such as anxiety, depression, relationship difficulties, and stress can also contribute significantly to ED, particularly in younger men. Often, physical and psychological causes coexist, creating a cycle where physical difficulties lead to performance anxiety, which further exacerbates the problem.

Lifestyle factors play a crucial role in erectile function. Smoking damages blood vessels, excessive alcohol consumption affects nerve function, obesity increases cardiovascular risk, and sedentary behaviour contributes to poor vascular health. Understanding these underlying causes is essential because effective treatment depends on addressing the root problem rather than simply treating symptoms. The link between ED and cardiovascular disease is particularly important – men with ED have an increased risk of heart attack and stroke, making thorough medical assessment and cardiovascular risk evaluation (such as QRISK3) vital.

How Aspirin Works in the Body

Aspirin (acetylsalicylic acid) is one of the most widely used medications globally, primarily prescribed for its antiplatelet and anti-inflammatory properties. Understanding its mechanism of action helps clarify whether it might theoretically benefit erectile function.

Aspirin works by irreversibly inhibiting the enzyme cyclooxygenase (COX), specifically COX-1 and, to a lesser extent, COX-2. This inhibition prevents the production of prostaglandins and thromboxane A2, substances involved in inflammation, pain, fever, and platelet aggregation. At low doses (typically 75mg daily in the UK), aspirin's primary effect is antiplatelet – it prevents blood cells called platelets from clumping together to form clots.

This antiplatelet action is why aspirin is routinely prescribed for secondary prevention of cardiovascular events in patients with established heart disease, previous stroke, or peripheral arterial disease. By reducing the risk of blood clots forming in narrowed arteries, aspirin helps prevent heart attacks and ischaemic strokes. Importantly, low-dose aspirin is not generally recommended for primary prevention of cardiovascular disease unless specifically advised by a healthcare professional.

Given that erectile dysfunction often shares common vascular risk factors with cardiovascular disease – namely atherosclerosis and impaired blood flow – some have theorised that aspirin's blood-thinning properties might improve penile blood flow and thus erectile function. The hypothesis suggests that by reducing platelet aggregation and potentially improving endothelial function (the lining of blood vessels), aspirin could theoretically enhance the vascular mechanisms necessary for achieving an erection, but this remains unproven for ED outcomes.

Aspirin has important contraindications and safety considerations, including active peptic ulceration or history of gastrointestinal bleeding, children under 16 years (risk of Reye's syndrome), hypersensitivity reactions including aspirin-sensitive asthma, and interactions with anticoagulants, other NSAIDs, and certain antidepressants. It is crucial to distinguish between theoretical mechanisms and clinically proven benefits. Whilst aspirin's cardiovascular benefits in secondary prevention are well-established through extensive clinical trials, its role in treating erectile dysfunction specifically requires rigorous scientific evaluation, which we shall examine in the following sections.

Evidence-Based Treatments for Erectile Dysfunction

There is no official link or robust clinical evidence supporting aspirin as an effective treatment for erectile dysfunction. Whilst some small studies have explored potential connections between aspirin use and erectile function, the evidence remains insufficient to recommend aspirin specifically for ED management. Current NICE guidance does not include aspirin as a treatment option for erectile dysfunction.

The gold-standard, evidence-based treatments for ED include:

Phosphodiesterase type 5 (PDE5) inhibitors remain the first-line pharmacological treatment. These include sildenafil, tadalafil, vardenafil, and avanafil. These medications work by enhancing the effects of nitric oxide, a natural chemical that relaxes muscles in the penis and increases blood flow during sexual stimulation. NICE recommends PDE5 inhibitors as first-line treatment, with effectiveness rates of approximately 60-70% across different patient groups. Generic sildenafil is usually available on NHS prescription for ED; other PDE5 inhibitors may be restricted by local formularies or require private prescription. Sildenafil 50mg is also available from pharmacists following a consultation (Viagra Connect).

Importantly, PDE5 inhibitors are contraindicated in patients taking nitrates or riociguat due to dangerous blood pressure drops, and caution is needed in those with unstable cardiovascular disease.

Lifestyle modifications form an essential component of ED management and can significantly improve erectile function:

• Smoking cessation

• Reducing alcohol intake to within recommended limits

• Achieving and maintaining a healthy weight

• Regular physical activity (at least 150 minutes of moderate exercise weekly)

• Managing stress and improving sleep quality

Psychological interventions, including cognitive behavioural therapy (CBT) and psychosexual counselling, are particularly valuable when psychological factors contribute to ED or when anxiety has developed secondary to physical causes.

Alternative treatments for men who cannot use or do not respond to PDE5 inhibitors include vacuum erection devices, intracavernosal injections (alprostadil), intraurethral alprostadil, and, in selected cases, penile prosthesis surgery.

Testosterone replacement therapy may be appropriate for men with confirmed hypogonadism (low testosterone levels with associated symptoms). Diagnosis requires two separate morning total testosterone measurements and assessment of luteinising hormone and prolactin levels. Testosterone alone rarely resolves ED without addressing other contributing factors.

Treatment should always be individualised following comprehensive assessment, addressing underlying cardiovascular risk factors, optimising management of conditions like diabetes and hypertension, and reviewing medications that may contribute to ED.

When to Seek Medical Advice About Erectile Problems

Men experiencing persistent erectile difficulties should seek medical advice rather than attempting self-treatment. Consulting your GP is important for several reasons: ED can be an early warning sign of serious health conditions, effective treatments are available, and proper assessment ensures safe, appropriate management.

You should contact your GP if:

• Erectile difficulties persist for more than a few weeks

• ED is causing distress or affecting your relationship

• You experience ED alongside other symptoms such as breathlessness or leg pain when walking

• You have cardiovascular risk factors (diabetes, high blood pressure, high cholesterol, smoking)

• You notice reduced morning erections or loss of libido

• ED developed after starting a new medication

Seek urgent medical attention if:

• You experience chest pain during sexual activity – call 999 immediately

• You have a painful erection lasting more than 4 hours (priapism) – attend A&E immediately

• You develop sudden erectile problems alongside neurological symptoms such as focal weakness, speech/vision changes, or perineal numbness with bladder/bowel symptoms

During your consultation, your GP will take a comprehensive medical and sexual history, which may feel sensitive but is essential for proper assessment. They will typically:

• Review your cardiovascular risk factors and general health

• Examine current medications that might contribute to ED

• Arrange blood tests including morning total testosterone (before 11am) on two separate occasions, HbA1c, fasting lipids, and possibly thyroid function and prolactin if indicated

• Measure blood pressure

• Assess for signs of cardiovascular disease

Do not take aspirin specifically for erectile dysfunction without medical advice. Whilst aspirin is available over the counter, it carries risks including gastrointestinal bleeding, particularly in those with certain medical conditions or taking other medications. Self-medicating with aspirin for ED is not evidence-based and may delay proper diagnosis and treatment.

Your GP can discuss evidence-based treatment options, address any underlying health concerns, and refer you to specialist services if needed. Remember that ED is a common, treatable condition, and seeking help is an important step towards both sexual health and overall cardiovascular wellbeing. Early intervention often leads to better outcomes and may identify cardiovascular risk factors that benefit from treatment, potentially preventing future heart disease or stroke.

If you experience side effects from any medication, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions