Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and diclofenac are amongst the most commonly used medicines in the UK for pain and inflammation. Whilst generally safe for short-term use, questions have emerged about whether NSAIDs cause erectile dysfunction in some men. The relationship between these widely used medicines and sexual function remains an area of ongoing research, with no definitively established causal link recognised by UK regulatory bodies. This article examines the current evidence, explores potential mechanisms, and provides guidance on when to seek medical advice if you have concerns about NSAIDs and erectile function.

Understanding NSAIDs and Their Common Uses

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medicines in the UK, available both over-the-counter and on prescription. This class of medicines includes familiar names such as ibuprofen, naproxen, diclofenac, and aspirin. NSAIDs work by inhibiting cyclooxygenase (COX) enzymes, which are responsible for producing prostaglandins—chemical messengers that promote inflammation, pain, and fever.

These medicines are commonly prescribed or recommended for a diverse range of conditions. Musculoskeletal problems such as osteoarthritis, rheumatoid arthritis, back pain, and sports injuries represent the most frequent indications. NSAIDs are also used for managing headaches, dental pain, period pain (dysmenorrhoea), and post-operative discomfort. Low-dose aspirin has a distinct role in secondary prevention of cardiovascular disease—reducing the risk of further heart attacks and strokes in people who have already had a cardiovascular event or who have established cardiovascular disease. It is not generally recommended for routine primary prevention in people without known cardiovascular disease.

Whilst NSAIDs are generally effective and well-tolerated for short-term use, they are not without potential adverse effects. The MHRA and NICE guidance emphasise the importance of using the lowest effective dose for the shortest duration necessary. Common side effects include gastrointestinal disturbances such as indigestion, nausea, and in more serious cases, peptic ulcers or bleeding. Cardiovascular risks, including elevated blood pressure and increased risk of heart attack or stroke, are also recognised, particularly with long-term use or in patients with pre-existing cardiovascular disease. The cardiovascular risk varies between NSAIDs; for example, diclofenac and high-dose ibuprofen carry higher cardiovascular risk than some other NSAIDs.

Renal impairment, fluid retention, and allergic reactions represent additional concerns. Important contraindications and cautions include active or previous peptic ulcer or gastrointestinal bleeding, severe heart failure, significant renal impairment, uncontrolled hypertension, and NSAID-exacerbated respiratory disease or asthma. NSAIDs should be avoided in the third trimester of pregnancy and used earlier in pregnancy only if clinically necessary, after careful assessment of risks and benefits.

Patients at higher risk of gastrointestinal complications (such as those over 65, with a history of peptic ulcer disease, or taking certain other medicines) should be considered for gastroprotection with a proton pump inhibitor (PPI). Cardiovascular risk should be assessed before starting or continuing NSAIDs, particularly in people with cardiovascular risk factors.

A particular concern is the risk of acute kidney injury when NSAIDs are combined with an ACE inhibitor or angiotensin receptor blocker (ARB) and a diuretic—the so-called 'triple whammy'. Renal function should be monitored in at-risk patients. Patients should be advised not to take more than one NSAID at the same time, including over-the-counter and prescribed NSAIDs, unless specifically directed by a healthcare professional.

Given their widespread use across all age groups, understanding the full spectrum of NSAID effects—including potential impacts on sexual function—is important for both patients and healthcare professionals. If you experience side effects from any medicine, you can report them via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

The Link Between NSAIDs and Erectile Dysfunction

The relationship between NSAID use and erectile dysfunction (ED) remains an area of ongoing investigation, and there is no official, definitively established causal link recognised by regulatory bodies such as the MHRA or EMA. Erectile dysfunction is not listed as an adverse effect in the UK Summaries of Product Characteristics (SmPCs) for commonly used NSAIDs such as ibuprofen, naproxen, diclofenac, or aspirin. However, emerging research has raised questions about whether regular or long-term NSAID use might contribute to erectile difficulties in some men.

Erectile dysfunction is a multifactorial condition with numerous potential causes, including vascular disease, diabetes, hormonal imbalances, neurological conditions, psychological factors, and medication side effects . The challenge in establishing a clear connection with NSAIDs lies in the fact that many men taking these medicines have underlying conditions—such as chronic pain, arthritis, or cardiovascular disease—that are themselves independent risk factors for ED.

Several proposed mechanisms could theoretically explain how NSAIDs might influence erectile function. These include effects on vascular endothelial function (the health of blood vessel linings), alterations in testosterone production, impacts on nitric oxide pathways (crucial for penile blood flow), and potential effects on the prostaglandin system, which plays a role in erectile physiology. It is important to emphasise that these mechanisms are theoretical and not proven causal pathways in humans.

It is important to emphasise that not all men taking NSAIDs will experience erectile problems, and for many, these medicines can be used safely without sexual side effects. If an association exists, it appears to be small and may be more evident with regular or chronic use rather than occasional, short-term treatment. A clear dose–response relationship has not been established. Individual variation in response to medicines means that what affects one person may not affect another.

If you are taking NSAIDs and have concerns about erectile function, it is essential not to stop your medicine abruptly without medical advice, particularly if it has been prescribed for a chronic condition.

How Anti-Inflammatory Medicines May Affect Sexual Function

To understand how NSAIDs might potentially influence sexual function, it is helpful to consider the physiological mechanisms involved in achieving and maintaining an erection. Erectile function depends on a complex interplay of neurological signals, hormonal balance, psychological factors, and adequate blood flow to the penile tissues.

NSAIDs exert their therapeutic effects by inhibiting COX enzymes, which reduces prostaglandin synthesis. Whilst this mechanism effectively reduces inflammation and pain, prostaglandins also have roles beyond inflammation. Some prostaglandins are involved in vascular regulation and smooth muscle relaxation—processes that are essential for penile erection. By broadly suppressing prostaglandin production, NSAIDs could theoretically interfere with these normal physiological functions, though the clinical significance of this for erectile function remains uncertain.

Another proposed mechanism involves the impact of NSAIDs on endothelial function. The endothelium (the inner lining of blood vessels) produces nitric oxide, a critical molecule that triggers the relaxation of smooth muscle in penile arteries, allowing increased blood flow during sexual arousal. Some research suggests that chronic NSAID use might impair endothelial function, potentially reducing nitric oxide availability and compromising erectile capacity. However, the clinical relevance of these findings to erectile dysfunction in humans is not yet established.

There is also evidence suggesting that certain NSAIDs may influence testosterone levels. Some studies, including research published in the Proceedings of the National Academy of Sciences (PNAS) in 2018, have indicated that regular use of ibuprofen and other NSAIDs might affect testicular function and hormone production. However, the clinical significance of these findings for erectile function remains uncertain, and more research is needed to understand the long-term implications.

Additionally, NSAIDs can cause fluid retention and elevate blood pressure in some individuals. Hypertension is a well-established risk factor for erectile dysfunction, as it damages blood vessels and impairs the vascular responses necessary for erections. Men with pre-existing cardiovascular risk factors may be particularly vulnerable to these effects.

It is worth noting that topical NSAIDs (such as gels or creams applied to the skin) have much lower systemic absorption than oral NSAIDs and are therefore less likely to cause systemic effects, including any theoretical impact on sexual function.

Finally, pain itself—the very symptom NSAIDs are often used to treat—can significantly impact sexual function through physical discomfort, fatigue, and psychological distress. Therefore, the relationship between anti-inflammatory medicine use and sexual health is complex and bidirectional.

Research Evidence on NSAIDs and Erectile Problems

The scientific literature examining the association between NSAID use and erectile dysfunction presents a mixed picture, with studies yielding varying results. This inconsistency reflects the methodological challenges inherent in studying medicine side effects in populations with multiple confounding health factors.

Several observational studies have suggested a possible association between regular NSAID use and increased risk of erectile dysfunction. A notable study published in the Journal of Urology in 2011 (Fang and colleagues) found that men who used NSAIDs regularly (defined as most days for at least three months) had a modestly increased risk of ED compared to non-users. However, the researchers acknowledged that this association could be partially explained by the underlying conditions for which NSAIDs were being taken, rather than the medicines themselves.

Research specifically examining ibuprofen has raised concerns about potential effects on testicular function. A study published in PNAS in 2018 (Kristensen and colleagues) involving young men taking ibuprofen at doses commonly used for pain relief found temporary changes in reproductive hormone levels, suggesting a possible impact on testicular steroid production. However, these findings were based on relatively short-term use, and the long-term clinical implications for erectile function remain unclear.

Conversely, other studies have failed to demonstrate a significant link between NSAID use and erectile dysfunction when controlling for confounding variables such as age, cardiovascular disease, diabetes, and other medicines. Systematic reviews examining drug-induced erectile dysfunction have noted that whilst many medicines are implicated, the evidence for NSAIDs remains inconclusive and requires further investigation.

It is important to recognise that aspirin, often grouped with NSAIDs, has a different risk-benefit profile. Some have speculated that low-dose aspirin used for cardiovascular protection might indirectly affect erectile function by improving overall vascular health. However, this is speculative and not supported by robust evidence. Aspirin should not be started solely to prevent or treat erectile dysfunction, and any decision to use aspirin for cardiovascular prevention should be based on established clinical indications and discussed with your GP.

The current evidence suggests that if NSAIDs do contribute to erectile dysfunction, the effect is likely to be small and more evident with regular or chronic use rather than occasional short-term treatment. More rigorous, prospective studies are needed to clarify this relationship and identify which patients might be most susceptible to such effects.

When to Speak with Your GP About Medicine Side Effects

If you are taking NSAIDs and have noticed changes in your erectile function, it is important to discuss this with your GP rather than simply discontinuing your medicine. Never stop prescribed NSAIDs abruptly without medical advice, particularly if you are taking them for a chronic inflammatory condition, as this could lead to a flare-up of your underlying disease.

You should arrange an appointment with your GP if you experience:

• New or worsening erectile difficulties that coincide with starting NSAID treatment

• Persistent erectile dysfunction that affects your quality of life or relationships

• Other concerning symptoms such as reduced libido, fatigue, or mood changes

• Cardiovascular symptoms including chest pain, breathlessness, or significant swelling in your legs

Seek urgent medical attention if you experience symptoms suggesting a serious cardiovascular event, such as severe chest pain, sudden breathlessness, collapse, or loss of consciousness.

During your consultation, your GP will take a comprehensive history to identify all potential contributing factors to erectile dysfunction. This assessment typically includes reviewing your complete medicine list (as many drugs can affect sexual function), evaluating cardiovascular risk factors, checking for diabetes or hormonal imbalances, and considering psychological factors such as stress, anxiety, or depression. In line with NICE guidance, erectile dysfunction should prompt assessment of cardiovascular risk, as it can be an early marker of cardiovascular disease.

Your doctor may recommend blood tests to assess testosterone levels, glucose control, lipid profile, and kidney function. Blood pressure measurement and cardiovascular assessment are also important, as vascular health is fundamental to erectile function. Your GP may calculate your cardiovascular risk score to determine whether additional interventions are needed.

If NSAIDs are thought to be contributing to your symptoms, your GP might consider alternative pain management strategies. These could include:

• Switching to paracetamol for mild-to-moderate pain

• Using topical NSAIDs (which have lower systemic absorption)

• Exploring non-pharmacological approaches such as physiotherapy, structured exercise programmes, weight management (if appropriate), or cognitive behavioural therapy (CBT) and pain management programmes for chronic pain

• Prescribing different classes of anti-inflammatory medicine if appropriate for your condition

For men with confirmed erectile dysfunction, treatment options are available regardless of the underlying cause. These include phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil, which are often effective. Important safety information about PDE5 inhibitors includes:

• They are contraindicated with nitrates (used for angina) and must not be used with recreational nitrates ('poppers')

• Caution is needed with alpha-blockers (used for prostate problems or high blood pressure); seek medical advice if you take both

• They can interact with other medicines; always inform your doctor or pharmacist of all medicines you take

PDE5 inhibitors can be prescribed on the NHS for certain conditions, though local prescribing policies may apply. Sildenafil (Viagra Connect) is also available over-the-counter from pharmacies following a consultation with a pharmacist to ensure it is safe and appropriate for you.

Your GP can also refer you to specialist services if needed, including urology, endocrinology, or sexual health clinics, depending on the likely underlying causes identified during your assessment. If you suspect you are experiencing a side effect from any medicine, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

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