Erectile dysfunction (ED) is rarely about attraction. This common medical condition affects approximately half of men aged 40–70 in the UK to some degree, yet partners often misinterpret it as a sign of reduced desire. ED is primarily a physiological or psychological health issue involving blood vessels, nerves, hormones, and mental wellbeing—not a reflection of how attractive a man finds his partner. Understanding that ED is a medical condition, similar to diabetes or hypertension, helps remove the personal interpretation that causes relationship strain. Open communication and proper medical assessment are essential for addressing both the physical symptoms and the emotional impact on relationships.

Understanding Erectile Dysfunction and Attraction

Erectile dysfunction (ED) is rarely a reflection of attraction or desire. This is one of the most important facts for partners to understand. ED is a common medical condition in the UK, with prevalence increasing with age—affecting approximately half of men aged 40–70 to some degree. The inability to achieve or maintain an erection sufficient for sexual activity is primarily a physiological or psychological health issue, not an indicator of reduced attraction to a partner.

The mechanism of achieving an erection is complex, requiring coordinated function of the nervous system, blood vessels, hormones, and psychological state. When any component of this system is disrupted, ED can occur regardless of how attracted a man feels to his partner. Clinical evidence consistently shows that men experiencing ED often report continued strong emotional and physical attraction to their partners, yet the physical response does not align with their feelings.

It is crucial to separate the physical symptom from emotional connection. Many men with ED experience significant distress precisely because they feel attracted to their partner but cannot physically respond as they wish. This disconnect can create a cycle of anxiety and avoidance that has nothing to do with the partner's desirability. Understanding that ED is a medical condition—similar to diabetes or hypertension—helps remove the personal interpretation that often causes relationship strain.

Open communication between partners is essential. When ED occurs, both individuals may make incorrect assumptions: the person experiencing ED may feel inadequate, whilst their partner may personalise the situation. Recognising ED as a health concern rather than a relationship barometer creates space for supportive dialogue and appropriate medical intervention. ED can have vascular, neurological, hormonal, psychological, or mixed causes, and proper assessment helps identify contributing factors and guide treatment.

Common Physical Causes of Erectile Dysfunction

Physical health conditions account for the majority of ED cases, particularly in men over 40. Cardiovascular disease is one of the leading causes, as erections depend on adequate blood flow to the penis. Conditions such as atherosclerosis (narrowing of blood vessels), hypertension, and high cholesterol can all impair this process. Importantly, ED can sometimes be an early warning sign of cardiovascular disease, appearing before other symptoms manifest, and warrants formal cardiovascular risk assessment.

Diabetes is another significant contributor, with studies suggesting that a substantial proportion of men with diabetes experience ED at some point. Elevated blood glucose levels can damage both blood vessels and nerves essential for erectile function. Neurological conditions including multiple sclerosis, Parkinson's disease, and spinal cord injuries can disrupt the nerve signals required for erections. Hormonal imbalances—particularly low testosterone (hypogonadism), thyroid disorders, or elevated prolactin—may also contribute, though vascular causes are more common.

Medications prescribed for other health conditions frequently cause or contribute to ED. Common examples include:

• Antihypertensive medications (particularly beta-blockers and thiazide diuretics)

• Antidepressants (especially selective serotonin reuptake inhibitors [SSRIs] and serotonin-noradrenaline reuptake inhibitors [SNRIs])

• Antipsychotics

• Medications for prostate conditions (such as finasteride and dutasteride)

• Antiandrogens

• Some first-generation antihistamines and cimetidine (an H2-receptor antagonist)

If you suspect a medicine is contributing to ED, do not stop taking it without consulting your GP. Alternative treatments may be available, and stopping certain medicines abruptly can be harmful. Your GP can review your medications and discuss options.

Lifestyle factors play a substantial role as well. Smoking damages blood vessels and reduces nitric oxide production, which is essential for erections. Excessive alcohol consumption, obesity, and lack of physical activity all contribute to ED through various mechanisms. Pelvic surgery or radiotherapy, particularly for prostate or bladder cancer, can damage nerves and blood vessels, leading to ED.

These physical causes operate independently of attraction or relationship quality, reinforcing that ED is fundamentally a health issue requiring medical assessment rather than a relationship problem. 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.

Psychological Factors Beyond Attraction

Whilst physical causes predominate, psychological factors contribute to ED in a significant minority of cases and often coexist with physical causes. However, these psychological factors rarely relate to lack of attraction. Instead, they typically involve stress, anxiety, depression, and relationship dynamics unrelated to physical desire.

Performance anxiety is particularly common and creates a self-perpetuating cycle. After experiencing ED once (which can happen to any man occasionally), worry about recurrence can trigger the stress response, releasing adrenaline that constricts blood vessels and makes erections more difficult. This anxiety is about fear of failure, not lack of attraction. Men caught in this cycle often report strong desire but overwhelming worry that prevents physical response.

Depression and generalised anxiety disorders significantly impact sexual function. These conditions can alter brain chemistry and reduce overall interest in activities that normally bring pleasure, including sex. The reduced libido and erectile difficulties stem from the mental health condition itself, not from feelings about a specific partner. Similarly, work-related stress, financial pressures, and major life changes can all contribute to ED through elevated stress hormones and mental preoccupation.

Relationship issues can contribute to ED, but these typically involve communication problems, unresolved conflicts, or intimacy issues rather than attraction. A man may feel attracted to his partner but struggle with erections due to relationship tension or fear of vulnerability. Past trauma, including sexual abuse or negative sexual experiences, can also create psychological barriers to erectile function.

The distinction between psychological and physical ED is often blurred. Many men experience a combination, where an underlying physical condition is exacerbated by anxiety about performance. Regardless of the primary cause, the presence of ED does not indicate reduced attraction, but rather highlights the need for comprehensive assessment and appropriate support.

Your GP can assess psychological factors and may refer you to NHS Talking Therapies for anxiety or depression, or to psychosexual therapy services where available locally. These services provide evidence-based support for psychological and relationship aspects of ED.

How Relationships Are Affected by Erectile Dysfunction

ED impacts relationships significantly, but the damage often comes from misunderstanding and poor communication rather than the condition itself. When partners interpret ED as rejection or lack of attraction, it creates emotional distance and resentment. The person experiencing ED may withdraw from physical intimacy entirely to avoid perceived failure, whilst their partner may feel unwanted or unattractive. This mutual misinterpretation can create a destructive cycle that erodes relationship satisfaction.

Research indicates that couples who maintain open communication about ED generally experience less relationship distress. When both partners understand that ED is a medical condition, they can work together towards solutions rather than assigning blame. Many couples report that addressing ED collaboratively actually strengthens their relationship by improving communication and emotional intimacy.

The psychological impact on the person experiencing ED should not be underestimated. Many men report feelings of inadequacy, embarrassment, and diminished masculinity. These feelings can lead to avoidance of intimate situations, reduced self-esteem, and even depression. Partners may misinterpret this withdrawal as disinterest, when it actually reflects the individual's own distress and shame about the condition.

Intimacy extends beyond penetrative sex, and couples who explore alternative forms of physical connection often maintain satisfying relationships despite ED. Focusing on mutual pleasure, emotional closeness, and non-penetrative activities can reduce performance pressure and maintain relationship bonds. Some couples find that addressing ED together leads to more varied and communicative sexual experiences.

Professional support can be invaluable for couples navigating ED. Relationship counselling or psychosexual therapy provides a safe space to discuss feelings, challenge assumptions, and develop coping strategies. NICE clinical guidance recognises the importance of addressing both the medical and relational aspects of ED, and recommends considering psychosexual therapy where psychological or relationship factors contribute. When both partners engage in the treatment process, outcomes improve significantly, and the relationship often emerges stronger and more resilient. Your GP can advise on locally available services, though availability varies across the UK.

When to Seek Medical Help for Erectile Dysfunction

Men should consult their GP if they experience persistent or recurrent erectile difficulties. Occasional erectile problems are normal and not necessarily cause for concern, but ED that occurs regularly over a period of several weeks or months warrants medical assessment. Early consultation is important because ED can be an early indicator of underlying health conditions, particularly cardiovascular disease.

A GP appointment is particularly important if ED:

• Occurs alongside chest pain, breathlessness, or other cardiovascular symptoms

• Develops suddenly rather than gradually

• Is accompanied by reduced libido, fatigue, or mood changes

• Follows starting a new medication

• Causes significant distress or relationship problems

• Occurs in younger men without obvious cause

Seek immediate medical attention if you experience:

• Chest pain during sexual activity

• An erection lasting more than 4 hours (priapism)

• Sudden loss of vision or hearing

• Acute penile injury or trauma

The GP will typically conduct a thorough assessment including medical history, physical examination, and blood tests. These investigations check for diabetes (HbA1c or fasting glucose), cardiovascular risk factors (blood pressure, lipid profile), and kidney or liver function. If you have symptoms suggesting low testosterone (such as reduced libido, fatigue, or loss of morning erections), your GP may arrange a morning blood test (ideally between 09:00 and 11:00) to measure total testosterone. If the level is low, the test will be repeated to confirm the result. Thyroid function and prolactin may be checked if clinically indicated. This comprehensive approach ensures that any underlying health conditions are identified and managed appropriately.

Treatment options vary depending on the underlying cause. Phosphodiesterase type 5 (PDE5) inhibitors—such as sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil—are first-line treatments for many men and work by enhancing blood flow to the penis. Tadalafil is available in both on-demand and daily low-dose regimens. These medications are effective for a substantial proportion of men with ED. However, they are not suitable for everyone.

Important safety information about PDE5 inhibitors:

• They must not be used if you take nitrate medicines (including glyceryl trinitrate [GTN], isosorbide mononitrate, or nicorandil) or riociguat, as the combination can cause a dangerous drop in blood pressure.

• Caution is needed if you take alpha-blockers for prostate symptoms or blood pressure, as the combination may lower blood pressure.

• Your GP will assess your cardiovascular health before prescribing, as sexual activity carries some cardiovascular risk in men with heart disease.

• Common side effects include headache, flushing, indigestion, and nasal congestion.

• Only obtain these medicines from your GP or a registered UK pharmacy (check the General Pharmaceutical Council register at gphc.org.uk). Unregulated online sources may supply counterfeit or unsafe products.

Lifestyle modifications often form an essential part of treatment. GPs may recommend smoking cessation, reducing alcohol intake, increasing physical activity, and weight loss where appropriate. For men whose ED has psychological components, referral to psychosexual therapy or counselling may be offered through NHS Talking Therapies or local services. In cases where medications are ineffective or unsuitable, other options include vacuum erection devices, penile injections, urethral suppositories, or surgical interventions. Your GP may refer you to a specialist urology service if there are structural abnormalities, if first-line treatments are ineffective, or if specialist investigation is needed. Referral to endocrinology may be arranged for confirmed hypogonadism or elevated prolactin.

Partners are encouraged to attend appointments when appropriate, as their involvement can improve treatment outcomes and relationship satisfaction. The NHS provides ED services through GP practices, with referral to specialist urology or sexual health services available when needed. Further information is available on the NHS website (nhs.uk) under erectile dysfunction. Remember that ED is a common, treatable condition, and seeking help is a positive step towards both physical health and relationship wellbeing.

Frequently Asked Questions