Does water help with erectile dysfunction? Many men in the UK experiencing erectile difficulties wonder whether simple lifestyle changes like increased hydration might improve their symptoms. Whilst adequate water intake is essential for overall health and cardiovascular function—both relevant to erectile capacity—the relationship between hydration and erectile dysfunction (ED) is more complex than commonly assumed. This article examines the physiological connections between hydration status and erectile function, reviews the clinical evidence, and places hydration within the broader context of evidence-based ED management recommended by NICE and NHS guidance.

Understanding Erectile Dysfunction and Hydration

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is a common condition that affects many men in the UK, with prevalence increasing with age. Whilst ED is commonly associated with cardiovascular disease, diabetes, psychological factors, and certain medications (including some antidepressants, antihypertensives, finasteride, and antipsychotics), questions often arise about whether simpler lifestyle factors—such as hydration—might play a role in erectile function.

Hydration is fundamental to numerous physiological processes, including cardiovascular function, blood pressure regulation, and tissue perfusion. The human body is approximately 60% water, and even mild dehydration can affect physical and cognitive performance. Given that erectile function depends heavily on adequate blood flow to the penile tissues, it is reasonable to consider whether hydration status might influence erectile capacity.

However, it is important to distinguish between general health optimisation and specific therapeutic interventions. Whilst maintaining adequate hydration is undoubtedly important for overall wellbeing, the relationship between water intake and erectile function is more nuanced than simple cause and effect. Understanding this relationship requires examining the physiological mechanisms underlying both hydration and erectile function, as well as reviewing the available clinical evidence.

This article explores the potential connections between hydration and erectile dysfunction, examines the physiological basis for any such relationship, and places hydration within the broader context of evidence-based ED management. Patients experiencing erectile difficulties should view hydration as one component of overall health rather than a standalone treatment.

Does Water Help with Erectile Dysfunction?

There is no official link established between increased water intake and improvement in erectile dysfunction. Whilst adequate hydration is essential for general health, clinical research has not demonstrated that drinking more water directly treats or reverses ED. The relationship between hydration and erectile function is indirect and primarily relevant in cases where significant dehydration is present.

Erectile function depends on a complex interplay of neurological, vascular, hormonal, and psychological factors. The process involves the relaxation of smooth muscle in the corpus cavernosum, increased arterial blood flow to the penis, and restriction of venous outflow—all coordinated through nitric oxide pathways and other signalling mechanisms. Water intake alone does not directly influence these specific pathways in the way that evidence-based treatments such as phosphodiesterase-5 (PDE5) inhibitors do. It's important to note that PDE5 inhibitors only facilitate erections when sexual stimulation is present.

That said, severe dehydration can theoretically impair erectile function through its effects on blood volume and cardiovascular performance. When the body is significantly dehydrated, blood volume decreases, which can reduce blood pressure and compromise tissue perfusion throughout the body, including the penile tissues. However, this scenario typically requires substantial fluid deficit—far beyond the mild dehydration that most people occasionally experience.

For men with ED, ensuring adequate hydration should be considered part of general health maintenance rather than a specific treatment. The NHS recommends drinking 6–8 glasses (approximately 1.2 litres) of fluid daily, though individual needs vary based on activity level, climate, and health status. People with heart failure, advanced kidney disease, or those on clinician-advised fluid restriction should follow their healthcare provider's guidance on fluid intake. Men experiencing erectile difficulties should focus on evidence-based interventions whilst maintaining good overall health practices, including appropriate hydration.

How Dehydration Affects Erectile Function

Dehydration occurs when fluid loss exceeds fluid intake, leading to reduced blood volume and altered electrolyte balance. The body prioritises vital organs during dehydration, potentially compromising blood flow to non-essential tissues. Whilst severe dehydration can theoretically affect erectile function, this is not a common cause of ED in clinical practice.

When dehydration reduces circulating blood volume, several physiological changes occur that could theoretically impact erectile capacity:

• Reduced blood volume: Dehydration decreases plasma volume, which can lower blood pressure and reduce the volume of blood available for penile engorgement during arousal.

• Increased blood viscosity: As fluid levels drop, blood becomes more concentrated and viscous, potentially impairing microcirculation and tissue perfusion.

• Hormonal responses: Dehydration triggers the release of vasopressin (antidiuretic hormone) and activates the renin-angiotensin-aldosterone system, causing vasoconstriction that may affect peripheral blood flow.

• Increased angiotensin II: This hormone, elevated during dehydration, causes blood vessel constriction and may counteract the vasodilation necessary for erectile function.

However, it is crucial to note that the level of dehydration required to significantly impair erectile function would typically be accompanied by other obvious symptoms, including dark urine, dizziness, rapid heartbeat, confusion, and extreme thirst. Most men with ED do not have dehydration as an underlying cause.

Chronic mild dehydration—a state some individuals may experience habitually—has not been conclusively linked to erectile dysfunction in clinical studies. Men concerned about ED should consider dehydration only if they have clear signs of inadequate fluid intake, and should seek medical evaluation to identify the actual underlying causes of their erectile difficulties. If you experience symptoms of severe dehydration (confusion, dizziness, rapid heartbeat), seek prompt medical attention.

Hydration and Blood Flow: The Connection

The relationship between hydration and blood flow is well established in cardiovascular physiology. Adequate hydration helps maintain optimal blood volume, blood pressure, and vascular function—all of which are relevant to erectile capacity, though the connection is indirect rather than causative.

Blood flow to the penis during erection increases significantly compared to the flaccid state. This requires not only functional blood vessels and intact neurological signalling but also sufficient circulating blood volume to support this increased perfusion. Hydration status influences blood volume and blood viscosity, both of which affect the cardiovascular system's ability to deliver blood efficiently throughout the body.

Some research suggests that even mild dehydration may affect endothelial function—the ability of blood vessel linings to regulate vascular tone through nitric oxide release. Since nitric oxide is the primary mediator of penile smooth muscle relaxation during erection, any factor that compromises endothelial function could theoretically affect erectile capacity. However, the clinical significance of mild dehydration's effect on endothelial function specifically in relation to ED remains unclear and unproven.

Furthermore, adequate hydration supports overall cardiovascular health, which is intimately connected to erectile function. Cardiovascular disease and ED share common risk factors and pathophysiological mechanisms, particularly endothelial dysfunction and atherosclerosis. Maintaining good hydration is one component of cardiovascular health, alongside other factors such as regular physical activity, healthy diet, smoking cessation, and blood pressure control.

Patients should understand that whilst hydration supports the cardiovascular system that enables erectile function, it is not a targeted treatment for ED. Men with erectile difficulties should focus on comprehensive cardiovascular risk factor management and evidence-based ED treatments rather than expecting hydration alone to resolve their symptoms.

Evidence-Based Treatments for Erectile Dysfunction

Effective management of erectile dysfunction requires identifying and addressing underlying causes whilst offering appropriate symptomatic treatment. NICE Clinical Knowledge Summary (CKS) on Erectile Dysfunction recommends a structured approach to ED assessment and management, beginning with thorough history-taking, physical examination, and relevant investigations.

Initial assessment should include blood pressure measurement, cardiovascular risk assessment (e.g., QRISK3), blood tests (HbA1c or fasting glucose, lipid profile), and morning total testosterone if features of hypogonadism are present. A medication review is essential to identify drugs that may contribute to ED.

First-line pharmacological treatment for ED consists of phosphodiesterase-5 (PDE5) inhibitors, including sildenafil, tadalafil, vardenafil, and avanafil. These medications work by enhancing nitric oxide-mediated smooth muscle relaxation in the corpus cavernosum, facilitating increased blood flow during sexual stimulation. PDE5 inhibitors are effective in approximately 70% of men with ED and are generally well tolerated, with common adverse effects including headache, flushing, dyspepsia, and nasal congestion.

PDE5 inhibitors are contraindicated in men taking nitrates or riociguat due to the risk of severe hypotension. Caution is needed with alpha-blockers, in patients with severe hypotension, unstable cardiovascular disease, recent myocardial infarction or stroke, and certain eye conditions including retinitis pigmentosa. Patients should seek urgent medical attention for erections lasting more than 4 hours (priapism) or sudden vision or hearing loss.

Lifestyle modifications form an essential component of ED management and may improve erectile function independently or enhance the effectiveness of pharmacological treatments:

• Weight loss: Obesity is strongly associated with ED; weight reduction can improve erectile function in overweight men.

• Physical activity: Regular exercise improves cardiovascular health and endothelial function, with evidence supporting its benefit in ED.

• Smoking cessation: Smoking damages blood vessels and is an independent risk factor for ED.

• Alcohol moderation: Excessive alcohol consumption can impair erectile function.

• Psychological interventions: Cognitive behavioural therapy or psychosexual counselling may benefit men with psychological ED or performance anxiety.

Second-line treatments include intracavernosal injections (alprostadil), intraurethral alprostadil, and vacuum erection devices. Third-line treatment involves penile prosthesis implantation for men who do not respond to other interventions.

When to seek medical advice: Men should consult their GP if they experience persistent erectile difficulties, as ED may be an early indicator of cardiovascular disease or diabetes. Referral to urology/andrology may be needed for treatment failures or structural abnormalities; to endocrinology for suspected hormonal issues; or to cardiology if high cardiovascular risk is identified. Urgent medical attention is required for priapism (erection lasting >4 hours), sudden vision or hearing loss while taking PDE5 inhibitors, or following penile trauma. Patients who experience side effects from any ED treatment should report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions