Erectile dysfunction — treatment options explained
Reviewed by the My London Pharmacy clinical team, Zaynab Ali, Pharmacist Independent Prescriber
·29 July 2026
·9 min read
Quick answer
Erectile dysfunction (ED) is difficulty getting or keeping an erection firm enough for sex. It is common and often treatable. In the UK, treatment usually starts with tablets known as PDE5 inhibitors, alongside attention to any underlying health issues, following a clinical consultation.
What erectile dysfunction is
Erectile dysfunction, sometimes called impotence, means finding it hard to get or maintain an erection suitable for sexual activity. An occasional off night is completely normal and rarely a cause for concern. When the difficulty is persistent, however, it is worth looking into, both because it can affect confidence and relationships and because it can occasionally be an early sign of another health condition.
ED is very common, particularly with age, though it can affect younger men too. It is a recognised medical issue rather than something to feel embarrassed about, and a range of effective treatments is available in the UK once a clinician has reviewed your circumstances. Seeking advice early often makes the problem easier to address.
Why erectile dysfunction happens
Erections rely on healthy blood flow, working nerves, balanced hormones and a relaxed state of mind, so ED can have physical causes, psychological causes, or a mix of both.
- Physical: narrowing of the blood vessels (linked to high blood pressure, high cholesterol or diabetes), hormonal changes, nerve conditions, and the side effects of some prescription medicines.
- Psychological: stress, anxiety, low mood and relationship pressures, which can affect men of any age.
- Lifestyle: smoking, drinking heavily, being overweight and a lack of physical activity.
Because ED is sometimes linked to cardiovascular health, a clinician may check your blood pressure and ask about your general health as part of the assessment. This helps make sure any underlying issue is not missed.
Why an erection can go away too soon
A common worry is getting an erection but then losing it quickly, sometimes before or soon after penetration. This overlaps a great deal with erectile dysfunction and often comes down to the same things: an erection is kept up by holding enough blood inside the penis, so anything that interferes with that flow, or with staying relaxed, can make it fade sooner than you would like.
Anxiety is one of the most frequent reasons an erection goes away fast. Worrying about performance releases adrenaline, which works against the relaxation needed to keep blood in place, and one off occasion can then feed worry about the next. Physical factors such as the early narrowing of blood vessels, drinking alcohol before sex, tiredness, or difficulty holding blood in the penis (sometimes called venous leak) can also play a part. If losing an erection quickly happens often, it is worth discussing with a clinician, who can look at both the physical and the emotional side and suggest an approach that helps.
Tablet treatments and how they work
For most men, treatment in the UK begins with a group of tablets called PDE5 inhibitors. These work by relaxing blood vessels in the penis so that, with sexual stimulation, more blood can flow in to produce an erection. Importantly, they do not cause an automatic erection and they do not increase desire; arousal is still needed for them to work.
Several options are available, and they differ mainly in how quickly they act and how long the effect lasts. Sildenafil Tablets are a widely used starting option, typically taken around an hour before sex. Cialis or Tadalafil lasts considerably longer, which some men prefer for a more spontaneous approach, and is sometimes taken as a low daily dose. Spedra® (Avanafil) is a faster-acting option, while Vardenafil offers another alternative a clinician may suggest if a different tablet has not suited you.
These are prescription-only medicines. A clinician will check they are appropriate for you, particularly if you take nitrates for heart problems or have certain other conditions, before recommending one.
Finding the right option for you
There is no single best tablet for everyone. The right choice depends on your health, any other medicines you take, how often you expect to be sexually active, and personal preference around timing. Many men try one option and adjust with clinical guidance if it does not suit them or causes minor side effects such as headache or flushing.
It is also worth giving a treatment a fair trial. Guidance suggests a tablet should be tried several times, at the right dose and with adequate stimulation, before concluding it has not worked. A clinician can advise on getting the most from your chosen treatment and on switching if needed.
Options beyond tablets: creams, gels and more
If tablets are not suitable or not effective, several other options exist, and a clinician can talk you through which might fit your circumstances.
For men who prefer not to take a tablet, a cream can be an option. Vitaros (Alprostadil Cream) contains alprostadil, a medicine that widens blood vessels; it is applied to the tip of the penis shortly before sex rather than swallowed, which some men find helpful if they cannot take PDE5 inhibitor tablets or would rather avoid them. There is no single best cream for everyone, but an alprostadil cream such as this is the main prescription cream used in the UK, and whether it suits you depends on your health and preferences. Alprostadil also comes as a small pellet placed into the urethra and as an injection (Alprostadil Injection) given into the side of the penis; these act locally to produce an erection and are usually considered when other measures have not worked.
Among newer, non-prescription options, Eroxon Erectile Dysfunction Treatment Gel is a topical gel applied to the head of the penis that some men use for milder difficulty; it is one of the more recent additions to what is available and can be used without a prescription, though it does not suit everyone. Talking therapies remain valuable when stress, anxiety or relationship factors play a part, and are often used alongside medical treatment rather than instead of it. Where a specific underlying cause is suspected, your clinician may arrange further tests or refer you to a specialist service.
How a vacuum pump is used
A vacuum pump, sometimes called a vacuum erection device, is a mechanical option that can help produce an erection without medicines, which makes it useful for men who cannot take or would rather avoid drug treatments. It consists of a clear plastic cylinder, a hand or battery pump, and a soft constriction ring.
In practice it is used roughly like this: the cylinder is placed over the penis against the body, the pump then removes air to create a vacuum that draws blood in and produces an erection, and once firm a ring is slid from the base of the cylinder onto the base of the penis to help keep the blood in place. The cylinder is removed and the ring can usually stay on for up to about 30 minutes, but no longer, before it is taken off. It is important to follow the manufacturer's instructions and any advice from your clinician, to use the device gently, and not to leave the constriction ring on beyond the recommended time. A clinician or specialist can show you how to use a pump correctly and check it is a suitable choice for you.
Lifestyle and underlying health
Because ED and general health are closely linked, everyday changes can make a real difference and support any prescribed treatment. Stopping smoking, keeping alcohol within recommended limits, staying active, and managing weight all help the health of your blood vessels. Addressing conditions such as high blood pressure, raised cholesterol or diabetes is equally important.
Recreational drugs are worth a mention here too. Cannabis is a common question: research on smoking cannabis (weed) and erectile dysfunction is mixed rather than clear-cut, but some studies suggest regular use may be associated with more erectile difficulties, and smoking anything exposes blood vessels to substances that can affect circulation over time. Other recreational drugs, and smoking tobacco, can affect erections as well. If you use cannabis or other substances and have noticed a change, it is worth being open about it with a clinician, who can give advice without judgement.
These steps are not a substitute for treatment where it is needed, but they can improve results and benefit your wider wellbeing. Good sleep and managing stress also support both sexual and general health.
Erectile dysfunction, the prostate and cancer
A frequent and understandable worry is whether erectile dysfunction means prostate cancer, or is a sign of it. Reassuringly, ED on its own is not prostate cancer and is not usually a symptom of it. Early prostate cancer often causes no symptoms at all, and erectile difficulties much more commonly stem from blood vessel, nerve, hormonal or psychological causes than from cancer.
There are, however, some genuine links worth understanding. Treatments for prostate cancer, such as surgery to remove the prostate, radiotherapy or hormone therapy, can affect the nerves and blood supply involved in erections and are a recognised cause of ED. An enlarged prostate that is not cancer (a common condition as men age), and some of the medicines used for it, can play a role too, and ED and prostate conditions both become more common with age, so they can simply coincide. If you have urinary symptoms, blood in your urine or semen, or other concerns alongside ED, see a clinician so these can be assessed properly, not because ED usually signals cancer, but because any worrying symptom deserves a proper check.
ED and your wider health
Because reliable erections depend on healthy blood vessels, ED can occasionally be an early signal of a circulation or heart-related issue before other symptoms appear. This is one reason a clinician may look at your blood pressure, weight and general health rather than treating the symptom in isolation.
Viewed this way, seeking help for ED is not only about your sex life; it can be a useful prompt to check in on your overall health. A consultation gives you the chance to do both at once.
When to see a clinician
It is sensible to seek advice if ED is persistent, is causing you distress, or comes alongside other symptoms such as chest pain on exertion, which should be checked promptly. A consultation lets a clinician review your health, discuss the options and, where appropriate, recommend a suitable treatment discreetly.
Our clinical team can discuss erectile dysfunction in confidence and advise on treatment options that may be suitable for you, subject to a clinical assessment.
Frequently asked questions
Is erectile dysfunction common?
Yes. ED affects many men, especially with age, and it is a recognised medical condition. Effective treatments are available in the UK following a clinical assessment.
How do ED tablets work?
PDE5 inhibitor tablets relax blood vessels in the penis so more blood can flow in during sexual stimulation. They support a natural erection but do not create one without arousal.
Which ED tablet is best?
There is no single best option. The right choice depends on your health, other medicines, and how quickly and for how long you need it to work. A clinician can help you decide.
Why does my erection go away so fast?
Losing an erection quickly is closely related to ED and often has the same causes, from performance anxiety and alcohol to early changes in blood flow. If it happens regularly, a clinician can help identify why and suggest treatment.
What is the best cream for erectile dysfunction?
There is no single best cream for everyone. In the UK the main prescription option is an alprostadil cream such as Vitaros (Alprostadil Cream), applied before sex; a clinician can advise whether it is suitable for you.
What is the latest treatment for erectile dysfunction?
Options continue to broaden, from long-standing tablets to creams and newer topical gels such as Eroxon Erectile Dysfunction Treatment Gel. The most suitable choice is individual, so it is worth discussing the current options with a clinician.
Does erectile dysfunction cause prostate cancer, or is it a sign of it?
No. ED does not cause prostate cancer and is not usually a sign of it. The main links are that prostate cancer treatments can cause ED, and both become more common with age. Any worrying urinary symptoms should still be checked.
Does smoking weed cause erectile dysfunction?
The evidence is mixed, but some research links regular cannabis use with more erectile difficulties, and smoking can affect blood vessels over time. If you have noticed a change, it is worth mentioning to a clinician.
How do you use a vacuum pump for erectile dysfunction?
A cylinder is placed over the penis and a pump creates a vacuum that draws blood in; a ring is then slid to the base to maintain the erection for a limited time. Follow the instructions and ask a clinician to show you correct use.
Can erectile dysfunction be a sign of another health problem?
Sometimes. ED can be linked to conditions affecting blood vessels, such as high blood pressure, diabetes or raised cholesterol, which is why a health check forms part of the assessment.
Do lifestyle changes help with ED?
They can. Stopping smoking, moderating alcohol, staying active and managing weight all support blood vessel health and may improve how well treatment works.