What is erectile dysfunction?

Erectile dysfunction (ED) is the consistent or recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is common — affecting approximately 40% of men at 40 and increasing with age — and has both physical and psychological causes. Physical causes include cardiovascular disease, diabetes, hypertension, hypogonadism, and medication side effects. Psychological causes include performance anxiety, depression, and relationship difficulties. Often both dimensions contribute.

Is ED a sign of cardiovascular disease?

ED is now recognised as an early marker of cardiovascular risk. The penile arteries are smaller than coronary arteries and tend to develop atherosclerotic changes earlier — ED may precede other cardiovascular symptoms by 3–5 years. New-onset ED, particularly in younger or middle-aged men, warrants cardiovascular risk assessment including blood pressure, lipid profile, and blood glucose testing.

What complementary approaches may help with ED?

Pelvic floor physiotherapy has good evidence — pelvic floor exercises can produce significant improvement in ED and are recommended as first-line by some guidelines. Exercise generally, particularly aerobic exercise, improves vascular health and testosterone levels. Mindfulness and sex therapy address the performance anxiety and psychological components. Nutritional approaches addressing metabolic and hormonal contributors may also be relevant.

When should ED be medically investigated?

New-onset ED — particularly in men under 50, or those without obvious psychological triggers — warrants medical assessment to investigate cardiovascular, hormonal (testosterone, thyroid), and metabolic causes. Medication review is also important, as many common drugs (antihypertensives, antidepressants, antiandrogens) can contribute to ED.

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Reviewed by Dr. Ian Henderson · Microbiobial Health & Medicine26 March 2026Emerging evidence

Quick answer

Erectile dysfunction is difficulty achieving or maintaining an erection sufficient for sexual activity, with physical, vascular, hormonal, and psychological contributing factors. Lifestyle approaches — including cardiovascular health, stress management, pelvic floor physiotherapy, and nutritional support — address the most common modifiable causes.

Do any of these feel familiar?

Erectile dysfunction is experienced as a persistent or recurrent difficulty achieving or maintaining an erection sufficient for satisfying sexual activity
The experience is deeply entangled with self-concept, masculinity, and relationship dynamics — making the psychological impact often greater than the physical
Many men describe significant shame, embarrassment, and a tendency to avoid intimacy entirely rather than risk failure
Performance anxiety, once established, can itself become a primary driver of further difficulty
Partners may internalise the issue as a reflection of their attractiveness or desirability

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