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Erectile Dysfunction

Picture of Dr Afraz Adam

Dr Afraz Adam

Chief Medical Officer
MBBS. FRNZCUC

Erectile Dysfunction (ED) happens when you can’t get or maintain an erection that’s firm enough for satisfying sex. In New Zealand, many men deal with it at some point in their lives.

Overview
Symptons
Causes
Risk Factors
Diagnosis
Treatment
Prevention

Overview

Understanding Erectile Dysfunction

It’s normal for any man to be concerned when erections don’t work the way they used to. Occasional difficulties are common, but if it keeps happening, it could be a sign of Erectile Dysfunction (ED).

ED is when you regularly can’t get or keep an erection firm enough for sex. It’s one of the most common men’s health issues, affecting up to 1 in 3 men over 40. While ED becomes more common with age, it isn’t an inevitable part of getting older.

ED can be caused by many factors — physical, mental, or lifestyle-related. Importantly, it can also be an early warning sign of cardiovascular disease or other health problems. Seeking help isn’t just about restoring sexual confidence — it can also protect your long-term health.

The good news is that ED is highly treatable. With the right support, most men can return to a satisfying sex life.

Symptoms

Erectile Dysfunction Symptoms

Erectile Dysfunction can look and feel different for every man, depending on the underlying cause. For some, it develops gradually, with erections becoming less firm or less frequent over time. For others, it may appear suddenly, often linked to stress, illness, or medication changes.

You may notice:

  • Difficulty getting an erection at all

  • Erections that don’t stay firm enough for penetration

  • Erections that fade quickly during sex

  • Erections that feel softer or less reliable than before

  • Morning or spontaneous erections becoming less frequent

  • Lower sexual confidence, interest, or satisfaction Painful urination

Sometimes ED is accompanied by other symptoms that point to an underlying health condition. For example:

  • Circulation issues: Cold feet, leg cramps when walking, or a history of heart disease may indicate blood flow problems.

  • Hormonal issues: Low energy, reduced muscle mass, or low libido can suggest low testosterone.

  • Mental health issues: Stress, anxiety, or low mood may show up alongside erection problems.

ED itself doesn’t usually cause pain, but it can be emotionally distressing. Many men report frustration, embarrassment, or tension in their relationships. Because ED can also be a warning sign of heart disease or circulation problems, it’s important to take it seriously — not only for your sex life, but also for your overall health. 

Seek urgent medical attention if ED comes on suddenly with no clear cause, or if it’s accompanied by numbness, pain, chest discomfort, or shortness of breath.

Causes

Causes of ED

ED doesn’t usually have one single cause — it often results from several factors working together.

Physical Health Causes

  • Circulation problems: Narrowed arteries, high blood pressure, or high cholesterol can reduce blood flow to the penis.

  • Diabetes: Damages both blood vessels and nerves, raising the risk of ED.

  • Hormonal imbalances: Low testosterone or thyroid disorders can reduce libido and erections.

  • Neurological conditions: Parkinson’s disease, multiple sclerosis, or spinal cord injury can affect the nerves needed for erections.

  • Obesity and metabolic syndrome: Excess weight raises risks for low testosterone and poor circulation.

Mental Health & Emotional Causes

  • Stress and anxiety: Everyday stress or performance worry can interfere with erections.

  • Depression: Can reduce sexual desire and worsen ED.

  • Performance anxiety: Fear of “failing” can create a cycle where ED becomes more likely.

Lifestyle Causes

  • Smoking: Damages blood vessels and circulation.

  • Alcohol: Heavy drinking affects nerves, hormones, and erections.

  • Lack of exercise: Leads to poor circulation and reduced energy.

  • Poor sleep: Disorders like sleep apnoea lower testosterone and contribute to ED.

  • Medications: Some blood pressure tablets, antidepressants, and others can cause ED. 

Surgery, Injury, or Trauma

  • Prostate surgery (prostatectomy): Often affects nerves and blood vessels, leading to temporary or lasting ED.

  • Pelvic trauma or radiation therapy: Can damage the structures required for normal erections.

“Early Warning” Causes

Because erections rely on healthy blood flow, ED can be an early sign of serious conditions like: 

  • Coronary artery disease

  • Peripheral artery disease

  • Increased risk of heart attack or stroke

Risk factors

Risk Factors for Erectile Dysfunction

You may be more likely to develop ED if you have:

  • Age over 40

  • Heart disease, high blood pressure, or diabetes

  • Obesity or lack of physical activity

  • Smoking or heavy alcohol use

  • Depression, anxiety, or high stress

  • History of prostate surgery or pelvic injury

  • Certain medications (blood pressure drugs, antidepressants)

  • Poor sleep or untreated sleep disorders

Diagnosis

Diagnosis of Erectile Dysfunction

Diagnosis usually starts with a simple check-up. Your healthcare provider may:

  • Review your medical and family history

  • Discuss your symptoms, lifestyle, and mental health

  • Do a physical exam of your penis and testicles

  • Order blood tests (testosterone, cholesterol, blood sugar, thyroid, kidney/liver function)

  • Recommend further tests or specialist referral if needed

Early diagnosis can uncover hidden health problems as well as guide the best ED treatment.

Treatment

Treatment for Erectile Dysfunction

ED treatment depends on the underlying cause and may include:

  • Medications: PDE-5 inhibitors (Viagra, Cialis) to improve blood flow; testosterone replacement therapy if low testosterone is identified.

  • Lifestyle changes: Exercise, healthy diet, better sleep, stress management, quitting smoking, reducing alcohol.

  • Psychological support: Counselling or therapy for stress, depression, or performance anxiety.

  • Devices or injections: Options if tablets aren’t effective.

  • Surgery: Rarely needed but may help in complex cases.

Safety first: Some ED medicines can interact with heart medications (especially nitrates). Always get checked before starting treatment.

Prevention

Preventing Erectile Dysfunction

Not every case of ED can be avoided, but healthy choices can lower your risk:

  • Stay active and maintain a healthy weight

  • Quit smoking and limit alcohol

  • Manage stress and get quality sleep

  • Keep up with regular health check-ups

  • Take care of your heart health — good circulation supports good erections