What is erectile dysfunction?
Erectile dysfunction (ED) is the ongoing inability to achieve or maintain an erection sufficient for satisfactory sex. Occasional difficulty is normal; ED is diagnosed when the problem is persistent. Causes are often mixed: reduced blood flow, nerve problems, low testosterone, medication side effects, and psychological factors such as stress and performance anxiety all contribute, with vascular causes becoming more common with age.
ED affects a large proportion of men over 40 and can occur at any age. It deserves proper assessment, not least because the penile arteries are narrow and can reveal early cardiovascular disease years before heart symptoms appear. Assessment involves a history, examination, blood pressure, and blood tests for glucose, cholesterol and testosterone. Specialist tests are reserved for complex cases and younger men.
Common symptoms
- Difficulty getting an erection
- Erections that do not last long enough for sex
- Erections that are less firm than before
- Loss of spontaneous morning erections
- Reduced sexual desire in some men
- Anxiety or avoidance around intimacy
How long will you wait?
NHS management of ED is largely through GPs, with routine urology or specialist clinic referrals commonly taking three to five months at many trusts and access to some treatments restricted by prescribing rules.
Privately, you can typically see a consultant urologist or men's health specialist within 3–7 days, with blood tests and a treatment plan usually in place within 1–2 weeks.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Lifestyle and risk factor treatment. Stopping smoking, exercise, weight loss and managing blood pressure, cholesterol and diabetes improve erections and protect the heart.
- PDE5 inhibitor tablets. Sildenafil and tadalafil are effective for around three-quarters of men and are the standard first-line treatment.
- Psychosexual therapy. Addresses the anxiety and relationship dynamics that commonly accompany and perpetuate ED, alone or alongside tablets.
- Vacuum devices and injection therapy. Mechanical pumps or self-administered injections work when tablets do not, with penile implants a definitive final option.
What does private treatment cost?
As a guide, a private men's health consultation typically costs around £200–£350 with blood tests around £150–£400; ongoing tablet treatment is inexpensive, while penile implant surgery, rarely needed, typically costs £12,000–£18,000 in the UK in 2026.
Does health insurance cover erectile dysfunction?
Cover for erectile dysfunction is more limited than for most conditions in this list: many private medical insurance policies exclude treatment of sexual dysfunction altogether, or cover only the investigation of an underlying acute cause such as a hormonal problem. Where cover exists, pre-existing difficulties are excluded as usual, and long-term tablet treatment is not funded. Check your policy wording carefully before assuming ED consultations will be reimbursed.
Frequently asked questions
Is erectile dysfunction a sign of something more serious?
It can be, and this is the strongest reason to get assessed rather than only buying tablets online. The arteries supplying the penis are narrower than the coronary arteries, so vascular ED can precede heart disease by several years, and ED is also a recognised early clue to diabetes. A simple check of blood pressure, glucose, cholesterol and testosterone turns the symptom into an opportunity for prevention.
Do tablets like Viagra work for everyone?
They help roughly three-quarters of men, but they need the right conditions: sexual stimulation is still required, sildenafil works best on an empty stomach, and several attempts on a proper dose are needed before judging failure. Daily low-dose tadalafil suits men who prefer spontaneity. They cannot be taken with nitrate heart medication. If tablets genuinely fail, effective second-line options exist, so do not stop at the pharmacy.
Could my ED be psychological rather than physical?
Often it is both, and the proportions matter less than treating each part. Clues towards a psychological component include sudden onset, normal morning or solo erections, and difficulty only in particular situations. Performance anxiety creates a self-reinforcing loop that tablets can helpfully interrupt while psychosexual therapy addresses the underlying pattern. Younger men with ED particularly benefit from an approach that takes both mind and body seriously.