If you're finding it hard to get or keep an erection, you're not on your own. Erectile dysfunction (ED) affects around half of men aged between 40 and 70,1 and it's usually very treatable. This guide covers how to treat erectile dysfunction: what causes it, how ED tablets work, which treatments are available, and when it's worth speaking to a doctor.
Most ED tablets work in the same way, by increasing blood flow to help you get and keep an erection. Below, we'll walk through how they work, which options are available, and the lifestyle changes that can help alongside them.
Why does erectile dysfunction happen?
About 9 in 10 cases of ED have a physical cause, most often reduced blood flow.
ED typically happens because something is getting in the way of the process behind an erection. It could be a single factor, or a mix of a few different ones.
Physical causes are behind most cases. Around 9 in 10 men with ED have an underlying physical cause, most commonly reduced blood flow linked to high blood pressure, high cholesterol, diabetes or hormone problems.1 Side effects from certain medicines can play a part too.2
Psychological factors matter as well. Stress, anxiety, depression and relationship worries can get in the way of an erection, even when everything's working fine physically. This is sometimes called performance anxiety.
Want more detail? Read about the physical causes of ED and psychological causes of ED.
How do ED tablets work?
Never take more than one ED tablet in 24 hours, and don't combine different brands or types of PDE-5 inhibitor on the same day.
Most ED medication belongs to a group of drugs called PDE-5 inhibitors. They work by blocking an enzyme called PDE-5, increasing blood flow to your penis after arousal.3
Here's what happens. Arousal triggers the release of nitric oxide, which raises a molecule called cGMP in your body. cGMP relaxes the smooth muscles in your penis, widening the blood vessels and creating an erection.
ED tablets increase blood flow. They don't create arousal or desire on their own.
After ejaculation, the PDE-5 enzyme breaks cGMP back down. The muscles contract again, blood flow drops, and the erection eases.
In ED, PDE-5 breaks cGMP down too early, so blood flow isn't sustained long enough for an erection. PDE-5 inhibitors block that early breakdown, giving the blood vessels more time to stay open.
Always speak to a pharmacist or GP before starting an ED medication. Do not take more than one tablet of any ED treatment within 24 hours, and do not combine more than one brand or type of PDE-5 inhibitor on the same day.
Which ED treatments are available?
All ED tablets work the same way. The differences come down to how fast they act and how long they last.
Pharmica offers a full range of ED treatments, from tablets to a vacuum pump device. Here's what's available and how each one works.
Sildenafil
Sildenafil contains sildenafil citrate. It blocks the PDE-5 enzyme, keeping cGMP levels high enough to relax the blood vessels in your penis and sustain an erection.
It comes in three strengths: 25mg, 50mg and 100mg. 50mg is the usual starting dose. If you get side effects, your prescriber might step you down to 25mg. If 50mg isn't enough, you can increase the dose up to 100mg.
Want to see it explained step by step? Our video guide to Sildenafil walks you through it.
Viagra
Viagra is medically identical to Sildenafil, so there's no difference between Viagra and Sildenafil when it comes to how well they work. Sildenafil is cheaper because it's generic, while Viagra costs more as the branded version.
Generic ED treatments like Sildenafil go through the same UK regulatory checks as branded ones. The Medicines and Healthcare products Regulatory Agency (MHRA) makes sure they match branded treatments for quality, strength and effectiveness.
Curious about the history? Read everything you need to know about the blue pill.
Viagra Connect
Viagra Connect is an over-the-counter version of Sildenafil and Viagra. You can buy it without a prescription.
It contains 50mg of sildenafil citrate and works the same way as Sildenafil and Viagra.
Tadalafil
Tadalafil contains tadalafil, which blocks PDE-5 to keep cGMP levels up and blood flowing to your penis - same as sildenafil.
It lasts longer than most other ED tablets. Tadalafil's half-life is 17.5 hours, which is why it can work for up to 36 hours.
It comes in four doses:
- Tadalafil 2.5mg and 5mg ("Tadalafil daily") - taken every day, so you're ready for sex whenever it happens
- Tadalafil 10mg and 20mg ("Tadalafil 36-hour") - taken around 30 minutes before sex
Cialis
Cialis is the branded version of Tadalafil. They're medically identical and equally effective, but Tadalafil is cheaper because it's generic.
Watch our video guide to Cialis, or see how it stacks up in our Cialis vs Viagra comparison.
Vardenafil
Vardenafil also blocks PDE-5 to keep blood flowing to your penis for an erection. Clinical trials have shown it can help men with diabetes, including some who hadn't responded well to other PDE-5 inhibitors before.4
It's available in 5mg, 10mg and 20mg. 10mg is the usual starting dose. Your prescriber might step you down to 5mg if you get side effects, or up to 20mg if 10mg doesn't work well enough.
Levitra
Levitra is the branded version of Vardenafil. Same active ingredient, same effectiveness. The only real difference is price, since Levitra is the branded option.
Spedra
Spedra contains avanafil, which blocks PDE-5 the same way as the other tablets on this list.
It's the fastest-acting tablet option, working in 15 to 30 minutes. Most others take at least 30 minutes.
It comes in three doses: 50mg, 100mg and 200mg. 100mg is the usual starting dose, with 50mg or 200mg as alternatives depending on how you respond.
Hezkue oral spray
Hezkue is an oral spray version of sildenafil, the same active ingredient as Viagra. It works by relaxing the muscles in your blood vessels to increase blood flow.
Each pump delivers 12.5mg of sildenafil, and the standard dose is 4 pumps (50mg). It starts working within 5 to 20 minutes and lasts 4 to 5 hours.
VaxAid Deluxe
VaxAid Deluxe is a non-invasive vacuum pump. It forms a seal around your pelvis to draw blood along the length of your penis, helping you get an erection without medication.
It's quick to use and works in the shower or bath too.
Not sure which treatment's right for you? Our guide on picking the right ED treatment can help.
Can lifestyle changes help with ED?
Lifestyle changes won't replace medication if you need it, but they can support your treatment, and sometimes help prevent ED developing in the first place.
Eating well
Diet doesn't treat ED directly, but certain foods support the blood flow that ED medication relies on.5 Spinach is a good example. It's rich in nitrates,6 which your body converts into nitric oxide, the same compound that widens blood vessels during an erection.7
Berries are worth adding too. Flavonoids in berries support your endothelium, the lining of your blood vessels, which plays a part in circulation throughout your body, including to the penis.8
Staying active
Losing weight and exercising more could cut your risk of ED by up to 70%.
Regular exercise lowers the risk factors linked to ED, like high blood pressure, heart disease and obesity, and if you're carrying extra weight, losing it can help too.1
Pelvic floor exercises (Kegels) can help as well. They involve tightening and releasing the muscles you'd use to stop a flow of urine midstream.
Hold the contraction for 3 to 5 seconds, then relax. Repeat 10 times, a few sets a day. You can do them lying down, sitting or standing, so they're easy to fit in without anyone noticing.
Give it 4 to 6 weeks of consistent practice before expecting a difference. Kegels aren't as effective as PDE-5 inhibitors, but they're a solid addition alongside treatment.
Quitting smoking
Does smoking cause ED? It's a major contributing factor. Smoking damages the lining of your blood vessels and causes plaque to build up, narrowing them over time. This is called atherosclerosis.9 Narrower blood vessels mean less blood flow, including to the penis.
Quitting smoking won't treat ED on its own, but it supports better circulation overall, which lowers your risk.
Cutting back on alcohol
Alcohol is a depressant. It interferes with your nervous system and hormone balance, which can blunt your body's erectile response.
It also disrupts deep and REM sleep, even though it might help you fall asleep faster. Those sleep stages are crucial for hormone regulation, including testosterone, so cutting back can support better sleep and better circulation.
Do natural remedies work for ED?
There's no solid evidence that herbal or "natural" remedies treat ED. Unlike licensed treatments, they haven't been through the testing and regulation that proves they're safe and effective, so you should be cautious about anything sold this way.
When should you seek medical advice?
ED is common, especially over 40, and an occasional off night is nothing to worry about.2
ED can be an early sign of heart disease, diabetes or a hormone problem, so it's worth getting checked if it keeps happening.
See a GP or a sexual health clinic if:
- ED keeps happening, rather than being a one off
- You notice other changes, like a lower sex drive or pain
- ED starts suddenly or alongside other new symptoms
Getting checked means any underlying cause gets picked up and treated too, not just the ED itself.
There's no single "ED test". Your GP will usually ask about your health, lifestyle and relationships, check your blood pressure, and examine you. They might also run blood tests to check for diabetes, cholesterol or low testosterone.1
If stress, anxiety or relationship difficulties are behind your ED, psychosexual counselling or therapy can help. A GP can point you toward NHS or private options.2
ED is very common and very treatable. Most men see real improvement with the right treatment.
Is ED curable? It depends on the cause. When it's down to something treatable, like a hormone problem or a medicine's side effect, sorting that out often resolves the ED too. When it's more about blood flow or age-related change, ongoing treatment is usually the realistic outcome, but for most men, ED is still very manageable.1
Frequently asked questions
What causes erectile dysfunction?
Most cases come down to a physical cause, most often reduced blood flow linked to conditions like high blood pressure, high cholesterol, diabetes or hormone problems. Psychological factors like stress, anxiety or relationship worries can cause it too, even when everything's working fine physically.
ED tablets are usually PDE-5 inhibitors. They increase blood flow to your penis after arousal, they don't create arousal or desire on their own.
What's the difference between Viagra and Sildenafil?
Nothing, medically. Viagra and Sildenafil contain the same active ingredient and work the same way. Sildenafil is just the cheaper, generic version.
Does smoking cause erectile dysfunction?
It's a major contributing factor. Smoking damages the lining of your blood vessels and narrows them over time, which restricts blood flow, including to the penis.
Can lifestyle changes help with ED?
Yes, alongside medication if you need it. Losing weight and exercising more may cut your risk of ED by up to 70%, and quitting smoking and cutting back on alcohol both support better blood flow too.
Is there a test for erectile dysfunction?
There's no single "ED test." A GP will usually ask about your health and lifestyle, check your blood pressure, examine you, and may run blood tests to check for diabetes, cholesterol or low testosterone.
Can erectile dysfunction be cured?
It depends on the cause. When it's down to something treatable, like a hormone problem or a medicine's side effect, treating that often resolves the ED too. Otherwise, ongoing treatment rather than a one-off cure is usually the realistic goal, but ED is still very manageable for most men.
When should I see a GP about ED?
See a GP or a sexual health clinic if it keeps happening rather than being a one-off, if you notice other changes like a lower sex drive or pain, or if it starts suddenly alongside other new symptoms. ED can be an early sign of an underlying condition, so it's worth getting checked.
References
- British Association of Urological Surgeons. Erectile dysfunction (impotence). BAUS; 2024. baus.org.uk
- NHS. Erection problems (erectile dysfunction). NHS; 2023. nhs.uk
- Dhaliwal A, Gupta M. PDE5 Inhibitors. StatPearls Publishing; 2023. ncbi.nlm.nih.gov/books/NBK549843
- Goldstein I, Young JM, Fischer J, et al; Vardenafil Diabetes Study Group. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care. 2003;26(3):777-783.
- Yu C. Foods to help improve your circulation. WebMD. webmd.com
- Jovanovski E, et al. Effect of spinach, a high dietary nitrate source, on arterial stiffness and related hemodynamic measures: a randomized, controlled trial in healthy adults. Clinical Nutrition Research. 2015;4(3):160-167. doi:10.7762/cnr.2015.4.3.160
- Lee M, Gerriets V. Nitrates. StatPearls Publishing; 2023. ncbi.nlm.nih.gov/books/NBK545149
- Martini D, et al. Role of berries in vascular function: a systematic review of human intervention studies. Nutrition Reviews. 2020;78(3):189-206. doi:10.1093/nutrit/nuz053
- Lee J, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis. 2011;215(2):281-283. doi:10.1016/j.atherosclerosis.2011.01.003
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.