Impotence, or erectile dysfunction or ED, is defined as the complete inability to get, or maintain an erection. This can make sexual activity difficult or even impossible.  

Erection problems are by far the most common sexual dysfunction among men. Viagra, or sildenafil, is one of the most widely prescribed treatments. 

ED can happen very occasionally, and can be linked with factors such as stress, tiredness or alcohol consumption. However, if it occurs more often, it may be caused by a more serious physical or psychological condition. 

Anyone can become impotent. It affects men of all ages, but it is more typically observed in men who are 40 or older. The risk of developing erectile dysfunction also increases with age. 

Causes of impotence

In men, when sexual stimulation takes place, blood vessels in the penis dilate, or open up, which allows blood to flow into the genital area. This brings about firmness and rigidity. 

However, for some men, even when they feel sexually aroused, erections either do not happen, or they can’t be maintained long enough for sex. There are a number of possible reasons why this might happen. 

One common cause of erectile dysfunction is that the blood vessels near the penis do not dilate in the event of sexual stimulation or, in other words, become too restricted. This might be linked with things like high cholesterol, diabetes or high blood pressure. Your doctor may want to try and address these things if they suspect they are the cause. 

If the problem does centre around the blood vessels being too restricted, they might also prescribe what are called phosphodiesterase type 5 inhibitors (or PDE5is for short). Pills like Viagra are PDE5is. They prevent the blood vessels from tightening, and encourage dilation. 

Another cause can centre around the balance of certain hormones, like testosterone. If this is the cause, there are a number of hormonal replacement treatments a doctor may prescribe. 

Some medications can also cause erection problems. These might bring about certain side effects which affect the blood or circulation, and in turn may inhibit the ability to achieve erections. 

Lastly, impotence might be the consequence of unhealthy lifestyle changes. For example, not eating well, not exercising enough, smoking and alcohol consumption can all have direct links with erection problems. Leading a healthier lifestyle is a proven way to treat erectile dysfunction and is usually one of the first things a doctor recommends. 


Can erectile dysfunction be prevented? In some cases it can, simply by following a healthy diet and lifestyle.

Healthy Diet

Eating a balanced and nutritional diet is perhaps one of the most important things we can do for our health. Our bodies need a broad variety of vitamins and nutrients to perform their functions. 

Eating foods high in sugar, salt or saturated fat consistently can vastly increase the risk of a great number of health conditions, including erectile dysfunction (as well as some which are more critical). 

It’s important to eat well. This includes staying within recommended reference intakes for calories, salt, fat and sugar. 


As a basic minimum, all adults should aim to do 150 minutes of moderate exercise every week. This can include things like brisk walking, dancing or even gardening. Alternatively, people can perform 75 minutes of vigorous activity instead, which can include things like running, jogging and riding a bike. Both are thought to have similar health benefits. 

Why is exercise good for erectile dysfunction? Simply, because exercise is good for blood flow and circulation. 

Smoking can be of severe detriment to the whole body. With regard to erectile dysfunction, smoking can bring about lasting damage to the blood vessels. 

Similarly, alcohol consumption can induce erectile dysfunction - both in the short-term and long-term. Alcohol misuse over a number of years can result in damaged blood vessels and circulation. 

Impotence and other Sexual Issues 

Often, in the media and elsewhere, ‘sexual issues’ are grouped together in a way that isn’t necessarily helpful. 

In reality, there’s a broad and varied spectrum of conditions relating to the sexual and reproductive organs. This can include, but is not limited to, conditions surrounding desire, arousal, pain, the ability to orgasm and the ability to conceive

With erectile dysfunction in mind, this condition can be the consequence of one or a number of other sexual issues - though it isn’t always. Sometimes it is simply a condition in itself. 

Pumps, implants and surgery

There are certain devices or procedures which can benefit those suffering with erectile dysfunction. 

Vacuum constriction pumps are pressurised devices which fit around the penis and encourage blood flow. Once firm, a band, or ring, is placed at the head of the penis and this ensures blood cannot leave after the pump is removed. 

There are a number of different types of penile implants, though they all do similar things. Essentially, rods are surgically inserted into the penis during a minimally invasive procedure. Some can induce a lasting state of rigidity. Some types are ‘inflatable’ which are utilised prior to sexual activity. 

Lastly, vascular reconstruction surgery is something which can be considered where several other options have been tried without success. The highly technical procedure involves the reconstruction, or rerouting, or certain blood vessels in the penis which may have collapsed, are blocked or otherwise do not function properly. 


Many don’t consider that ED might be happening in conjunction with, or solely be the result of an underlying psychological condition

Psychological causes can vary in severity, from things like performance anxiety to depression. However, if after the physical causes have been addressed adequately and your ED continues, it could be linked with your mental health. 

Therefore, it might be worth having a conversation with your doctor to see if some form of talking therapy is appropriate for you. 

Page last reviewed:  17/08/2020