GPAtlas🧭 When to suspect
Erectile dysfunction (ED) is the persistent inability to attain or maintain an erection sufficient for satisfactory sexual performance. It is extremely common – affecting roughly half of men aged 40–70 to some degree – and prevalence rises steeply with age.
The single most important concept for primary care is that ED is rarely "just" a sexual or psychological problem. It is an independent marker of cardiovascular disease, sharing the same risk factors and frequently appearing 3–5 years before a coronary event (the arterial-size hypothesis: the smaller penile arteries silt up before the coronaries). Every new presentation is therefore a window to assess and reduce cardiovascular risk. For this reason, proactively ask about ED in all men with cardiovascular disease, at every hypertension review, and at the annual review of type 1 or type 2 diabetes.
| Cause category | Typical examples |
|---|---|
| Vasculogenic (most common) | Atherosclerosis, hypertension, diabetes, smoking, hyperlipidaemia, obesity, metabolic syndrome – ED as a cardiovascular sentinel. |
| Neurogenic | Multiple sclerosis, Parkinson's disease, spinal cord injury, cauda equina, pelvic or prostate surgery. |
| Endocrine | Testosterone deficiency (hypogonadism), hyperprolactinaemia, thyroid disease, diabetes. |
| Drug-induced | Thiazides, beta-blockers, spironolactone, SSRIs/TCAs, antipsychotics, 5-alpha reductase inhibitors (finasteride), anabolic steroids, opioids, and recreational drugs. |
| Psychogenic | Performance anxiety, depression, relationship difficulty, stress – typically situational, sudden onset, with preserved early-morning erections. |
| Anatomical / structural | Peyronie's disease, hypospadias, phimosis. |
Source: BSSM Guidelines
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