Common, treatable, and sometimes the earliest warning sign of heart disease.
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Erectile dysfunction is difficulty getting or maintaining an erection firm enough for sex, persisting over time. Occasional difficulty is universal and means nothing; a consistent pattern over three months or more is worth assessing.
It is common and becomes more so with age — affecting a meaningful minority of men in their forties and the majority by their seventies — but it is never simply "getting older", and it is never simply a sexual problem.
An erection is a vascular event. It depends on healthy blood vessels widening on demand, and the arteries involved are among the narrowest in the body. That is why erectile dysfunction is frequently the earliest visible sign of cardiovascular disease, appearing on average three to five years before a cardiac event in men who go on to have one. Treating the symptom and ignoring that is a missed opportunity of a fairly serious kind.
So a proper consultation does two things: it gets you effective treatment, which usually works well; and it checks the blood vessels, blood pressure, cholesterol and blood sugar that the symptom is pointing at — which is what our Well Man panel is for.
1. Do you still get spontaneous erections — overnight, or on waking?
If yes, the mechanism works, and the cause is more likely psychological or situational. If those have faded away over months or years, that points to a physical, usually vascular, cause.
2. Did it start suddenly or gradually?
These are not mutually exclusive. A physical problem very commonly acquires a layer of performance anxiety on top, and treating only one half leaves people stuck.
This is the first thing worth reviewing, because a change can resolve the problem entirely:
Low testosterone — less often the cause than the internet suggests, and typically accompanied by low desire and fatigue rather than erectile difficulty alone. Thyroid disease and raised prolactin are less common but worth excluding.
Performance anxiety, depression, stress, relationship difficulties, and — increasingly recognised in younger men — the effect of heavy pornography use on arousal expectations. These are genuine causes, not a label applied when tests are normal.
The diagnosis is made from the history. What matters is establishing the type and identifying the underlying risk, and that is done with questions and blood tests rather than examination.
Our Well Man panel covers this set in one visit.
A single low result is not a diagnosis. It requires two morning samples, plus LH, FSH and prolactin to establish whether the problem is in the testes or the pituitary. Treating on one afternoon reading is how men end up on lifelong therapy they did not need.
Penile curvature or a palpable plaque, testicular abnormality, and prostate assessment where urinary symptoms coexist. We refer for these rather than working around them.
This assesses well remotely — it is a history-based diagnosis, blood tests can be arranged, and many men find a private video appointment considerably easier than raising it in a ten-minute face-to-face slot.
Before anything is added, what you already take is reviewed. Switching a beta blocker or thiazide, or adjusting an antidepressant, resolves the problem in a proportion of men without any new drug at all.
Sildenafil, tadalafil and similar drugs work for the large majority of men.
Never take these with nitrates — GTN spray or tablets for angina, isosorbide, nicorandil, or recreational poppers. The combination can cause a catastrophic and potentially fatal fall in blood pressure. Anyone with unstable angina, a recent heart attack or stroke, or significant heart failure needs assessment before these are prescribed at all.
This is one of the clearest arguments against buying them online without a consultation — quite apart from the question of what is actually in an unregulated tablet.
Where blood pressure, cholesterol or blood sugar are raised, we treat those — which improves erectile function and, more importantly, changes what happens over the next decade.
Vacuum devices, injection therapy, Peyronie's disease, and surgical options go to urology. Where a psychological component predominates, psychosexual therapy is genuinely effective and we can refer for it — it is not a consolation prize.
Go to A&E immediately for an erection lasting more than four hours (priapism), particularly if painful. This is a urological emergency — after four to six hours permanent tissue damage begins, and delay causes lasting loss of function. It is a recognised risk of injection therapy and, rarely, of tablets.
Call 999 for chest pain, severe breathlessness, or collapse — particularly after taking a PDE5 inhibitor, and above all if you have also taken any nitrate medication.
Seek prompt assessment for:
Book a routine consultation for consistent difficulty over three months, ED that has appeared alongside new medication, ED with low mood or loss of desire, or ED in a man under 40 — where an underlying cause is more likely and more important to find.
This is the unusual area of medicine where what motivates you and what matters clinically are the same thing. Everything below improves erectile function and reduces cardiovascular risk.
Testosterone is produced predominantly during sleep. Chronic short sleep lowers it measurably. Untreated sleep apnoea is strongly associated with ED and is very commonly undiagnosed — if you snore heavily, wake unrefreshed or have been told you stop breathing at night, that is worth investigating in its own right.
Do not buy erection medication from unregulated websites. Counterfeit tablets are widespread, contents are unpredictable, and the reason a prescription exists is the nitrate interaction — which can kill. Herbal "natural Viagra" products have repeatedly been found to contain undeclared sildenafil at unknown doses.
Sildenafil is available over the counter from pharmacies as Viagra Connect, and generic sildenafil on prescription is very cheap. Your NHS GP treats erectile dysfunction free, and NHS prescriptions for sildenafil are available to anyone — the old restriction to specific conditions was removed.
So the medication itself is not what a private consultation is for.
What it is for is the thing most services skip entirely: erectile dysfunction is a cardiovascular symptom. The arteries supplying the penis are narrower than the coronary arteries, so ED frequently appears two to five years before a heart attack or stroke. It is an early warning, and treating it without assessing cardiovascular risk misses the point of the presentation.
That assessment — blood pressure, lipids, HbA1c, testosterone — is where a consultation genuinely earns its fee, and it is what the online pill retailers do not do.
Where money is wasted: “ED supplements” and testosterone boosters, and shockwave therapy sold privately, where evidence remains limited.
The safety point that matters: never combine sildenafil or tadalafil with nitrates — including GTN spray and recreational poppers — which can cause a catastrophic fall in blood pressure.
Sudden-onset ED, particularly in a younger man with no risk factors, is more likely psychological, and that needs a different conversation rather than a stronger tablet.
NICE Clinical Knowledge Summary, Erectile dysfunction, is the principal reference. It recommends assessing cardiovascular risk in all men presenting with ED, since it is an independent marker of cardiovascular disease — the basis for the central point above.
CKS recommends measuring morning testosterone, alongside HbA1c, lipids and blood pressure, as part of initial assessment.
CKS recommends a PDE5 inhibitor as first-line treatment for most men, and notes that NHS prescribing restrictions on sildenafil were lifted, allowing generic sildenafil on the NHS.
CKS is explicit that PDE5 inhibitors are contraindicated with nitrates and nicorandil, and cautions on recent stroke or myocardial infarction and significant hypotension.
British Society for Sexual Medicine guidelines cover second-line options and the assessment of psychogenic ED, where sudden onset and preserved nocturnal erections are characteristic.
No. ED becomes more common with age because vascular disease, diabetes and medication use become more common with age — not because ageing causes it directly. It is a signal worth investigating at any age, and it is treatable at any age.
Because in most men this is a blood vessel problem, and blood vessels are not confined to one organ. The arteries involved in an erection are narrower than the coronary arteries, so they show narrowing first — which is why ED tends to precede a cardiac event by several years. Those years are the opportunity, and blood tests are how you use them.
Usually one of four things. The dose was too low; you tried it too few times — four to eight attempts at a full dose is the fair test; you took sildenafil after a heavy meal; or there was no sexual stimulation, which these drugs require. If a proper trial genuinely fails, alternatives and referral exist. Roughly seven in ten men respond to a PDE5 inhibitor used correctly.
Sometimes, often partly, rarely entirely. Morning erections and sudden situational onset both point to a psychological component — and psychological causes are real, common, and treatable, not a way of saying nothing is wrong. Most men have some element of both, which is why treating only one half tends to disappoint.
You can, and we would advise against it. Counterfeits are common, and the reason these drugs are prescription-only is the interaction with nitrates, which can cause a fatal drop in blood pressure. There is also the point that buying a tablet skips the assessment that might have found the diabetes or the raised blood pressure underneath.
Probably not. Low testosterone is a less frequent cause than online marketing implies, and it usually presents with low desire and fatigue rather than erectile difficulty alone. It requires two morning samples with pituitary hormones before anyone should be treating it. A single afternoon reading is not a basis for lifelong therapy.
Frequently, unless you say otherwise — which is one of the more painful and avoidable parts of this. Explaining that it is a circulation problem, and that you are having it looked at, generally reduces the tension considerably.
Often, yes. Where it is medication-related, changing the drug can resolve it. Where it is lifestyle and vascular, stopping smoking, exercising and losing weight produce genuine measurable improvement. Where it is psychological, therapy works. Treatment is not necessarily permanent.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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