Key facts
- Erection problems are common: in men aged 40 to 70, complete erectile dysfunction rose from 5% at 40 to 15% at 70.1
- Erection problems can come before heart trouble: men with them had a roughly 45% higher risk of later heart attacks and strokes.2
- Lifestyle changes help: in one trial, 31% of men who lost weight and exercised more got back normal erections.4
- If it keeps happening, see a doctor. It’s common, and treatable.7
What’s normal
Almost every man has an off night: tiredness, stress, alcohol or nerves can all get in the way. That’s not a problem. It’s worth acting on when it keeps happening.
And it’s more common than men think. In a well-known study of men aged 40 to 70, about half reported some degree of erection difficulty (most of it mild), and complete erectile dysfunction rose from 5% at age 40 to 15% at age 70.1
Why your heart is part of this
Erections depend on healthy blood flow, and erection problems can show up before heart problems do. In a study of 9,457 men aged 55 and over, men with erection problems had about a 45% higher risk of later heart attacks, strokes and similar events. The researchers called erectile dysfunction “a harbinger” of heart disease in some men.2 A review of 12 studies covering 36,744 men found the same pattern, with higher risk of heart disease and stroke.3
That’s why it’s worth seeing a doctor about erection problems that keep happening: it can be an early, useful warning, and catching it early is good news.
What helps, with evidence
Lose weight and move more
In a two-year trial of 110 obese men aged 35 to 55, one group was coached to lose weight and exercise more; their exercise went from 48 to 195 minutes a week. Their erection scores improved while the other group’s didn’t, and 17 of 55 men (31%) got back normal erectile function, against 3 of 55 in the comparison group.4
Exercise, especially cardio
A review of seven trials found that exercise improved erection scores, with moderate-to-vigorous aerobic exercise (brisk walking, running, cycling, swimming) looking most effective.5
Stop smoking
Smokers have about 1.5 times the odds of erection problems compared with men who never smoked, and former smokers sit in between.6
The rest of the basics
The NHS also recommends keeping alcohol to 14 units a week or less and finding ways to cut stress.7
When to see a doctor
The NHS says to see a doctor or a sexual health clinic if erection problems keep happening.7 Common causes that are worth knowing about, and treating, include:
- high blood pressure or high cholesterol
- diabetes
- depression or anxiety
- hormone problems
Proven prescription treatments exist. Get them from a doctor and a real pharmacy: the NHS warns about fake medicines sold online,7 and the FDA has found prescription drugs hidden in “natural” sexual enhancement products (more on that).
Sources
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB (Massachusetts Male Aging Study). Journal of Urology 1994;151(1):54–61. PubMed
- Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294(23):2996–3002. PubMed
- Dong JY, Zhang YH, Qin LQ. Journal of the American College of Cardiology 2011;58(13):1378–1385. PubMed
- Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004;291(24):2978–2984. PubMed
- Silva AB, Sousa N, Azevedo LF, Martins C. British Journal of Sports Medicine 2017;51(19):1419–1424. PubMed
- Cao S, et al. PLOS ONE 2013;8(4):e60443. PubMed
- NHS. Erection problems (erectile dysfunction). nhs.uk