Clinically Reviewed By
Honorary Associate Professor Jeremy Ockrim MD BSc(Hons) FRCS(Urol)
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
Male Sexual Health
Male sexual health encompasses a range of conditions that affect men's physical and emotional wellbeing. These issues are extremely common — erectile dysfunction alone affects over 50% of men between the ages of 40 and 70 — yet many men feel too embarrassed to seek help, or assume that little can be done.
The reality is that the vast majority of sexual health concerns are very treatable. With the right assessment, most men can achieve a significant improvement in their sexual function and quality of life. Our specialists have extensive experience in this area and approach all consultations with sensitivity, discretion, and a genuine commitment to helping you.
You can expect a thorough, unhurried consultation in a private and respectful environment. There is no need to feel awkward — our team has helped many men in exactly your situation.
Erectile Dysfunction (ED)
Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is important to distinguish between occasional difficulties — which are entirely normal and experienced by most men at some point — and persistent problems that occur regularly and cause distress.
When ED is consistent or worsening, it warrants a proper medical assessment. It is rarely "just in your head", and even when psychological factors play a role, there are usually effective treatments available.
ED and Cardiovascular Health — An Important Link
Erectile dysfunction can be an early warning sign of cardiovascular disease. ED and heart disease share the same underlying risk factors — atherosclerosis, hypertension, diabetes, high cholesterol, and smoking all affect blood vessel function, which is essential for erections. Because the penile arteries are smaller than coronary arteries, ED may appear before symptoms of heart disease.
All men presenting with ED should have a cardiovascular risk assessment as part of their workup. Treating the underlying vascular risk factors often benefits both sexual function and long-term heart health.
Other Conditions
Priapism — Medical Emergency
A prolonged, painful erection lasting more than four hours that is unrelated to sexual stimulation. Priapism requires immediate medical attention to prevent permanent damage to erectile tissue. If you are experiencing this, please go to your nearest emergency department without delay. Ongoing management would be referred to a specialist andrologist.
Other Conditions — Specialist Referral
For conditions such as Peyronie's disease, premature ejaculation, ejaculatory dysfunction, and low testosterone / hypogonadism, we work closely with a well-established and experienced network of andrologists who specialise in these areas.
If your assessment identifies one of these conditions, we will arrange a prompt referral to the most appropriate specialist to ensure you receive expert, targeted care.
Causes of Erectile Dysfunction
ED is most commonly multifactorial — meaning several causes contribute simultaneously. Understanding the likely cause (or causes) is essential to selecting the right treatment.
Psychological (most common)
Anxiety, depression, performance anxiety, stress, and relationship difficulties are common contributors. Even when ED starts with a physical cause, a psychological component often develops over time and must be addressed.
Vascular
Reduced blood flow to the penis due to atherosclerosis, hypertension, diabetes, high cholesterol, or smoking. Lifestyle factors play a major role and modification can bring real improvement.
Neurological
Multiple sclerosis, spinal cord injury, Parkinson's disease, or nerve damage following pelvic surgery (including prostate surgery) can all impair the nerve signals needed for erection.
Hormonal
Low testosterone (hypogonadism), thyroid disorders, raised prolactin, and other hormonal imbalances can reduce libido and impair erectile function. These are identified through targeted blood tests.
Medication Side Effects
Several commonly prescribed medications can impair erectile function, including antidepressants (SSRIs), beta-blockers, diuretics, and some antihypertensives. A medication review is always part of our assessment — often a simple change can make a significant difference.
Assessment & Investigations
A thorough assessment is the foundation of effective treatment. We take a holistic view — understanding not only the physical factors but also the psychological and relational context.
Clinical History
A detailed history including the nature and onset of symptoms, sexual and relationship history, relevant medical history, medications, and lifestyle factors.
Physical Examination
Including genital and prostate examination, blood pressure, and signs of systemic disease. Secondary sexual characteristics and testicular size are assessed where relevant.
Blood Tests
Testosterone (total and free), LH, FSH, prolactin, HbA1c (diabetes screen), fasting lipid profile, thyroid function (TFTs), full blood count (FBC), and PSA where indicated.
Cardiovascular Risk Assessment
Blood pressure measurement and formal cardiovascular risk scoring, with onward referral to cardiology where indicated.
Penile Doppler Ultrasound
A specialist imaging test that assesses arterial and venous blood flow in the penis. Performed at rest and following intracavernosal injection of a vasodilating agent to assess functional vascular response.
Nocturnal Penile Tumescence Testing
Used in selected cases to distinguish between physiological and psychological causes of ED by assessing spontaneous overnight erections. This investigation is not performed by our team — if indicated, we would refer you to the care of a specialist andrologist.
Treatment Options
Treatment is tailored to the individual — taking into account the likely cause, severity, your preferences, and any relevant medical factors. We support patients with lifestyle modifications and oral therapy. For treatments beyond this, we would discuss referral to one of our specialist andrology colleagues.
Lifestyle Modification
Regular aerobic exercise, achieving and maintaining a healthy weight, smoking cessation, and reducing alcohol intake can produce substantial improvements in erectile function — and in overall health. We will discuss practical steps that work for your life.
PDE5 Inhibitors (Oral Therapy)
First-line medical treatment. Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) work by enhancing blood flow to the penis. They are effective for the majority of men with ED and are generally well tolerated. Daily low-dose tadalafil is an option for those who prefer spontaneity. PDE5 inhibitors must not be taken with nitrate medications — your specialist will check for any contraindications before prescribing.
Vacuum Erection Devices
A non-invasive mechanical option that uses negative pressure to draw blood into the penis. A constriction ring maintains the erection. Effective and suitable for many men, particularly those who cannot take oral medication.
Delivered by our andrology colleagues if clinically warranted
Penile Injection or Intraurethral Therapy (Alprostadil)
Self-administered injections of alprostadil (prostaglandin E1) directly into the penile tissue, or an intraurethral preparation, produce a reliable erection within 10–15 minutes. Highly effective — including for men who do not respond to oral medication. Straightforward to learn with proper instruction.
Low-Intensity Shockwave Therapy (LiSWT)
A non-invasive treatment for vascular ED that uses focused acoustic waves to stimulate new blood vessel growth in penile tissue. A course of outpatient sessions can produce durable improvements, and may restore responsiveness to oral medication in some men.
Delivered by our andrology colleagues if clinically warranted
Penile Prosthesis Implant
For men with severe or refractory ED who have not responded to other treatments, a penile prosthesis — inflatable (three-piece) or malleable (semi-rigid) — offers a permanent, reliable solution. Satisfaction rates are among the highest of any ED treatment. Performed as a day-case or overnight procedure.
Delivered by our andrology colleagues if clinically warranted
Psychosexual Counselling
Psychological and psychosexual therapy is a valuable component of treatment for many men, either as the primary treatment or alongside medical therapies. We can facilitate referral to specialist psychosexual therapists where this would be beneficial.
Referral to a specialist psychosexual therapist arranged where appropriate
Your Emotional Wellbeing Matters
Sexual health problems can have a profound effect on a man's sense of self, his confidence, his relationships, and his overall mental health. Feelings of shame, inadequacy, frustration, and anxiety are extremely common — and completely understandable. You are not alone in experiencing them.
We take a genuinely holistic approach. Our consultations are unhurried, and we take the time to understand the full picture — not just the physical symptoms. Where psychological factors are contributing, or where you are finding the emotional impact particularly difficult, we can facilitate referral to a specialist psychosexual therapist.
Partners are warmly welcome to attend consultations if you feel this would be helpful. Sometimes understanding what is happening — and hearing that effective treatment is available — can be deeply reassuring for both partners.
You Don't Have to Go Through This Alone
Many of our patients tell us they wish they had come sooner. Whether you have been struggling for months or years, it is never too late to seek help. Our team will listen, take your concerns seriously, and work with you to find a solution that makes a real difference to your life.
Meet your Specialists
Assessment and treatment of male sexual health concerns is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Don't let embarrassment stand in the way — sexual health concerns are among the most treatable conditions in urology. With the right assessment and a personalised treatment plan, the vast majority of men can achieve a meaningful improvement in sexual function and quality of life.
Our specialists will listen without judgement, investigate thoroughly, and guide you through every option available to you. We understand that coming forward takes courage — and we will make sure the experience is worthwhile.
The first step is a confidential consultation. We look forward to helping you.
Further Reading — BAUS Patient Information
Frequently Asked Questions About Male Sexual Health
Take the First Step
Book a confidential consultation with one of our men's health specialists today. Effective help is available — you just need to ask.