Struggling to keep it up? Here’s what it might say about your health…

You might assume it’s simply because you (or your husband) are getting older. Or you can blame it on the booze instead.

But struggling to maintain an erection could be a sign of something far more sinister, experts say.

Impotence – which is estimated to affect half of all men over 40 – can be caused by high blood pressure and diabetes, according to the NHS.

Here, so-called erection experts explain the lesser-known, medical causes….

Cardiovascular disease

While it’s usually related to stress, not being able to perform in the bedroom can be a warning sign of heart disease.

For a man to become erect, blood vessels that carry blood to his penis must widen. As a result, more blood flows into the penis and it swells.

But cardiovascular disease can narrow the arteries that supply blood, reducing the flow of blood through it.

This then causes problems in getting or maintaining an erection.

Narrowing of the arteries or atherosclerosis can increase the risk of a heart attack.

Because arteries in the penis are so narrow, ED can be one of the first warning signs, says the British Heart Foundation.

Professor Albert Ferro, a specialist in cardiovascular clinical pharmacology at King’s College London, told MailOnline: ‘ED can be due to a host of factors.

‘In recent years it has been increasingly recognized that erectile dysfunction can be an early manifestation of cardiovascular disease.

“Rapid diagnosis of silent heart disease is important because it allows preventive treatments to be started at an earlier stage, helping those individuals live longer and healthier lives.”

Three-quarters of men are unaware that difficulty keeping it up is a recognized sign of heart disease, according to a 2000 poll by The Urology Foundation.

diabetes

Diabetes is usually only related to having high blood sugar levels and not producing enough insulin.

But men with diabetes are three times more likely to have trouble getting or keeping an erection, charities say.

And men with diabetes are up to 10 to 15 years more likely to develop erectile dysfunction than men who don’t, according to Diabetes UK.

Diabetics may have damaged blood vessels and nerves, making it more difficult to keep it up.

Other factors that can make it more difficult to keep it up related to diabetes are being overweight, smoking and not getting enough exercise.

“Bad lifestyles, such as unhealthy diets, lack of exercise, smoking, chronic stress, and lack of sleep, can also cause ED,” says Amr Raheem, consultant andrologist at International Andrology London.

But experts say you shouldn’t just grab a blue pill and hope it will solve your problems.

He added, “All of the above factors work by damaging erectile tissue, nerves and blood vessels responsible for erection.

That’s why it’s important to see your doctor if you develop erectile dysfunction, rather than just taking Viagra. Your doctor will perform blood tests to rule out any underlying health problems.”

Hormonal imbalances

Low testosterone levels can also be the cause of performance problems, experts say.

Testosterone regulates sex drive and blood flow in men.

If you don’t have enough of it, your libido can be compromised, says EDclinics. It says it can also reduce blood flow, which is essential for maintaining an erection.

Having low levels can also cause stress and weight gain, both of which can contribute to ED, according to the Cleveland Clinic.

Low levels can be caused by a host of factors, including drinking too much alcohol, diabetes, aging and obesity.

Testosterone replacement therapy (TRT) can help with erectile dysfunction in this case, but with side effects such as oily skin, decreased sperm count and sleep apnea, TRT is not for everyone.

“As a society, we need to break the stigma around erectile dysfunction and start conversations,” says Rebecca Porta of The Urology Foundation.

She added, “ED can have a major impact on a person’s mental health, especially in cases where it affects fertility and intimacy.”