The REAL reason why men should worry about erection problems has been revealed to me by a top NHS doctor – and it has nothing to do with their sex lives: PROFESSOR ROB GALLOWAY

Back in the day, when ER waiting lists weren’t that long—okay, this was fifteen years ago—I saw a man who refused to tell the triage nurse what his problem was. He insisted that he needed to see a doctor, he needed urgent help, so I saw him immediately.

He then told me that he had spent the night with his new girlfriend and had not managed to get an erection. When she fell asleep, he snuck out and came to the emergency room, thinking we could help him.

As you might imagine, he was dismissed with a short lecture about wasting NHS resources and certainly no treatment.

I hadn’t thought much about it until last week when I spoke to a friend, Dr David Weinstein, an NHS GP specializing in men’s health: erectile dysfunction, low libido and low testosterone.

“Didn’t you ask him about his general health?” he chastised me.

David went on to explain that erectile dysfunction is the “canary in the coal mine” for cardiovascular disease because it is so often the first sign of other diseases, including heart attack and stroke.

While I’m not suggesting that someone who can’t get an erection should come to the emergency room, there’s no doubt that our views on men’s sexual health are changing. Poor circulation (due to diabetes, poor diet, smoking, high blood pressure or being overweight) is one of the main causes of erectile dysfunction and also the cause of heart attack and stroke – hence the connection.

Erectile dysfunction may also be linked to irritable bowel syndrome, according to a recent study in the journal Sexual Medicine.

It showed a strong link between the two conditions – whether this is a direct link or a common underlying cause, such as anxiety, remains to be proven.

So yes, erectile dysfunction is a bigger problem than we used to think. It can reflect your general health and should not be hidden.

But what is the solution? There is a lot of talk about men needing testosterone therapy because levels naturally decline with age.

But another study, published a few weeks ago in the journal Proceedings of the Royal Society B: Biological Sciences, confirms that it’s not that simple.

For the study, 41 men recorded their feelings of sexual arousal and desire, and their testosterone levels were measured from sputum samples. What was surprising to me is that if the man’s testosterone level was above a certain threshold, it didn’t matter whether his level was high or low compared to other men in terms of his libido. Not being an expert in the field, I relied on David Weinstein’s explanation.

“This evidence proves what we knew,” he told me.

‘If a man comes to me and complains that he feels tired all the time, can’t get erections or has a low libido, one of the most important

what you need to do is check their testosterone level. But in many cases the levels are fine, so increasing the levels will not work for erectile dysfunction, for example. We have to look at other factors.

‘This includes their cholesterol, HbA1C (blood sugar levels), blood pressure – and also assessing their lifestyle.

‘Lack of erections often causes low libido – it’s not always the other way around,’ he explains.

‘It is crucial that we look at their overall wellbeing and mental health – and take a holistic approach to treatment, managing lifestyle risk factors such as diet, and anxiety.’

Only then should a doctor consider medication for erectile dysfunction, he adds. This of course also includes medications such as Viagra, which work by opening the blood vessels in the penis.

Topical gels are also used. Eroxon is a penis gel (available without a prescription from pharmacies) that creates a cooling and warming sensation that stimulates blood flow. Research shows that it can work for up to 60 percent of patients.

If not, another new and novel treatment is low-intensity shockwave therapy; essentially, sound waves are beamed onto tissue.

This has been shown to help other conditions, such as inflamed tendons in tennis elbow.

In erectile dysfunction, it appears that the sound waves can remodel damaged blood vessels, improve blood flow to the penis and rejuvenate erectile tissue.

A study published in the journal Andrologia in 2022 showed that after weekly treatment for a month, patients had significantly stronger erections than men who received a placebo treatment. This effect lasted at least six months.

There are other, more advanced therapies that may be useful in the future.

An example is injections of platelet-rich plasma (PRP), which is packed with natural growth factors and is often used by athletes after an injury. These are being tested for erectile dysfunction and the results of a study by the University of Manitoba in Canada, involving 660 patients, are expected by the end of this year.

Stem cell therapy – in which cells from the bone marrow are implanted into damaged tissue – also has potential. In a few years it may have moved from the laboratory to the treatment room.

Some supplements like L-arginine and L-citrulline may help because they increase blood flow in the same way Viagra does: increasing levels of a natural compound, nitric oxide, which dilates blood vessels.

Research published in the journal Urology in 2011 showed that L-citrulline supplements improved erectile dysfunction symptoms in 24 men significantly more than a placebo.

But anything else you may have read about on the internet, like vitamin this or that, salt injections or sodium bicarbonate, I would avoid.

The fact that there is a huge market for such products online is undoubtedly largely due to the shyness of raising the issue. And we need to make sure men talk to the right experts about their sexual well-being.

That’s where people like David Weinstein can help; they have the time and expertise to understand the issues and make a real difference in people’s lives.

Although I no longer see erectile dysfunction as an ’emergency’ in the emergency room, I have now started checking with my male patients – and where appropriate – asking them about their sexual health. Because it could be a signpost to their overall health, and it is crucial that they know how important it is to get a medical assessment.

So if this is you or your partner, get help. It not only helps your sex life, but can also be life-saving.

@drrobgalloway