Erectile dysfunction: how porn, bike riding, alcohol and ill-health contribute to it, and six ways to maintain peak performance

Erectile dysfunction (ED) is a distressing condition in which men either cannot achieve, or maintain, an erection. This has a negative effect on their sex life, which can have far-reaching consequences for their relationships and psychological health.

Occasional difficulties in bed do not constitute ED – it is the persistent and consistent inability to maintain an erection through satisfactory intercourse. It is more common than men might think, given that they are loath to discuss it with others, often even their doctors. The condition has many causes and, as a result, affects men of all ages – though it becomes increasingly prevalent with age.

About 10 per cent of those in their 40s suffer, 15 per cent in their 50s, a third in their 60s, and half of septuagenarians. Across the board, about 20 per cent of men struggle with impotence.

Dr Andrew Yip Wai-chun, a Hong Kong-based urologist, says ED is caused primarily by disease, and in 80 per cent of cases diabetes mellitus, hypertension and high blood cholesterol are the main medical causes.

The condition is often an early warning sign of heart disease and other circulatory problems. To achieve and maintain an erection, extra blood must be able to flow unimpeded. Anything that interferes with healthy flow – for example atherosclerosis, the artery-clogging process at the root of most heart attacks, strokes, and other cardiovascular conditions – has the potential to cause erectile dysfunction, too.

Because blood vessel problems are the leading cause of erectile dysfunction, erections have been described as a useful barometer for a man’s overall health. The American Heart Association urges that physicians screen for cardiovascular risks in patients who have erectile dysfunction, even if no other risk factors are present; the onset of ED can precede cardiac events by two to five years.