What causes impotence?

An erection depends on blood vessels, nerves, hormones, sexual interest and a relaxed mental state working together. A problem in any of these areas can make erections less firm, less predictable, or difficult to maintain. Type 2 diabetes, hypertension and obesity can affect blood vessels and nerves. Depression, anxiety, relationship strain and tiredness may reduce arousal or make sexual performance feel pressured. Some prescribed medicines can also contribute; do not stop a medicine without medical advice.

A change in erection quality may happen alongside loss of libido, although these are different concerns. The pattern matters: a gradual change, erections that occur during sleep, pain or curvature, and other symptoms can help a clinician identify the likely contributing factors.

Arrange a GP consultation if the problem continues, returns often, or is affecting your wellbeing or relationship. Note when it began, whether desire has changed, which medicines or supplements you take, and whether erections occur at other times. A clinician may check blood pressure, review medicines, ask about mood and relationships, and offer a blood test or diabetes screening when appropriate.

Regular movement, sleep, limiting alcohol, stopping smoking and managing long-term conditions can support sexual function. Treatment depends on the cause and may include counselling, medicine review or prescribed erectile-dysfunction treatment.

Seek prompt medical advice for a sudden change with chest discomfort, breathlessness, weakness, severe headache or other new neurological symptoms. Arrange an assessment for persistent erectile difficulty, pain, a new penile curve, blood in urine or semen, or marked loss of sexual desire. These symptoms do not identify one diagnosis on their own, but they deserve a focused review.

Ask whether your symptoms suggest a blood-flow, nerve, hormone, medicine-related or emotional contributor; which checks are appropriate; whether any current medicine could be involved; and which treatment options fit your health history.