Erectile Dysfunction
Erectile dysfunction is persistent difficulty getting or keeping an erection firm enough for sex, and in most men it has an identifiable, treatable cause.
Symptoms
- Difficulty getting an erection
- Erections that do not last long enough for sex
- Softer erections than before
- Reduced morning or spontaneous erections
- The pattern matters: gradual onset suggests a physical cause, sudden onset with normal morning erections suggests stress or anxiety
Causes
The most common causes are vascular: the same narrowing of blood vessels that underlies heart disease shows up earlier in the smaller penile arteries, which is why new ED is worth taking seriously as a health signal. Other causes include low testosterone, diabetes, medication side effects, smoking, alcohol, and psychological factors such as performance anxiety. Often several overlap.
How PVT tests for it
A PVT consult covers a focused history (the pattern of the problem says a lot), an examination where appropriate, and bloods at Lancet covering hormones, glucose and cholesterol. This both finds the cause of the ED and flags any cardiovascular risk that deserves attention in its own right.
Treatment
ED responds well to treatment in most men. Options include proven oral medication, treating an underlying hormone deficiency, adjusting a culprit medication, and cardiovascular risk management. Shockwave therapy and regenerative options at 15 on Orange can be discussed where clinically reasonable, and psychosexual support helps where anxiety has taken hold.
When to see a doctor
See a doctor when erection problems persist beyond a few weeks, or sooner if they arrived alongside other symptoms such as low libido or fatigue. New ED in a man over 40 is also a sensible prompt for a cardiovascular check, even if the ED itself is not distressing.
Medically reviewed by Dr D. Moodley [DOCTOR_NAME_PLACEHOLDER], HPCSA [HPCSA_NUMBER_PLACEHOLDER]. Last reviewed 1 July 2026.
Questions about Erectile Dysfunction
Age raises the odds, but ED at any age has a cause, and most causes are treatable. Plenty of men in their 70s have reliable erections; plenty in their 30s have ED from stress, medication or early vascular changes. Age alone is not the explanation.
Because the arteries in the penis are narrower than those around the heart, so vascular disease often shows up as ED several years before it shows up as chest pain. New ED is a genuinely useful early warning, and acting on it protects more than your sex life.
For most men, yes. PDE5 inhibitors, the class that includes sildenafil and tadalafil, are effective in roughly 7 out of 10 men when used correctly. When they do not work, that is useful information that points the assessment towards hormonal, vascular or other causes.
It can be, especially when the problem started suddenly and morning erections are normal. Anxiety-driven ED is real ED and responds well to treatment, often a combination of short-term medication to break the cycle and psychosexual support.
Book a private consult
Most patients are seen within the week at Milnerton or Table View. You can book by WhatsApp without saying why you are coming in.
R650 private doctor consult, paid upfront by cash or card. It covers the assessment, test selection, explanation of your first results, and a script where clinically appropriate. Lab tests are billed separately by the blood lab (Lancet). Medical aid is optional: you claim back yourself if you have it.