💊 Men's Health
Erectile Dysfunction (ED)
Very common, highly treatable, and often an early warning sign of something else.
Erectile dysfunction affects up to 40% of Nigerian men over 40. It is not a reflection of manhood or character. It is a medical symptom with identifiable, treatable causes. In many cases, it is also the first sign of diabetes, cardiovascular disease, or low testosterone.
Signs and Symptoms
✓ Difficulty achieving an erection
✓ Difficulty maintaining an erection during sex
✓ Reduced interest in sexual activity
✓ Erections that are weaker than before
✓ Morning erections absent or reduced
Risk Factors
- Type 2 diabetes (most common cause in Nigeria), damages penile nerves and blood vessels
- Hypertension and cardiovascular disease: reduced blood flow to penile tissue
- High cholesterol: endothelial damage reduces vasodilation
- Obesity and metabolic syndrome: associated with low testosterone and vascular disease
- Excessive alcohol consumption: suppresses testosterone and impairs nerve conduction
- Smoking: accelerates vascular damage; smokers are twice as likely to have ED
- Stress, anxiety, and depression: the most common cause in men under 40
- Low testosterone (hypogonadism): reduced libido and erectile function
- Some medications: beta-blockers, spironolactone, antidepressants, antipsychotics
- Pelvic surgery or radiotherapy: nerve damage
When to Seek Help
RoutineED lasting more than 3 months, affecting your relationship or confidence, book a GP appointment for assessment and blood tests
SoonED in a man under 40 with no obvious psychological cause, warrants cardiovascular and hormonal screening
NowED with chest pain, exertional breathlessness, or leg pain on walking: ED may be the first symptom of significant cardiovascular disease; seek urgent review
Tests & Diagnosis
🧪 Fasting Blood Glucose and HbA1c
Diabetes is the most common reversible physical cause of ED in Nigerian men. Ruling it out first is essential. A normal result does not end the workup, pre-diabetes and insulin resistance also contribute.
🧪 Fasting Lipid Profile
High LDL cholesterol damages the endothelium: the inner lining of blood vessels, including those supplying penile tissue. Elevated lipids are both a cause of ED and a cardiovascular risk marker.
🧪 Morning Total Testosterone
Testosterone peaks between 7–10 am. A morning sample is essential for an accurate reading. Low testosterone (below 10–12 nmol/L) contributes to reduced libido and impairs erection quality.
🧪 Blood Pressure Measurement
Hypertension is independently associated with ED. If untreated, the arterial damage compounds over time. Paradoxically, some antihypertensive medications (especially older beta-blockers and thiazides) also worsen ED.
🧪 Penile Doppler Ultrasound (specialist referral)
For men where vascular ED is suspected, a Doppler scan of the penile arteries after injection of a vasodilator agent measures blood flow and arterial function. Available at specialist urology centres.
Treatment Options
1
Address the underlying cause first
Treating poorly controlled diabetes, hypertension, obesity, or testosterone deficiency often improves ED significantly without any direct ED medication. Lifestyle change, weight loss, exercise, alcohol reduction, smoking cessation, independently restores erectile function in many men.
2
PDE5 inhibitors: sildenafil (Viagra), tadalafil (Cialis)
First-line pharmacological treatment. These drugs enhance the natural erectile response by relaxing penile smooth muscle and increasing blood flow. Tadalafil (Cialis) taken daily at 5 mg is preferred for men who want spontaneous sexual activity without timing a tablet. Must not be taken with nitrates (used for angina), dangerous blood pressure drop. Available on prescription.
3
Testosterone replacement (if deficient)
If morning testosterone is confirmed low, testosterone therapy (injections, gel, or patches) can restore libido and contribute to erection quality. Important: testosterone replacement reduces sperm production, men planning fatherhood need specialist fertility guidance before starting.
4
Psychological counselling
For men where stress, anxiety, relationship conflict, or depression is the primary driver, particularly under 40, structured psychosexual therapy or CBT with a mental health professional is more effective than medication alone.
5
Vacuum erection devices, penile injections, or implants
For men who do not respond to oral medication or cannot take PDE5 inhibitors, alprostadil injections directly into the penis, vacuum erection devices, or surgical penile implants are effective options managed by a urologist.
Frequently Asked Questions
Is erectile dysfunction a normal part of ageing?
Partial: the frequency of ED does increase with age, but it is not inevitable or untreatable at any age. Age-related ED usually reflects accumulated vascular damage from diabetes, hypertension, and smoking, not ageing itself. Healthy 70-year-olds with well-controlled cardiovascular risk factors maintain erectile function. ED at any age deserves evaluation, not acceptance.
Can I buy sildenafil (Viagra) over the counter safely?
Sildenafil is widely available in Nigerian pharmacies, often without prescription. While it is generally safe for healthy men, it is dangerous with nitrates (isosorbide mononitrate, glyceryl trinitrate, used for angina), can precipitate cardiovascular events in men with undiagnosed heart disease, and does not address the underlying cause. See a doctor before starting, an ECG and cardiovascular assessment take 20 minutes and could save your life.
Does ED mean I have low testosterone?
Not necessarily. Most men with ED have normal testosterone levels, the cause is vascular or psychological. Low testosterone (hypogonadism) is one cause of ED, but primarily presents with low libido, fatigue, and mood changes rather than purely mechanical erection difficulty. A morning testosterone blood test confirms or excludes it.
Will treating ED improve my general health?
Yes, in an important indirect way. ED is a potent motivator for men to engage with healthcare. The investigation process often reveals undiagnosed diabetes, hypertension, or high cholesterol. Treating these conditions reduces cardiovascular risk, improves energy, and prolongs life, the ED improvement is often the most visible benefit of a much broader health rescue.
Ready to speak to a doctor?
Confidential, judgement-free consultations: book online or via WhatsApp.
💬 Book on WhatsAppLast updated 16 October 2026.