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Erectile dysfunction

Also called: ED; impotence

Exercise strongly helps Strength

Difficulty getting or keeping an erection. It is most often a blood vessel problem before it is anything else - which makes it an early warning sign for cardiovascular disease - and the pelvic floor muscles that maintain rigidity are trainable.

How common: Affects around a third of men overall, rising steeply with age

Open the Pelvic Floor & Core Recovery routine All problems

What it is

An erection depends on arterial inflow and on trapping the blood once it is there. The trapping is done partly by two pelvic floor muscles, ischiocavernosus and bulbospongiosus, which compress the base of the penis and maintain rigidity.

The arterial half matters beyond sex. The penile arteries are small, so endothelial dysfunction shows up there before it shows up in the larger coronary arteries - often by several years. Erectile dysfunction in a man in his forties or fifties is a recognised early marker of cardiovascular disease and is a reason to have blood pressure, cholesterol and glucose checked.

What it feels like

  • Difficulty getting an erection, or losing it before or during sex
  • Erections that are less firm than they were
  • Fewer or absent morning erections, which is a useful clue about the mechanism
  • Anxiety about performance, which then becomes its own cause
  • Often arriving alongside weight gain, tiredness or reduced exercise tolerance

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Endothelial dysfunction and vascular disease
The arteries supplying the penis are narrow, so they show impaired dilation earlier than larger vessels. This is the commonest cause after the age of forty and it is why the symptom carries cardiovascular significance.
Weak pelvic floor muscles
Ischiocavernosus and bulbospongiosus compress the veins at the base of the penis to maintain rigidity. Trials of pelvic floor training show restoration of function in a substantial proportion of men - comparable to some drug treatments.
Diabetes
Affects both the small blood vessels and the nerves supplying the area. Erectile dysfunction is very common in diabetes and often appears early.
High blood pressure and its treatment
Raised pressure damages the vessels, and several antihypertensives - particularly thiazides and beta blockers - contribute independently. Worth a conversation with the prescriber rather than stopping anything.
Obesity and low testosterone
Abdominal fat converts testosterone to oestrogen and suppresses the brain's signal to the testes. The resulting low testosterone reduces desire and contributes to the vascular picture.
Smoking
Directly damages endothelial function and is strongly associated. It is one of the fastest things to change.
Performance anxiety
Once it has happened, anticipating it happening again produces sympathetic activation, which physiologically opposes erection. This is a genuine mechanism, not a figure of speech, and it can maintain the problem after the original cause has gone.
Depression and its treatment
Depression reduces desire and function, and SSRIs commonly cause sexual side effects. Both halves need addressing rather than one being blamed.
Sleep apnoea
Associated independently, through oxygen desaturation, sympathetic activation and lowered testosterone. Frequently missed.
Cycling
Long hours on a narrow saddle can compress the pudendal nerve and artery. Saddle choice and position matter, and it is a genuinely reversible cause in high-volume cyclists.

Who tends to get it

  • Men over forty, in whom the vascular contribution rises
  • Anyone with diabetes, high blood pressure or high cholesterol
  • Smokers
  • Men with central obesity, low testosterone or sleep apnoea
  • High-volume cyclists on poorly fitted saddles

What makes it worse, and what settles it

Makes it worse

  • Smoking
  • Inactivity and weight gain around the middle
  • Alcohol, which impairs function acutely and chronically
  • Performance anxiety, which is self-sustaining once established
  • Ignoring it, which misses both a treatable symptom and a cardiovascular warning

Settles it

  • Pelvic floor muscle training, which restores function in a substantial proportion of men in trials
  • Regular aerobic exercise, which improves endothelial function directly and has good evidence here
  • Losing central fat, which improves both vascular function and testosterone
  • Stopping smoking and reducing alcohol
  • Getting cardiovascular risk factors checked, which is the most important thing on this page

What actually helps

The short version: Vascular and pelvic floor components; ischiocavernosus and bulbospongiosus maintain rigidity

Strength work: Core: Pelvic Floor - pelvic floor muscle training; Full Body; aerobic work for endothelial function

Stretching: Hips: Flexors; Hips: Adductors

Massage: Not primary

Also worth doing: Cardiovascular risk factor management - ED is often the first sign of vascular disease

What the evidence says: Dorey RCT: pelvic floor muscle training restored normal function in 40% and improved it in a further 35% at 6 months, matching the comparison intervention.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routinePelvic Floor & Core Recovery

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

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Get it checked if…

New ED is a cardiovascular warning sign - it often precedes coronary events by 3-5 years; recommend a medical check

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Pelvic floor training and aerobic exercise both produce meaningful improvement over three to six months, and lifestyle change has trial evidence comparable to some medication. Medication is effective and is not a failure to have needed. The most important message is the one least often given: erectile dysfunction in midlife is a vascular warning sign, and the cardiovascular assessment it should trigger may matter more in the long run than the symptom itself.

Prevalence basis: Male sexual health surveys

Others the same routine covers

These share the Pelvic Floor & Core Recovery routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

Endometriosis pelvic pain Urinary incontinence in women Leaking when you run, jump or lift Pelvic organ prolapse Abdominal separation after birth Recovery after a C-section After a hysterectomy Premature ejaculation Overactive bladder Bowel leakage Male chronic pelvic pain Incontinence after prostate surgery

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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