Erectile dysfunction:
definition, causes,
treatments and
medical care.
Also known as impotence or erection problems, erectile dysfunction affects around 1 in 3 men over 40. A medical team specialised in men’s health supports you from diagnosis to follow-up. Our aim: to treat the cause, not just the symptom.
Discreet consultation
Online medical assessment, from home, in under 5 minutes.
Registered doctor
Registered with the Medical Council (France or EU), specialised in men’s health.
Partner pharmacy
Prepared and delivered discreetly within 48 to 72 hours, in plain packaging.
Vigour Programme
A guided 3-month programme, to go further than medication alone.
Doctors online
What is
erectile dysfunction?
Also known as impotence or erection problems, erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. Here is the medical summary to understand it in under a minute, before going further.
- 01Persistent difficulties for more than 3 months, in more than 50% of attempts: this is what is meant by impotence or erectile dysfunction.
- 02Around 1 in 3 men over 40 is affected by erection problems, all severities combined.
- 03Causes are most often mixed: organic (vascular, hormonal) and psychological (performance anxiety, stress).
- 04It can be an early warning sign of cardiovascular disease — the penis is a genuine indicator of overall health.
- 05The majority of erectile dysfunction cases have a documented, effective medical solution (PDE5 inhibitors).
- 06Remote medical consultation removes the embarrassment and speeds up the care of erection problems.
Occasional failure or genuine erectile dysfunction?
Erectile dysfunction in the medical sense means difficulties that have been present for at least three months and in more than 50% of attempts. An isolated failure — tiredness, stress, alcohol — does not constitute an erectile disorder. If you are wondering why you can no longer get an erection, the first step is to assess how often and for how long these episodes occur.
Symptoms vary: a complete inability to achieve an erection, an erection too weak for penetration (a soft erection), or a loss of rigidity during intercourse. Erectile dysfunction, impotence and erectile disorder are used interchangeably to describe the same clinical reality.
How a healthy erection works
An erection is a neurovascular event. Sexual stimulation triggers the release of nitric oxide in the corpora cavernosa of the penis, the smooth muscle relaxes, blood flows in massively and the penis becomes rigid.
A failure at any one of these levels — libido, nerve signal, blood vessels, testosterone balance — can cause a disorder. Understanding this mechanism is essential to treating the cause, not just the symptom.
How
prevalent
is erectile dysfunction?
Erectile dysfunction is not an inevitable part of ageing, but impotence does become more common with age and the onset of other health problems. According to the Massachusetts Male Aging Study, close to 52% of men aged 40 to 70 report an erectile disorder, all severities combined.
What are the
causes
of erectile dysfunction?
The causes of erection problems are most often mixed, combining organic factors (vascular, hormonal, neurological) and psychological factors. In younger men the origin is often psychogenic, whereas after 50 organic causes become predominant (see our age-by-age benchmarks above). Identifying the origin of the dysfunction is essential for an appropriate treatment, rather than a one-size-fits-all prescription. An online sex therapist can complement medical care when the psychogenic component dominates, particularly when a drop in libido is also present.
Organic causes
- Atherosclerosis
The penile arteries (1–2 mm) become blocked before the coronary arteries (3–4 mm). Erectile dysfunction becomes an early marker of cardiovascular disease, sometimes 2 to 5 years before a coronary event.
- Diabetes
Damages the blood vessels and the nerves that control erection; affects 40 to 50% of diabetic men. Blood glucose control directly influences erection quality.
- High blood pressure
Damages the arterial wall and limits the vasodilation needed for an erection. Some antihypertensive drugs also worsen erectile disorders.
- Testosterone deficiency
Hypogonadism (hormone deficiency) affects libido and erection quality after 50. A hormone work-up (total and bioavailable testosterone) is recommended when in doubt.
- Prostate conditions
Benign enlargement, prostatectomy or anti-androgen treatments can damage the erectile nerves and cause a lasting erectile disorder.
- Peyronie’s disease
Fibrous plaques in the corpora cavernosa causing penile curvature, pain and erectile dysfunction. Often associated with other vascular causes.
Psychological causes
- Sudden onset
Often linked to a specific event (break-up, sexual failure, period of acute stress, bereavement, conflict at work).
- Preserved nocturnal erections
A key diagnostic criterion. The presence of spontaneous nocturnal erections (NPT, Nocturnal Penile Tumescence) points to a psychogenic origin and rules out most vascular causes.
- Varies with context
Disorder present with a partner but absent during masturbation, or the reverse. This variability almost always signals a psychological factor.
- Performance anxiety
The fear of failing activates the sympathetic nervous system, which works against the vascular relaxation essential to an erection. A major cause in younger men.
- Stress and depression
A classic vicious circle: a first failure creates anxiety, which triggers the next. Antidepressants (SSRIs in particular) can also induce drug-related erectile dysfunction.
- Sex therapy
Very effective at breaking this cycle, sometimes combined with medication. An online sex therapist can support the couple.
Erectile dysfunction and
cardiovascular health.
Erectile disorder is now recognised as a sentinel symptom. It can precede a heart attack or a stroke by 2 to 5 years, because atherosclerosis affects the small-calibre arteries first.
The arteries of the penis are 1 to 2 mm in diameter, compared with 3 to 4 mm for the coronary arteries. When blood flow to the penis decreases, it is often a sign that the same process is under way throughout the vascular system. Any man over 40 with erectile dysfunction and no obvious psychological cause should have a full cardiovascular work-up: blood pressure, lipid profile, fasting blood glucose and sometimes an exercise stress test.
Seeking help for impotence also means looking after your heart. It is an opportunity to detect silent conditions (high blood pressure, diabetes, dyslipidaemia) before they cause a cardiac event.
Symptoms and
warning signs:
when to see a doctor?
The majority of men affected have never seen a doctor about their erectile dysfunction. According to a nationally representative study carried out in France in 2026 among 1,000 men, 58% have never sought medical advice, mainly out of embarrassment. Many turn to self-medication, exposing themselves to the risk of serious drug interactions. Medical diagnosis relies on a clinical interview, the IIEF-5 score (International Index of Erectile Function) and blood tests (blood glucose, lipid profile, testosterone). A remote assessment by a doctor removes a major barrier to care and allows you to obtain an online prescription if treatment is indicated.
- Persistent erection difficulties for more than 3 months
- A noticeable drop in libido with no obvious explanation
- Increasingly frequent failures, even during masturbation
- Associated cardiovascular risk factors (diabetes, high blood pressure, smoking)
- IIEF-5 score below 21 (validated international questionnaire)
What are the
treatments
for erectile dysfunction?
First-line treatment relies on PDE5 inhibitors (sildenafil, tadalafil, vardenafil), which restore an erection in around 70% of patients. Other second-line options exist, suited to the cause of the erectile dysfunction and to the patient’s profile. The four molecules most often prescribed — Viagra®, Cialis® and their generics — are compared below.
The original Pfizer brand of sildenafil, marketed since 1998. The most prescribed PDE5 inhibitor in the world, studied in more than 130 clinical trials. Relevant for patients who wish to stay on the original brand or who have not tolerated a generic formulation well. Same active molecule and identical clinical results to the generic; only the excipients (binders, colourings, coating) and the packaging differ.
The original Lilly brand, the reference molecule for tadalafil. Indicated for erectile dysfunction and also for benign prostatic hyperplasia (BPH), with a clinical benefit on the associated urinary symptoms. The 5 mg daily dose is particularly suited to men who have intercourse frequently.
Exactly the same active molecule as Viagra®, at a markedly more affordable price. Indications, dosages and clinical results identical to the original brand. Taken 30 to 60 minutes before intercourse, with sexual stimulation. Available in 25, 50 or 100 mg. A good first-line option for the majority of men.
A long-acting PDE5 inhibitor. Its 24-to-36-hour window of effectiveness restores genuine spontaneity, with no need to plan intercourse. Two possible regimens: on demand (10 or 20 mg) or a daily low dose (2.5 or 5 mg) for men with regular sexual activity or who want a continuous effect.
Alternative and second-line treatments
When PDE5 inhibitors are insufficient or contraindicated, several medical and surgical options are available, to be discussed with a urologist or an andrologist.
- Intracavernosal injections
Self-injection of prostaglandins (alprostadil) at the base of the penis. 70 to 90% effective; indicated as second-line treatment when PDE5 inhibitors are insufficient or contraindicated.
- Low-intensity shockwave therapy
Extracorporeal penile-vascular lithotripsy. Stimulates new blood vessel growth in the corpora cavernosa. Indicated for mild to moderate erectile dysfunction of vascular origin. Besançon University Hospital (CHU) was a pioneer of the technique in France.
- Vacuum erection device
A non-invasive mechanical device that creates a vacuum around the penis to draw in blood. A drug-free solution, sometimes offered when oral treatments are contraindicated.
- Sex therapy and couples therapy
Essential when performance anxiety is maintaining the disorder. Can be combined with medication to break the psychogenic vicious circle, particularly in younger men. An online sex therapist can support you.
- Penile implant
An inflatable or semi-rigid intracavernosal prosthesis. A surgical solution of last resort, indicated when other treatments have failed, with a satisfaction rate above 90%.
- Treating the underlying cause
Diabetes control, blood pressure control, hormone supplementation if testosterone deficiency is confirmed, adjustment of the medicines involved (beta-blockers, SSRIs, anti-androgens).
91% of our patients see their sexual health improve.
Of 2,447 patients supported by Kano for erectile dysfunction, 91% report a significant improvement in their erectile function on treatment. The first treatment prescribed is not always the right one: 39% of patients have their dose or molecule adjusted at the first follow-up, with an average improvement of +43% in erectile function at the next one.
Source: Kano 2025 report on erectile dysfunction.
Prescription-only medicines (List I in France). The molecule and the dose are determined by your doctor after assessment.
A care pathway
built
around you.
Four steps that work together: consultation, medical report, treatment and programme. The same doctor from diagnosis to follow-up, to treat the cause, not just the symptom.
Assessment by a specialist doctor
A detailed medical questionnaire with IIEF-5 score, review of your file by a registered doctor, differential diagnosis and check for contraindications. Not an algorithm.
- IIEF-5 questionnaire
- Medical history & current medicines
- Contraindications checked
Written diagnosis and care pathway
You receive a personalised medical report: interpretation of your score, causes identified, cardiovascular signals to monitor, and the course of action recommended by your doctor.
- Written medical report
- Causes and risk factors
- Digital prescription if indicated
What your doctor recommends, and nothing more
A medicine from the PDE5-inhibitor family, an over-the-counter supplement, or both: your doctor decides. Each item is purchased separately, after the consultation, and nothing is bundled into the price.
- Medicine delivered by a licensed pharmacy
- PureFlow supplement if recommended
- Plain packaging, with no medical markings
Going further than medication
A guided programme in the Kano app, built from your consultation: pelvic floor exercises, cardio sessions, stress management. Medication works in the moment; the programme works on the causes.
- Guided sessions every day
- Personalised from your medical report
- One-off purchase, no subscription
What makes the difference: the same doctor from diagnosis to follow-up.
Not a new practitioner at every exchange. Not an algorithm in their place. A continuous medical pathway, all within a single app.
€35 for the consultation.
A one-off payment, with no subscription or automatic debit. It covers the medical assessment, the written report and the prescription if a treatment is indicated. Whatever your doctor then recommends — medicine, supplement or the Vigour Programme — is purchased separately, and only if you decide to.
- Consultation with a doctor specialised in men’s health
- Written medical report with your IIEF-5 score
- Secure digital prescription if a treatment is indicated
- Secure messaging with your doctor
- Access to your patient area and to the KANO app
Going further than
medication.
Six documented levers that improve erectile function on their own or alongside treatment. They are recommended as first-line measures by the learned societies, and your doctor details them in your medical report.
150 minutes a week improve endothelial function and blood flow to the penis.
Reduces cardiovascular risk factors and improves erectile function.
Measurable benefits on penile microcirculation from the first few weeks.
Losing 5 to 10% of body weight can be enough to improve erections.
Meditation, breathing, cognitive therapy — key for younger men with performance anxiety.
Chronic sleep deficit impairs testosterone and vascular function.
Knowing them is not enough.
Nobody fails for want of having read the list. People give up because they do not know where to start, at what intensity, or how to keep going for three months. The Vigour Programme turns these levers into guided sessions, a few minutes a day in the KANO app, built from your consultation and adjusted as you progress.
A medical team
expert in sexual health,
always by your side.
Medical DirectorDr Sam Ward
“Erectile dysfunction is a signal about your general health. Our role is to read that signal seriously, without taboo and without shortcuts.”
Your questions about
erectile dysfunction.
Yes, in some cases. When the cause is psychological (performance anxiety, stress) or linked to lifestyle (smoking, a sedentary lifestyle, excess weight), lifestyle changes combined with sex therapy can be enough to restore a satisfactory erection. When the origin is organic (diabetes, atherosclerosis, hypogonadism), medical treatment greatly improves erectile function but often has to be continued for as long as the underlying cause persists. Treating the cause (diabetes control, testosterone supplementation, stopping smoking) remains the most lasting route.
Yes, this is now firmly established. Erectile disorder is considered a sentinel symptom: it can precede a heart attack or a stroke by 2 to 5 years. The arteries of the penis (1 to 2 mm) become blocked by atherosclerosis before the coronary arteries (3 to 4 mm). Any man over 40 with erectile dysfunction and no obvious psychological cause should have a cardiovascular work-up: blood pressure, lipid profile, fasting blood glucose.
Prevalence increases with age: around 8% before 30, 33% between 40 and 50, 50% between 50 and 60, and more than 65% after 60. But impotence is not confined to older men. Young men can be affected too, particularly by performance anxiety, stress or an unfavourable lifestyle. Appropriate medical support makes it possible to regain a satisfying sex life at any age.
It can be, particularly in younger men. Performance anxiety, stress, depression and relationship conflicts are the leading psychogenic causes of erectile disorders. The cause is purely psychological in 10 to 20% of isolated cases and mixed (psychological and organic) in a further 20 to 30%. After 50, organic causes (vascular, hormonal, neurological) become predominant, often with a secondary psychological impact.
Several clues point to a psychogenic origin: sudden onset linked to a specific event, preserved nocturnal or morning erections (NPT, Nocturnal Penile Tumescence), a disorder that varies with context (present with a partner, absent during masturbation or the reverse), and a young age with no cardiovascular risk factors. Conversely, a gradual onset, absent or weak nocturnal erections, a constant disorder whatever the context, and the presence of risk factors (diabetes, high blood pressure, smoking, age over 50) point to an organic cause. Only a doctor can make the differential diagnosis with a full work-up.
Yes, very frequently. This is what is known as performance anxiety. The fear of failing activates the sympathetic nervous system (the stress system), which works against the vascular relaxation essential to an erection. It is a classic vicious circle: a first failure creates apprehension, which triggers the next. Sex therapy, stress-management techniques (meditation, breathing, cognitive behavioural therapy) and sometimes a temporary course of medication are very effective at breaking this cycle.
Several classes of medicines are involved. Antidepressants (particularly SSRIs such as paroxetine, sertraline and fluoxetine) impair sexual function in 30 to 60% of patients. Beta-blockers (propranolol, atenolol) and some diuretics (thiazides, spironolactone) can induce erectile dysfunction. The anti-androgens used in prostate cancer cause a fall in libido and erectile function. Finasteride (a treatment for hair loss) can also be responsible. Never stop a treatment without medical advice: an adjustment with the prescriber often restores erectile function.
Your general practitioner is the first point of contact. They can make the diagnosis, order an initial work-up (blood glucose, lipid profile, testosterone) and prescribe first-line treatment (PDE5 inhibitors). In the event of a complex organic cause or failure of the initial treatment, a urologist or an andrologist takes over. For predominantly psychogenic causes, a sex therapist or a psychologist specialised in sexual health provides complementary care. A remote medical consultation, such as the one offered by Kano, removes the embarrassment and speeds up access to a diagnosis.
Lifestyle changes are the most effective natural treatments: regular physical activity (150 minutes a week), a Mediterranean diet, stopping smoking, losing 5 to 10% of body weight, stress management and regular sleep. Some plants (Korean ginseng, maca, tribulus) are sometimes cited, but their effectiveness in erectile dysfunction remains poorly documented scientifically and they can interact with other treatments. Pelvic floor (Kegel) exercises have proven effectiveness in men. No natural approach replaces a medical assessment when the disorder persists for more than 3 months.
Disclaimer: the information on this page is provided for information purposes only and does not replace professional medical advice. The treatments mentioned (sildenafil, tadalafil) are prescription-only medicines. In an emergency, call 112 (or 15 in France).
