Can I just buy treatment online?

It is not a good idea. Products sold without a prescription are not always what they claim to be, and nobody checks whether they are safe for you. You also miss the chance to find the cause.

Will my GP at home be told?

Only if you want. Your data are handled with reinforced confidentiality. Reports are available in English, so if you choose to share them with your GP, you can.

Can I keep my treatment going if I travel a lot?

Yes. Reviews are by video call. Prescriptions are Spanish e-prescriptions dispensed in Spanish pharmacies, so plan ahead before a long trip.

Journal Hormonal health

Erectile dysfunction: causes, diagnosis and treatment (and why your heart deserves a look too)

What causes erectile dysfunction, why it can appear years before heart problems, how a doctor assesses it, and which treatments have evidence behind them.

4 min readEducational content by RejuvelookUpdated in October 2026

In short

Erectile dysfunction is common, treatable and rarely just a matter of age or relationships. It shares risk factors with heart attacks and can appear years before any heart symptoms. That is why it is worth investigating: treating the symptom helps, and checking blood pressure, blood sugar and cholesterol can protect your heart.

Key points

Around half of men aged 40 to 70 have some degree of erectile dysfunction; complete ED triples across that age range.
In men with coronary heart disease, ED came before angina in two out of three cases, on average about three years earlier.
Men with ED have 44% more cardiovascular events, and the relative risk is higher the younger they are.
Lifestyle change and treating cardiovascular risk factors measurably improve erectile function.
Low-intensity shockwave therapy has low-certainty evidence and a small effect.

Erectile dysfunction (ED) is the persistent inability to get or keep an erection firm enough for satisfying sex ^[2]. It is common, it is treatable, and talking to a doctor about it is easier than most men expect. It can also tell you something valuable about your heart.

What it is and why it happens

The Massachusetts Male Aging Study found some degree of ED in 52% of men aged 40 to 70. Complete ED rose from 5% at 40 to 15% at 70 ^[1].

Age matters, but it is not the whole story. In the same study, ED was linked to heart disease, high blood pressure, diabetes, certain medicines, depression and anger, and smoking added to the risk in men with heart disease or high blood pressure ^[1]. In practice, causes are usually mixed: vascular, metabolic, hormonal, neurological, psychological and relational.

Why it can be an early warning for the heart

An erection depends on small arteries widening properly. A well-supported hypothesis holds that these arteries, narrower than the coronary arteries, show the damage of atherosclerosis earlier. It is a hypothesis rather than a proven fact, but the data point that way.

Among 300 men with confirmed coronary heart disease, half had ED. In two out of three of them, the ED had started before any heart symptoms, on average just over three years earlier ^[3]. In a study of more than 9,000 men, ED was linked to a 45% higher risk of cardiovascular events, similar to the extra risk from smoking ^[4].

A meta-analysis of 14 studies and nearly 93,000 men confirms it: 44% more cardiovascular events and 25% higher all-cause mortality, with a higher relative risk in younger men ^[5]. That is why the 2024 Princeton consensus advises treating any man with ED as being at cardiovascular risk until proven otherwise ^[6].

How it is diagnosed

Diagnosis starts with a good clinical conversation, often using a validated erectile function questionnaire. The 2025 European urology guidelines set out a basic and an advanced assessment, depending on the case ^[2]:

Sexual and medical history: how long, morning erections, desire, medication, smoking, alcohol and mood.
Blood pressure and, when relevant, weight and waist.
Blood tests: glucose, a lipid profile and, if desire is low or there are other symptoms, a morning testosterone level.
An estimate of cardiovascular risk. In selected men, the Princeton consensus suggests refining it with tests such as a coronary calcium score ^[6].

If a hormonal cause is suspected, our guide to low testosterone symptoms explains how it is confirmed.

What has evidence behind it

Treatment is chosen according to the cause, how well you tolerate each option, how invasive it is and what you want from it ^[2]. For most men, the first option is oral medication, always prescribed and after checking for contraindications.

Alongside that, looking after your blood vessels pays off. In a meta-analysis of trials, lifestyle change and treating cardiovascular risk factors significantly improved erectile function ^[7]. A 2026 review of 16 trials and nearly 1,500 men confirms it: diet, exercise or both improve erectile function modestly, with moderate certainty ^[9]. Regular aerobic exercise on its own improved erectile function scores by almost 3 points, and more in severe cases ^[10]. Losing weight, moving more, stopping smoking and controlling blood sugar and blood pressure help both your erections and your heart. Our guide to medical weight loss in Spain explains how that is approached.

When there is an emotional or relationship component, psychological or psychosexual support is part of the treatment, not an extra. If oral medication is not enough, urologists have further options.

What the evidence says

Each statement shows its level of evidence and the sources behind it.

Supported

Erectile dysfunction is linked to more cardiovascular events and higher mortality, and should prompt a check of cardiovascular risk factors.^[4]^[5]^[6]High-quality evidence
Oral medication, prescribed by a doctor, is the first option for most men; treatment is chosen according to the case, tolerability and preferences.^[2]High-quality evidence

With caveats

Lifestyle change and treating blood pressure, glucose or cholesterol improve erectile function, although the average effect is moderate.^[7]^[9]^[10]Moderate evidence
The idea that the smaller penile arteries fail before the coronary arteries is a well-supported hypothesis, not a proven fact.^[3]Moderate evidence

Not enough support

Low-intensity shockwave therapy: a small effect, perhaps larger in the long term, with low-certainty evidence and studies often funded by device makers.^[8]Low-quality evidence

What to expect, realistically

Oral medication works for many men, but not always at the first attempt: sometimes the dose needs adjusting or another option suits better. Lifestyle changes take longer to show and their average effect is moderate, but they protect more than your erections.

On low-intensity shockwave therapy, the 2025 Cochrane review concludes it may have a small short-term effect, perhaps somewhat larger in the long term, based on low-certainty evidence ^[8]. It is an option under study, not a proven solution.

Risks, and who it is not for

Oral ED medication is not for everyone. It must not be combined with some heart medicines, such as those used for angina, and your cardiovascular health needs checking first. Buying it online without a prescription is risky: you do not know what it contains or whether it is safe for you.

If you get chest pain, breathlessness or dizziness during sex, that is not an erection problem. It is an emergency.

How it works at Rejuvelook

We see men with erectile dysfunction online anywhere in Spain, in English or Spanish and in complete confidence. The consultation is by video call: your history, your risk factors and the pattern of your symptoms. If needed, the doctor requests blood tests at a lab near you.

With the results, the doctor explains what lies behind it and which options make sense: lifestyle change, medication on a Spanish e-prescription when indicated, psychological support, or referral to urology or cardiology if your case needs it. Follow-up is there to fine-tune treatment, not just to renew it.

When to see a doctor

Book a medical consultation, or go to A&E if it is severe or sudden, if you notice:

Chest pain or tightness, breathlessness or dizziness during sex or exertion: this is an emergency (call 112 in Spain).
A painful erection lasting more than four hours: go to A&E (urgencias) straight away.
A new bend in the penis, pain or a lump you can feel: this needs a urologist.
Sudden erectile problems together with loss of desire, breast changes or testicular changes.

Frequently asked

Can I see a doctor about ED without going to the clinic?

Yes. The consultation is by video call anywhere in Spain, in English or Spanish, in complete confidence. Blood tests, if needed, are done at a lab near you. If your case needs an examination in person, we will say so and point you in the right direction.

Will I have to go into intimate detail?

Only as much as is needed to understand the problem: how long it has been happening, in which situations, and how it affects your life. The doctor guides the conversation with specific questions, without judgement.

Does medication work for every man?

Not always first time. Sometimes the dose or the way it is taken needs adjusting, or a different option works better. That is why there is follow-up rather than a prescription and goodbye.

Is it safe with my heart or blood pressure medication?

It depends on what you take. Some heart medicines, such as those used for angina, must not be combined with oral ED medication. The doctor reviews everything you take, including anything prescribed at home, before prescribing.

References

Sources checked against PubMed or Crossref. Cited as plain text, without links.

1.Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. doi: 10.1016/s0022-5347(17)34871-1. PMID: 8254833.Verified on 2 October 2026
2.Salonia A, Capogrosso P, Boeri L, Cocci A, Corona G, Dinkelman-Smit M, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie's Disease. Eur Urol. 2025;88(1):76-102. doi: 10.1016/j.eururo.2025.04.010. PMID: 40340108.Verified on 2 October 2026
3.Montorsi F, Briganti A, Salonia A, Rigatti P, Margonato A, Macchi A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44(3):360-4; discussion 364-5. doi: 10.1016/s0302-2838(03)00305-1. PMID: 12932937.Verified on 2 October 2026
4.Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. doi: 10.1001/jama.294.23.2996. PMID: 16414947.Verified on 2 October 2026
5.Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013;6(1):99-109. doi: 10.1161/CIRCOUTCOMES.112.966903. PMID: 23300267.Verified on 2 October 2026
6.Köhler TS, Kloner RA, Rosen RC, Burnett AL, Blaha MJ, Ganz P, et al. The Princeton IV Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc. 2024;99(9):1500-1517. doi: 10.1016/j.mayocp.2024.06.002. PMID: 39115509.Verified on 2 October 2026
7.Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011;171(20):1797-803. doi: 10.1001/archinternmed.2011.440. PMID: 21911624.Verified on 2 October 2026
8.Ergun O, Kim K, Kim MH, Hwang EC, Blair Y, Gudeloglu A, et al. Low-intensity shockwave therapy for erectile dysfunction. Cochrane Database Syst Rev. 2025;7(7):CD013166. doi: 10.1002/14651858.CD013166.pub3. PMID: 40654049.Verified on 2 October 2026
9.Li T, He X, Huang W, Liu G, Feng Q. Efficacy of lifestyle interventions in treating erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials. J Sex Med. 2026;23(6). doi: 10.1093/jsxmed/qdag137. PMID: 42143598.Verified on 2 October 2026
10.Khera M, Bhattacharyya S, Miller LE. Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials. J Sex Med. 2023;20(12):1369-1375. doi: 10.1093/jsxmed/qdad130. PMID: 37814532.Verified on 2 October 2026

Educational content. It does not replace a medical consultation or provide a diagnosis. Tests and treatments are indicated only after medical consultation and in line with regulation.