Before you read this section, it's important to remember that although the conditions we talk about are linked to erectile dysfunction, it does not mean your partner must be suffering from any or all of them.

We have only focused on some of the physical causes of erectile dysfunction in this section. Many other medical conditions can cause erection problems, including hormonal disorders such as low testosterone and neurological disorders such as Parkinson’s Disease.

Some prescription medicines can also be the cause of erectile problems, such as those for high blood pressure and depression. If after reading this section you are concerned about your partners health, please talk to your partner about seeing his doctor as soon as possible.

Cardiovascular disease and erectile dysfunction

The association between erectile dysfunction and subsequent development of cardiovascular disease has been shown to be in the range of risk associated with current smoking or family history of heart attack. Cardiovascular disease (coronary heart disease) happens when the arteries become narrow and restrict the supply of oxygen and blood to the heart. Cardiovascular disease can affect anyone, men and women, and there are around 270,000 heart attacks in the UK each year. Also, 1.2 million people experience angina, a type of chest pain that is the major symptom of cardiovascular disease.

Atherosclerosis is a build-up of fatty materials within the walls of the arteries. This happens when cholesterol and other substances start sticking to the artery walls, building up 'plaques' that reduce the space through which blood can flow. It can be a cause of cardiovascular disease, symptoms may include:

• breathlessness
• palpitations
• fainting
• fluid retention
• fatigue
• chest pains

If your partner has any of these symptoms, he should talk to his doctor as soon as possible.

High blood pressure and high cholesterol are both risk factors for cardiovascular disease, as well as smoking, diabetes and being overweight. High blood pressure is a silent disease in that it causes no symptoms, so it's important that your partner gets his checked regularly by his doctor so he can take steps to reduce it. Other factors such as your partner's genes, waist line, age and ethnic background can all affect his risk of cardiovascular disease.

If you know your partner is at risk of cardiovascular disease, or already has cardiovascular disease, there are lots of things they can do to improve the health of their heart. Taking regular exercise, watching their diet and cutting out smoking can go a long way to keeping them healthy.

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Diabetes and erectile dysfunction

Diabetes is a very common cause of erectile dysfunction. There are over 2 million people in the UK known to have diabetes, and your risk of developing it increases with age. More than half of all men with diabetes also have erectile dysfunction to some degree by the age of 60.

There are two types of diabetes - type 1 and type 2.

Type 1 diabetes happens when the cells in the pancreas are unable to produce sufficient insulin. This type of diabetes generally affects younger people, and those affected need to take insulin regularly to stay well.

Type 2 diabetes usually happens in middle-aged or older people. It is thought to be caused when the body no longer responds to its own insulin or not enough insulin is produced (or both). People who are overweight are more likely to develop type 2 diabetes, and it tends to run in families.

Symptoms of diabetes may include:

• increased thirst
• going to the toilet more frequently, especially at night
• extreme tiredness
• weight loss

If your partner has any of the symptoms shown above, please get him to talk to his doctor as soon as possible. A simple blood test can be used to see if he has diabetes and then steps can be taken to control it. Making sure his diabetes is properly controlled can play a large part in staying fit and healthy.

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Prostate problem and erectile dysfunction

The prostate is a gland at the bottom of a man's bladder wrapped around the tube (urethra) that carries urine out to the penis. It's about the size of a golf ball and makes the liquid to carry sperm. Erectile dysfunction can be a symptom or a result of prostate problems.

Prostate cancer is the most common cancer in older men. Nearly 32,000 cases of prostate cancer are diagnosed in the UK every year. More than 60% of these cases happened in men over the age of 70.

If it's caught early enough, prostate cancer is a very treatable disease. Unfortunately, if prostate cancer is diagnosed at a late stage of the disease, it is less treatable. As a result, it is important for a man to be aware of his prostate health after the age of 45.

Have a look at the prostate checklist for signs of a problem prostate as well as looking out for the following symptoms.

• going to the toilet more frequently, especially at night
• difficulty starting urination
• difficulty stopping urination (dribbling)
• poor/weak stream
• bladder feels full even after going to the toilet

If your partner has any of these symptoms, it is important for him to talk to his doctor as soon as possible. His doctor can then carry out basic tests such as a simple physical examination and a PSA (Prostate Specific Antigen) test, to assess his risk of prostate cancer. Remember that these symptoms, while they do need to be checked, may be nothing to worry about.

Surgery is a common approach for treating prostate cancer in men under the age of 70. Unfortunately, removing the prostate can result in erectile dysfunction in around 70% of cases, this is usually due to damage to the nerves during surgery.

Benign prostatic hyperplasia* is a condition that mainly affects men over the age of 50. The prostate begins to grow again when men reach the age of 40, and for many men this growth can cause problems. As it grows, the prostate can begin to press on the urethra, causing the urine flow to become slower and less forceful. Use the prostate checklist to see if your partner has any of the symptoms of a problem prostate.

* Hyperplasia means enlarged, while benign means the growth is not due to cancer.

Prostate checklist for him

• Do you sometimes feel a need to urinate when you don't expect to (for example, after you have just been to the toilet)?
• Do you urinate two or more times during the night?
• Are you bursting to go and then find you barely produce a trickle?
• Do you strain to urinate?
• Does it take ages to start?
• Has your stream become less of a torrent and more of a trickle?
• When you urinate are you always stopping and starting?
• Do you have any discomfort (for example, pain or a burning sensation) when you urinate?
• Is there any sign of blood in your urine?
• Does your bladder still feel full after you've finished?
• Do you still trickle after you've stopped?

If the answer to some of the questions above is “yes” his prostate might be playing up. Encourage him to talk to his doctor as soon as he can.

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Stress and erectile dysfunction

Stress is part of everyone's daily life. In short bursts, such as when a mental or physical challenge arises, it can give you a buzz. Too little stress and life can become dull. However, there are times when stress takes over, and that is when your body begins to react badly to it.

Stress not only affects you emotionally, but can also cause directly related medical problems. These physical effects are because stress is part of the instinct we need to escape danger. Faced with pressure, challenge or danger, our bodies release hormones such as adrenaline, which increase heart rate and blood pressure, restrict blood flow to non-essential areas of the body and reduce stomach activity.

It also releases cortisol, another hormone which releases sugar and fat into your system to give you energy.

Symptoms of stress include:

• panicky feelings, anxiety for no apparent reason, and an inability to cope;
• heart palpitations, dizziness, blurred vision and fatigue (tiredness);
• frequent heartburn, diarrhoea, stomach cramps and loss of appetite;
• headaches, muddled thinking, negative thoughts and angry outbursts;
• disturbed sleep patterns, and feeling agitated or hostile;
• loss of sex drive.

How does stress affect your partner's erections?

Not too long ago most men were thought to have a psychological basis for their erectile problems. Depression, anxiety, nerves, stress - all these seem to affect everyone at one time or another.

Your partner's emotions can stop him having an erection or make it disappear too soon. This produces a chain reaction. If he has trouble having sex one day, the next time he tries he will have in the back of his mind the worry that he might fail again. This performance anxiety is in itself a form of stress which only adds to the general levels of stress he is suffering.

So how can he cope with stress?

Because stress triggers a physical response from your body, the first thing to consider is exercise. A gentle walk or cycle, or more rigorous exercise, are natural ways for the body to 'burn off' those excess levels of stress factors - see the section on exercise. However, there may be situations when he can't do much or any exercise, so in those cases suggest a few of these ideas to help reduce levels of stress.

• Do some enjoyable activities whenever possible.
• Take a short break after meals to relax.
• Take breaks during the workday to relax.
• Wear comfortable and loose clothing when possible.
• Take off your shoes when you can.
• Walk, work and eat at a relaxed pace.
• If you notice tension in your body during the day, take a minute to breathe deeply, stretch and relax.
• If you find yourself worrying throughout the day, take a minute to breathe and concentrate on something in the present, such as the scenery around you.

The main problem with stress is that it reduces your levels of self-motivation, so in more severe cases even these simple 'stress-busters' can become difficult to do. If at any time he feels he really can't cope, he should get professional advice.

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Obesity and erectile dysfunction

Obesity is a growing problem in many western countries. There are many reasons for obesity, including genetic, environmental, behavioural, psychological and metabolic factors. But there is one thing they all have in common - if you take in more energy than you use up, you will put on weight.

So how does obesity affect erections?

Physically, obesity indirectly causes erectile dysfunction through a range of associated complications such as diabetes, hypertension (high blood pressure) and cardiovascular disease.

As well as the physical effect these diseases have on your partner's erections, some medications used to treat them (e.g. some drugs for hypertension) can also cause erectile dysfunction.

So how can he avoid obesity?

The best way to tackle obesity is by eating healthily and doing regular exercise.

Diet

Your diet is crucial. What you eat, and even when you eat, directly affects your weight. Diets high in saturated fats and salt (for example, chocolate, cheese, red meat and crisps) are particularly bad for you. Saturated fats may cause cardiovascular disease as they are deposited in your body's tissues and bloodstream, while too much salt causes high blood pressure and can lead to dehydration.

Fruit and vegetables and unrefined carbohydrates should make up the bulk of your diet. Choose brown and wholegrain carbohydrates and be sparing with high-fat additions, such as cheese, cream and butter. Aim for five portions of fruits and vegetables a day and vary the colour and type to get maximum vitamins.

Think about how you prepare food - steaming and grilling are healthier ways of cooking than frying and roasting. Go easy on the amount of butter and oil you add.

Try not to overeat - listen to your body and stop when you're full. It can take up to 30 minutes for the stomach to register that it's full, so eat slowly and wait before tucking into seconds. Serve food in the kitchen, not from the table where you might be tempted to go back for more.

Cut down on high fat snacks, junk food and ready meals, as they are often packed with fat and sugar and don't fill you up. Dried fruit, oatcakes, yoghurt and fruit are healthier and keep you full for longer.

Exercise:

Exercise doesn't just burn up calories: regular aerobic exercise increases your metabolic rate, so that even when you are not exercising, the body uses more calories overall. However, this effect is quickly lost once regular exercise stops.

Regular exercise increases appetite, but the faster metabolic rate means it's easily burnt off, particularly if you make the right food choices as described above.

Exercising when you're overweight can be tough because the extra weight means your body has to work harder. Stick to activities that increase your heart rate, make you sweat and get you slightly out of breath. If you feel embarrassed about joining a gym, try gardening, swimming, badminton, or attending fitness classes specifically designed for people who are overweight.

In addition, try to fit more activity into your daily routine. Walk or cycle to work, and take the stairs rather than the lift. If you have never exercised before, a brisk 30 minute walk each day is a really good starting point.

Please note that if you haven't done any exercise for a while it may be worth consulting your GP or nurse before embarking on an exercise programme.

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