What is erectile dysfunction?
Erectile dysfunction is the persistent inability (for at least 3 months) to achieve or maintain an erection sufficient for satisfactory sexual activity. It's important to distinguish ED from isolated episodes — which are completely normal under stress, fatigue, or alcohol — versus a recurring pattern that warrants medical evaluation. ED affects approximately 40% of men at age 40 and 70% at age 70, though these figures include mild cases. More than 80% of cases respond well to the right treatment.
ED is not just a quality-of-life issue: it's recognized as an early marker of cardiovascular disease. The arteries supplying the penis are smaller than coronary arteries, so they develop atherosclerosis earlier — meaning ED in men under 60 can precede heart disease by years. This makes medical evaluation important not just for sexual function, but for overall health.
Key facts
- ✓ED in men under 60 without obvious psychological cause warrants cardiovascular screening
- ✓Sildenafil (Viagra generic) and tadalafil are safe for most men but require medical evaluation first
- ✓Both drugs are contraindicated with nitrate medications (for chest pain) — a dangerous combination
- ✓Lifestyle changes (exercise, diet, quitting smoking, reducing alcohol) significantly improve ED
- ✓Psychological causes are more common in men under 40; organic causes become more prevalent after 50
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Book your consultation →Causes: physical and psychological
Physical (organic) causes are the most common in men over 50: cardiovascular disease and atherosclerosis reducing penile blood flow, diabetes (damages nerves and vessels), hypertension, dyslipidemia, obesity, and smoking. Hypogonadism (low testosterone) contributes in some cases. Medications including certain antihypertensives (beta-blockers, thiazides), antidepressants (SSRIs), and finasteride can cause ED as a side effect. Pelvic surgeries affecting the prostate or colon may damage erection-related nerves.
Psychological causes dominate in men under 40: performance anxiety (the self-fulfilling fear of failure), depression, chronic stress, relationship issues, and sexual trauma. The key diagnostic question is whether morning erections are preserved — if yes, the erectile mechanism is physically intact and the cause is likely psychological. If morning erections are absent, an organic component is more likely. A doctor can clarify this through a structured evaluation.
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PDE5 inhibitors are first-line treatment: sildenafil (25–100 mg taken 30–60 min before sex) and tadalafil (10–20 mg on demand, or 5 mg daily). They work in 60–80% of cases of organic ED. They are contraindicated with nitrates and require medical evaluation before prescribing. For psychological ED, cognitive-behavioral therapy or sex therapy is highly effective, sometimes combined with a short course of PDE5 inhibitors to break the anxiety cycle.
If testosterone deficiency is confirmed, testosterone replacement therapy can improve ED. Lifestyle modifications — regular aerobic exercise, Mediterranean diet, weight loss, quitting smoking, reducing alcohol — have been shown in clinical studies to improve ED independently, sometimes with effects comparable to medication in mild cases. These changes are recommended for all patients regardless of whether medication is prescribed.
FAQ
Is it safe to take sildenafil without a prescription?
Sildenafil is safe for most healthy men, but it's contraindicated with nitrates (used for chest pain), severe hypotension, and serious liver disease. Without a medical evaluation, you risk a dangerous interaction. Getting a prescription through an online consultation is fast and ensures the medication is appropriate for you.
Could my ED be an early sign of heart disease?
Yes, particularly in men under 60 without obvious psychological causes. ED is now considered a cardiovascular risk marker. If you have ED without a clear explanation, a doctor should evaluate your blood pressure, blood glucose, lipid profile, and overall cardiovascular risk.
What's the difference between sildenafil and tadalafil?
Both are PDE5 inhibitors, but sildenafil works for 4–6 hours (taken on demand), while tadalafil has a much longer window of 24–36 hours. Tadalafil 5 mg daily is also used as a continuous low-dose option. The choice depends on how often you anticipate sexual activity and personal preference.
Is the online consultation for ED really confidential?
Yes. At Delvir, consultations are 100% private. Your medical information is protected and never shared. You speak with a physician from your phone or computer, from wherever you are. The digital prescription is sent directly to you.
Conclusion
ED is a medical condition with identifiable causes and effective treatments. The most important step is talking to a doctor rather than self-medicating. Today, you can do that privately, quickly, and without setting foot in a clinic.
At Delvir, you can consult a physician online from S/80, from anywhere in Peru.