ED is a health signal, not a verdict on fertility.

Erectile dysfunction is usually caused by reduced blood flow, nerve damage, hormones, medicines, or stress and anxiety, and often by more than one.

Diabetes, high blood pressure, high cholesterol, smoking, heavy drinking and excess weight all narrow or damage the blood vessels and nerves involved. Low testosterone and some medicines play a part. Stress, low mood and relationship strain can cause ED on their own, even in a healthy man.

ED affects fertility only by making sex difficult; it does not mean the sperm are poor, because erections and sperm production are controlled separately.

Many couples find ED starts after they begin trying. Sex on a schedule, around the fertile window, turns intimacy into a test, and anxiety about that test is itself a cause of ED. The things that cause ED, such as diabetes, smoking and weight, can also lower sperm quality, which is why both are checked.

Tests for ED look for the cause: blood pressure, blood sugar, cholesterol and a morning testosterone level, along with a history and examination.

Guidelines treat ED as an early sign of heart and blood vessel disease, so these checks matter for your health, not just for a pregnancy. A semen analysis checks the sperm. A questionnaire may be used to understand how often it happens and when.

ED is treated by addressing the cause and, where safe, with tablets such as sildenafil or tadalafil, which do not harm sperm or a pregnancy started while taking them.

Counselling helps when pressure and anxiety are the cause [CONFIRM: in-house or referral]. Vacuum devices, injections and implants are specialist options. If sex remains difficult, IUI places his own washed sperm in the womb at ovulation. IVF with ICSI is only needed if the sperm or her tests also call for it. [CONFIRM: ED medicines prescribed at Jananam or by referral]

Stop timing sex to one or two days and have sex every 2 to 3 days through the month instead; it covers the fertile window without the pressure.

Stop smoking, cut down on alcohol, move more and work towards a healthy weight. Do not take testosterone or bodybuilding supplements: they switch off sperm production. Talk to each other; ED under pressure is common and it usually improves when the pressure goes. Tamil speakers can read our Tamil page.