Erectile Dysfunction & Men's Sexual Health London 2026: Doctor-Led, Discreet, Evidence-Based Treatment
Reviewed by the medical team at The Online GP by The Wellness | Last updated: April 2026 | GMC-
What lifestyle changes improve erectile function?
The lifestyle evidence base for ED is substantial. The Online GP by The Wellness builds personalised plans around the changes with the strongest evidence.
Smoking cessation. Smoking is one of the strongest modifiable risk factors for ED, with effects on endothelial function and small vessel disease. Cessation produces measurable improvement in ED within 3 to 6 months in most men.
Weight loss. Obesity is associated with around twice the risk of ED. A 5 to 10% reduction in body weight improves erectile function through multiple mechanisms (testosterone, insulin sensitivity, vascular function, mood).
Physical activity. 150 minutes of moderate aerobic activity per week reduces ED incidence by 30 to 40%. Resistance training adds independent benefit. Pelvic floor exercises (Kegel exercises) improve ED in selected men.
Diet pattern. The Mediterranean dietary pattern has the strongest evidence in ED prevention. The MEDITA trial showed reduced ED incidence in men following a Mediterranean diet over 2 years.
Alcohol moderation. Heavy alcohol intake worsens ED both acutely and chronically. UK guidance (no more than 14 units per week) applies.
Sleep optimisation. Sleep deprivation and untreated sleep apnoea are independent ED risk factors. Sleep apnoea diagnosis and treatment (CPAP) substantially improves ED in many men.
Stress and mental health. Chronic stress, depression, and anxiety drive ED through both psychological and biological mechanisms. Treatment of underlying mental health conditions often improves ED.
Recreational drug avoidance. Cocaine, MDMA, anabolic steroids, and high cannabis use are all associated with ED. Patients are encouraged to disclose use; the consultation is confidential and non-judgemental.
The lifestyle plan included with the £495 Comprehensive Men’s Health Package is personalised, written, and reassessable, not generic advice.
registered doctors | clinic | 10 Portman Square, Marylebone, London W1H 6AZ
At a glance
The Online GP by The Wellness offers discreet, doctor-led erectile dysfunction (ED) treatment in central London from £59 for an initial GP consultation. Same-day private prescriptions for licensed PDE5 inhibitors (Sildenafil, Tadalafil, Vardenafil, Avanafil) are available where clinically appropriate, with repeat prescriptions at £40. For men wanting a thorough underlying-cause workup, the Comprehensive Men’s Health Package at £495 includes a 30-minute consultation, a full hormone and cardiovascular blood panel, and a structured 12-week review. Multilingual care, complete confidentiality, and same-day appointments often available.
Service | Price | Time
Initial GP consultation (phone or video) | £59 | 15–30 min
Initial GP consultation (in-person) | £220 | 30 min
Specialist Men’s Health consultation | £350 | 30 min
Comprehensive Men’s Hormone & Cardiovascular Panel | £445 | Bloods 24–48h
Comprehensive Men’s Health Package | £495 | Same-day pathway
Repeat ED prescription (Sildenafil/Tadalafil etc.) | £80 | Same day
Premature ejaculatd prescription | £59–£150 | Same dayion consultation an
Book today: WhatsApp +44 7961 280835 | Email team@thewellnesslondon.com | Call 020 3951 3429
Why does erectile dysfunction matter clinically in 2026?
Erectile dysfunction is one of the most common conditions affecting men, with prevalence rising steadily with age. According to the Massachusetts Male Aging Study and subsequent UK epidemiological data, around 1 in 5 UK men over 40 experience some degree of ED, rising to around 50% by age 60 and 70% by age 70. Younger men are increasingly affected too: published cohort data suggest 1 in 4 men under 40 report some erectile difficulty.
ED matters for two reasons that are equally important. First, it has a substantial impact on quality of life, relationships, mental health, and self-confidence. Second, it is a sentinel marker for cardiovascular disease. The blood vessels of the penis are smaller than the coronary arteries; endothelial dysfunction often manifests as ED several years before a cardiac event. Men presenting with new ED have approximately a 1.5 to 2 times higher risk of cardiovascular events over the following 5 to 10 years compared to age-matched men without ED, according to data published in the Journal of the American College of Cardiology and the European Heart Journal. New-onset ED in a man over 40 should always prompt cardiovascular risk assessment.
The Online GP by The Wellness treats ED as a whole-patient assessment, not just a prescription pad. Our pathway combines a discreet GP consultation, comprehensive blood panel where indicated (testosterone, lipids, glucose, thyroid, prolactin), cardiovascular risk assessment, lifestyle review, and rapid access to licensed prescription treatment. For patients who want to address underlying causes (low testosterone, hypertension, diabetes, sleep apnoea), we coordinate the wider workup. For patients who simply want a discreet prescription, we provide that too.
Looking for a discreet, doctor-led conversation? WhatsApp +44 7961 280835
What causes erectile dysfunction?
ED has multiple causes, often overlapping. A doctor-led assessment identifies which are operating in your individual case, because treatment depends on cause. The major categories are:
Vascular causes (the most common, particularly in men over 40): Atherosclerosis (narrowing of the small arteries supplying the penis); Hypertension (high blood pressure), particularly when uncontrolled; Diabetes mellitus, with ED affecting around 50% of men with diabetes; High cholesterol and metabolic syndrome; Smoking, with effects on endothelial function and small vessel disease; Obesity, particularly central obesity.
Hormonal causes: Low testosterone (hypogonadism), affecting around 5 to 10% of men over 40 and a higher proportion of men with metabolic syndrome; Raised prolactin, which can be caused by pituitary issues or some medications; Thyroid dysfunction (both hyperthyroidism and hypothyroidism affect sexual function); Cortisol or adrenal disorders in selected cases.
Neurological causes: Diabetic neuropathy; Spinal cord disease, multiple sclerosis, Parkinson’s disease; Post-surgical (prostatectomy, pelvic surgery); Pelvic radiation.
Medication-related ED: Antihypertensives (beta-blockers, thiazide diuretics, in some men); Antidepressants (SSRIs and SNRIs in particular); Antipsychotics; 5-alpha reductase inhibitors (finasteride, dutasteride); Antiandrogens used in prostate cancer treatment.
Psychological causes: Performance anxiety, particularly in younger men; Depression, anxiety, and stress; Relationship issues; History of sexual trauma.
Structural and other causes: Peyronie’s disease (penile curvature with plaques); Pelvic floor dysfunction; Sleep disorders, particularly obstructive sleep apnoea; Excess alcohol or recreational drug use.
Most clinical presentations involve more than one of these. The most common pattern in men over 40 is mixed vascular plus medication plus psychological factors. The Online GP by The Wellness assessment is designed to identify the dominant drivers in your individual case.
What does the doctor-led assessment include?
A doctor-led assessment at The Online GP by The Wellness is structured to identify both treatable underlying causes and the most appropriate symptomatic treatment. The full pathway can be completed in a single visit for most patients.
Step 1: Confidential clinical history (15 to 20 minutes). The GP takes a detailed history covering: nature and duration of erectile difficulty, partner relationships and sexual frequency, distinction between erectile dysfunction and reduced libido or premature ejaculation, presence or absence of morning erections (helpful in distinguishing organic from psychological causes), comorbidities, all current medications and supplements, smoking and alcohol history, recreational drug use, sleep, stress, and mental health. Validated questionnaires such as the International Index of Erectile Function (IIEF-5) may be used to quantify severity.
Step 2: Examination. A focused examination including blood pressure (often the single most informative measurement), heart rate, weight, BMI, waist circumference, and where indicated assessment of secondary sexual characteristics, gynaecomastia, testes, and a brief neurological screen. Genital examination is performed only with consent and only where clinically indicated (suspected Peyronie’s, hypogonadism, structural concern).
Step 3: Comprehensive blood panel where indicated (24 to 48 hour turnaround). The Comprehensive Men’s Hormone & Cardiovascular Panel at £445 includes: total and free testosterone, sex hormone-binding globulin (SHBG), luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin, oestradiol, full blood count, fasting glucose, HbA1c, lipid panel, urea and electrolytes, liver function, thyroid function (TSH), PSA where age-appropriate, and vitamin D. This is the level of workup a urology or endocrinology consultant would arrange.
Step 4: Risk stratification and treatment plan. Cardiovascular risk assessed using QRISK3 or similar validated tool. Treatment plan integrates lifestyle modification, treatment of underlying conditions (hypertension, diabetes, dyslipidaemia, low testosterone where confirmed), and rapid access to licensed PDE5 inhibitor prescription where appropriate.
Step 5: Discreet prescription delivery. Prescriptions can be delivered to your nominated pharmacy, posted in plain packaging, or collected at our Marylebone clinic. Repeat prescriptions are £40 with a brief asynchronous review for stable patients.
Want to start with a confidential consultation? WhatsApp +44 7961 280835 | Email team@thewelln
Which medications are used to treat erectile dysfunction?
The first-line treatment for most men with ED is a phosphodiesterase type 5 (PDE5) inhibitor. These medications work by enhancing the natural erectile response to sexual stimulation, improving blood flow into the penis. They do not cause spontaneous erections and require sexual stimulation to work. The Online GP by The Wellness prescribes all four licensed PDE5 inhibitors based on individual suitability.
Sildenafil (generic Viagra). Available 25mg, 50mg, 100mg. Onset 30 to 60 minutes. Duration 4 to 6 hours. Take on demand, ideally on an empty stomach (high-fat meal delays absorption). Generic sildenafil is the most cost-effective PDE5 inhibitor and works well for many men. Branded Viagra is significantly more expensive without proven clinical advantage.
Tadalafil (generic Cialis). Available 2.5mg, 5mg, 10mg, 20mg. Onset 30 to 45 minutes. Duration up to 36 hours. Can be taken on demand or as a daily 5mg dose for continuous coverage. Particularly suited to men who want spontaneity without timing pressure, men with concurrent benign prostatic hyperplasia (BPH; tadalafil treats both ED and BPH), and men whose partners prefer flexibility.
Vardenafil (generic Levitra). Available 5mg, 10mg, 20mg, plus orodispersible tablet. Onset 25 to 60 minutes. Duration 4 to 6 hours. The orodispersible form dissolves on the tongue without water, useful for discretion or for men who dislike swallowing tablets.
Avanafil (Spedra). Available 50mg, 100mg, 200mg. Onset 15 to 30 minutes (the fastest-acting PDE5 inhibitor). Duration around 6 hours. Better tolerated than sildenafil in some men. More expensive than generic alternatives.
Effectiveness: PDE5 inhibitors work in around 70% of men with ED across all causes, with higher response rates in men with primarily vascular ED and lower response rates in men with severe diabetic ED, post-prostatectomy ED, or significant nerve damage. Around 30% of men do not respond adequately to a first PDE5 inhibitor; switching to a different PDE5 inhibitor or adjusting dose helps a meaningful proportion.
Important contraindications: PDE5 inhibitors must not be used with nitrates (glyceryl trinitrate, isosorbide mononitrate) or with riociguat. They require caution in significant cardiovascular disease, after recent stroke, in severe liver disease, or in unstable cardiac status. Side effects include headache, flushing, nasal congestion, dyspepsia, transient visual changes, and rare serious effects (priapism, sudden hearing loss). The Online GP by The Wellness assessment screens for all relevant contraindications.
What if PDE5 inhibitors do not work?
For men who do not respond adequately to PDE5 inhibitors, several options exist, ranging from second-line medical treatments to specialist referral.
Optimisation of first-line treatment. Many “non-responders” have not had an adequate trial. We review dose, timing, food interaction, sexual stimulation, and underlying conditions (untreated hypertension, low testosterone, sleep apnoea). Switching between PDE5 inhibitors helps a meaningful proportion. Daily low-dose tadalafil (5mg daily) suits some men where on-demand dosing has failed.
Treatment of underlying causes. Confirmed low testosterone treated with TRT can restore PDE5 inhibitor responsiveness in some men (see our TRT London 2026 guide). Optimisation of diabetes, hypertension, dyslipidaemia, or sleep apnoea improves erectile function independently and synergistically.
Vacuum erection devices (VEDs). These produce an erection by creating negative pressure around the penis, drawing blood in. A constriction ring at the base maintains the erection during sex. Effective in many men where pharmacotherapy has failed; useful in post-prostatectomy ED. Available privately or via specialist urology referral.
Intracavernosal injections (alprostadil). Self-administered penile injection causing reliable erection in over 80% of users including those who do not respond to PDE5 inhibitors. Requires specialist initiation through urology services. The Online GP by The Wellness coordinates referral.
Intraurethral alprostadil. A small pellet inserted into the urethra. Lower effectiveness than injection but easier to use.
Low-intensity shockwave therapy. A growing area in regenerative ED treatment, using focused acoustic waves to stimulate angiogenesis. Evidence base is mixed but improving. The London PRP Clinic by The Wellness can advise on regenerative options.
PRP for sexual health. Platelet-rich plasma therapy is offered through The London PRP Clinic by The Wellness as part of a regenerative approach. Discuss with our team to understand realistic expectations and evidence.
Penile prosthesis (implant). A surgical option through specialist urology, considered when other treatments have failed. The Wellness can refer to leading London urology consultants.
Psychological therapy. Cognitive behavioural therapy (CBT) and sex therapy are highly effective in psychogenic ED and useful adjuncts in mixed-cause ED. Couples therapy may be more effective than individual therapy in some scenarios.
Want to discuss options beyond PDE5 inhibitors? WhatsApp +44 7961 280835
What is the link between low testosterone and ED?
Low testosterone (hypogonadism) is a contributor to ED in around 5 to 10% of men presenting with ED, with higher rates in men with metabolic syndrome, type 2 diabetes, or chronic illness. Symptoms suggestive of low testosterone include: reduced libido (typically more prominent than ED itself), morning erections noticeably less frequent or absent, fatigue, low mood, reduced muscle mass, increased central fat, reduced exercise capacity, and difficulty concentrating.
Diagnosis requires both symptoms and confirmed low blood testosterone on at least two morning samples. The British Society for Sexual Medicine (BSSM) and European Association of Urology (EAU) recommend total testosterone below 8 nmol/L (231 ng/dL) as confirming hypogonadism, with the range 8 to 12 nmol/L (231 to 346 ng/dL) being borderline and requiring clinical correlation. Free testosterone, calculated from total testosterone and SHBG, is informative when SHBG is abnormal (rises in liver disease, hyperthyroidism, anti-androgen therapy; falls in obesity, type 2 diabetes, hypothyroidism).
The Online GP by The Wellness Comprehensive Men’s Hormone & Cardiovascular Panel at £445 measures total and free testosterone, SHBG, LH, FSH, prolactin, oestradiol, and the metabolic markers needed to interpret these results. Testosterone replacement therapy (TRT) is offered through our separate doctor-led TRT pathway, with full BSSM-aligned monitoring. See our TRT London 2026 guide for full details on TRT eligibility, treatment options, and monitoring.
For men whose testosterone is low and ED is the dominant symptom, optimising testosterone often restores PDE5 inhibitor responsiveness. For men whose testosterone is normal, treatment focuses on the other contributing causes.
What about premature ejaculation?
Premature ejaculation (PE) is the second most common male sexual concern after ED, with prevalence around 20 to 30% of men. PE and ED frequently coexist, and the relationship can be bidirectional: men with ED sometimes develop PE through anxiety; men with PE sometimes develop ED for similar reasons. A careful clinical history distinguishes them.
The Online GP by The Wellness offers PE assessment and treatment as part of our men’s sexual health pathway. Treatment options include: behavioural techniques (start-stop method, squeeze technique) often used alongside medical treatment; topical anaesthetic creams or sprays containing lignocaine and prilocaine, applied 15 to 30 minutes before intercourse; Dapoxetine (Priligy), the only SSRI licensed specifically for PE in the UK, taken on demand 1 to 3 hours before sexual activity; off-label SSRIs such as low-dose paroxetine taken daily, with discussion of off-licence prescribing and monitoring; combination therapy with PDE5 inhibitors where ED coexists; psychological treatment and sex therapy for psychogenic PE or relationship factors.
Initial GP consultation for PE is £59 (phone) or £79 (in-person). Most patients can have an effective treatment plan within a single visit.
How does The Wellness compare with other London ED clinics?
London offers many pathways for men’s sexual health, ranging from online prescription services to specialist consultant urology. The table below summarises the main options for self-paying patients in 2026, based on publicly available pricing.
Provider | Initial consultation | Repeat prescription | Pathway
The Online GP by The Wellness | £59 (phone) / £220 (in-person) | £150 | Doctor-led GP, discreet, multilingual, integrated workup, Marylebone
108 Harley Street | from £500 | varies | Specialist men’s health, Harley Street, premium
Online GP services (e.g. Push Doctor, Babylon) | £40–£60 | £30–£50 | Brief telemedicine, no physical exam
Online prescription pharmacies £40–£60 | Form-based, no doctor consultation in many cases
Specialist urology consultant | £400–£600 | varies | Required for surgical or complex cases
The Online GP by The Wellness sits in the doctor-led, integrated, mid-tier price band. Materially less expensive than Harley Street specialist consultations, but significantly more clinically thorough than form-based online prescription services. The differentiators that matter to our patients:
GMC-registered GPs prescribing every script, not algorithm-only services. Comprehensive workup option integrating cardiovascular, hormonal, and metabolic assessment in a single pathway. Same-day appointments typically available, with phone, video, and in-person options. Multilingual care including Arabic, Spanish, French, and Dutch speaking doctors. Discreet pathway: confidential consultations, plain-packaging prescriptions, no public-facing waiting room signage. Marylebone medical clinic at 10 Portman Square, walking distance from Baker Street, Bond Street, and Marble Arch. Integrated with broader services: TRT, executive health screening, diabetes assessment, cardiovascular workup, blood tests, all available without switching providers. Connection to The London PRP Clinic by The Wellness for men interested in regenerative options.
For men who simply want a discreet, fast prescription with confidence in safety, this works. For men who want a thorough underlying-cause workup, this works equally well. We adjust the depth of assessment to your goal.
