Treatments — Scrotal & Andrology
Erectile Dysfunction — Assessment & Treatment
Erectile dysfunction is one of the most common conditions in men — and one of the most successfully treated. Rather than simply prescribing medication, Mr. Jesuraj investigates the root cause and builds a treatment plan around your specific situation.
A private, professional setting. Your consultation is handled with complete confidentiality.
Not just a prescription — a thorough assessment to find what’s actually causing the problem.
ED in younger men is often an early warning sign of cardiovascular disease — important to investigate.
Understanding ED
You Are Not Alone — and This Is Treatable
Erectile dysfunction affects an estimated 1 in 5 men in the UK — rising significantly with age, but increasingly common in younger men too. Despite being so prevalent, most men delay seeking help for years due to embarrassment or the mistaken belief that nothing can be done.
ED is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It can be caused by physical factors, psychological factors, or — most commonly — a combination of both. Understanding which is driving your symptoms is the key to effective treatment.
Importantly, ED in men under 50 is associated with an increased risk of cardiovascular disease. The blood vessels that supply the penis are small and can show signs of disease earlier than larger vessels. A proper assessment is therefore not just about sexual function — it can be an important health check.
Understanding the Causes
What Causes Erectile Dysfunction?
ED is rarely simple — it usually involves an interplay of physical and psychological factors. Identifying which are at play is the foundation of effective treatment.
Physical Causes
- Cardiovascular disease & poor blood flow
- Diabetes mellitus (Types 1 & 2)
- High blood pressure (hypertension)
- High cholesterol
- Hormonal imbalance — low testosterone
- Obesity & metabolic syndrome
- Neurological conditions (MS, Parkinson’s)
- Peyronie’s disease — penile scarring
- Side effects of medication
- Previous pelvic surgery or radiotherapy
- Smoking, excessive alcohol
Psychological Causes
- Performance anxiety
- Depression & low mood
- Relationship difficulties
- Stress — work, financial, life events
- Past sexual trauma
- Low self-confidence or body image
- Fear of intimacy
Psychological ED often presents with normal morning erections and erections during masturbation — an important diagnostic clue that helps distinguish psychological from physical causes.
Mixed Causes — Most Common
Most men with ED have a combination of physical and psychological factors. A physical cause reduces erectile function, which then triggers performance anxiety — which further worsens the physical problem. This cycle is very treatable once both elements are addressed.
Even when the root cause is physical, psychological support and lifestyle changes are an important part of effective treatment.
Our Assessment
A Thorough Approach — Not Just a Prescription
Mr. Jesuraj takes a comprehensive approach to ED — going well beyond simply prescribing a PDE5 inhibitor to find what is really driving your symptoms.
Detailed History
A thorough exploration of your symptoms — onset, severity, presence of morning erections, relationship factors, psychological wellbeing, medications, smoking and alcohol. This alone often points strongly to the likely cause.
Physical Examination
Assessment of blood pressure, cardiovascular risk factors, signs of hormonal imbalance, genital examination for Peyronie’s plaques, testicular size and any neurological signs.
Targeted Blood Tests
Testosterone, LH, FSH, prolactin, blood glucose (HbA1c), lipid profile, thyroid function and full blood count — tailored to your specific presentation and risk factors.
Penile Doppler Ultrasound
Where vascular ED is suspected, a penile Doppler study can assess blood flow in the penile arteries directly — identifying arterial insufficiency or venous leak as specific causes.
Tailored Treatment Plan
Based on all findings, a personalised treatment plan is prepared — addressing the specific physical and psychological factors identified, not a one-size-fits-all approach.
Treatment Options
How We Treat Erectile Dysfunction
Treatment is always personalised. The right option depends on the cause, severity, your preferences and your overall health.
Oral Medication (PDE5 Inhibitors)
Sildenafil (Viagra), tadalafil (Cialis) and vardenafil are effective for many men. However, they work best when the underlying cause is addressed simultaneously — and don’t work for everyone. Mr. Jesuraj advises on the right agent, dose and timing for your situation.
First-line for many patientsHormone Therapy
Where low testosterone (hypogonadism) is identified, testosterone replacement therapy can dramatically improve erectile function, libido and energy levels. This requires careful assessment and monitoring.
Where hormonal cause identifiedIntracavernosal Injection Therapy
Alprostadil injections directly into the penis produce reliable erections regardless of the cause of ED. Effective when oral medication has failed. Mr. Jesuraj provides full instruction and follow-up for self-injection therapy.
Highly effective — even when tablets failVacuum Erection Device
A non-invasive mechanical device that draws blood into the penis to produce an erection. Particularly useful following pelvic surgery or where medication is contraindicated. No side effects, no medication.
Non-invasive optionPsychological Support & Referral
Where anxiety, depression or relationship factors are contributing, referral to a psychosexual therapist or clinical psychologist is an important part of treatment. Mr. Jesuraj works collaboratively with psychological services.
Often combined with medical treatmentLifestyle Modification
Addressing the modifiable risk factors that drive vascular ED — weight, exercise, smoking cessation, alcohol reduction, blood pressure and cholesterol control. These changes can produce significant improvements in erectile function independently of medication.
Addresses root causes directlyDon’t Wait
When Should You Seek Help?
There is no threshold of severity you need to reach before seeking assessment. If ED is affecting your quality of life, your relationship, or your confidence — that is reason enough. Early assessment also means earlier identification of any underlying cardiovascular or hormonal conditions.
ED that has been present for 3 months or more
ED occurring in a man under 50 — cardiovascular risk assessment is important
ED not responding to oral medication (sildenafil, tadalafil)
ED associated with reduced libido — suggests possible hormonal cause
ED alongside penile curvature or pain — Peyronie’s disease assessment needed
ED following pelvic surgery, prostate treatment or radiotherapy
A private consultation with Mr. Jesuraj is the right first step — expert, discreet and available within days.
Book a ConsultationCommon Questions
Frequently Asked Questions
Is ED a normal part of ageing?
ED becomes more common with age, but it is not inevitable and should not simply be accepted. At any age, it has treatable causes — and in younger men especially, it warrants proper investigation for underlying cardiovascular or hormonal conditions.
Will I need to take tablets forever?
Not necessarily. For men where a reversible cause is identified — hormonal imbalance, medication side effects, lifestyle factors — treating the root cause may restore erectile function without ongoing medication. For others, long-term treatment provides reliable results.
My GP prescribed Viagra but it didn’t work — what now?
Many men find oral medication ineffective, particularly when taken incorrectly, at the wrong dose, or when the underlying cause hasn’t been addressed. A specialist assessment can identify why it failed and offer effective alternatives including injection therapy.
Could my ED be caused by my heart?
Possibly. The penile arteries are among the first to show signs of atherosclerosis (hardening of the arteries). ED in a man under 50 with cardiovascular risk factors should prompt a proper cardiovascular assessment — something Mr. Jesuraj includes as part of his ED evaluation.
Does ED mean my testosterone is low?
Not necessarily — but it is worth checking. Low testosterone causes reduced libido more reliably than ED itself, but the two often co-exist. A hormone profile is a routine part of the assessment and can identify a treatable hormonal cause.
Is the consultation confidential?
Completely. Private medical consultations are fully confidential. Mr. Jesuraj will only communicate with your GP if you explicitly ask him to. Many patients prefer that their GP is not informed — this is entirely your choice.
Take the First Step — In Complete Confidence
Appointments available Monday, Thursday and Friday at Best Life Clinic, Stockton-on-Tees. Most patients seen within 7 days. No GP referral required.