Erectile Dysfunction Treatment Online — Express Assessment
Most men with erectile dysfunction never mention it to a doctor, and most of them could be treated. An EU-registered doctor reviews a 3-minute questionnaire, usually within 15 minutes, checks your heart and the medicines you take, and prescribes sildenafil or tadalafil if it is safe for you — collected at a pharmacy you choose. €34.
- €34, one fixed fee
- Doctor review usually within 15 minutes
- Daily 7am–11pm CEST
- 14 EU countries, no appointment
The right tablet, chosen for you
Sildenafil works for four to six hours from about an hour after the dose; tadalafil lasts up to 36 hours or is taken as a low daily dose. The doctor picks the one that fits how you live.
Why the questionnaire asks about your heart
Erectile dysfunction can be an early sign of heart or blood-vessel trouble, so the questions on chest pain, breathlessness, blood pressure and nitrates decide whether a tablet is safe for you.
If it cannot be prescribed
Nitrate medicines, a heart attack or stroke in the last six months, or chest pain on exertion rule the tablets out until you have been examined. The doctor explains why, and the €34 is refunded in full.
Erectile dysfunction treatment online — key facts
| First-line treatment | An ED tablet (a PDE5 inhibitor — sildenafil, tadalafil, vardenafil or avanafil) taken before sex, or tadalafil 5 mg once daily; all need sexual stimulation to work |
|---|---|
| Who it is for | Men 18 and over with erectile difficulties for more than a few weeks, no nitrate medicines, no recent heart attack or stroke, no chest pain on light exertion |
| Never with nitrates | GTN spray or tablets, isosorbide, nicorandil, riociguat and recreational poppers — the combination can drop blood pressure dangerously |
| Give it a fair trial | Up to eight attempts at the full dose, with stimulation and on an emptier stomach, before calling a tablet a failure — most early 'failures' are dose or timing |
| Not treated online | Chest pain or breathlessness on exertion, a heart attack or stroke in the last six months, uncontrolled blood pressure, a painful or bent erection, an erection lasting over four hours — that one is an emergency |
| The prescription | In English, naming the active ingredient, carrying a verification code; recognised at pharmacies across the EU under Directive 2011/24/EU; a supply for several months when the doctor agrees |
| Price and time | €34, one fee; an EU-registered doctor reviews the questionnaire usually within 15 minutes, daily 7am–11pm CEST; full refund if it cannot be prescribed online |
What is the treatment for erectile dysfunction?
First-line treatment for erectile dysfunction is an ED tablet (a PDE5 inhibitor: sildenafil, tadalafil, vardenafil or avanafil) taken before sex, or tadalafil at a low daily dose, once a doctor has checked for nitrate medicines and heart disease. The tablets work with stimulation, not instead of it, and stopping smoking, losing weight and exercise improve the result. If two tablets fail, a urologist discusses injections, a vacuum device or implants.
How to get ED treatment online — what happens after you press start
1. The questionnaire — about 3 minutes
It asks about difficulty getting or keeping an erection, any curve or pain, and ED medicines you have tried and how they suited you. It then asks whether a doctor has told you to avoid physical or sexual activity, about a stroke or heart attack in the last six months, blood pressure and cholesterol, chest pain or breathlessness on light exercise, the medicines you take (including nitrates), blood disorders and allergies. Every one of those is a safety question, not curiosity.
2. The doctor's review
The doctor reads it personally. If the tablets are safe for you, the doctor chooses between sildenafil and tadalafil and the starting dose, and explains timing, food and alcohol, and what to do if the first attempts disappoint. A nitrate, a recent cardiac event, exertional chest pain or a curved painful erection means no tablet from a questionnaire — the doctor explains and moves you to a video consultation or your own doctor.
3. The pharmacy
The prescription appears in your Mobi Doctor profile in English, naming the active ingredient, so a pharmacy you choose in any of the 14 EU countries can dispense the generic. You pay the pharmacy for the tablets; Mobi Doctor does not sell or dispense medicines.
Chest pain or breathlessness on exertion, a heart attack or stroke in the last six months, a bent or painful erection, or you take nitrates? Book a video consultation instead.
Right for the Express Assessment if
- You are a man aged 18 or over with erection difficulties for more than a few weeks
- You take no nitrate medicines and have had no heart attack or stroke in the last six months
- You can climb two flights of stairs without chest pain or marked breathlessness
- Your blood pressure is controlled, or you know it is normal
- You are in one of the 14 EU countries Mobi Doctor covers
Book a video consultation instead if
- You take nitrates (GTN, isosorbide, nicorandil) or riociguat, or use poppers
- A heart attack, stroke or unstable angina in the last six months, or a doctor has told you to avoid sexual activity
- Chest pain or breathlessness on light exertion
- Uncontrolled high or very low blood pressure, severe liver disease, or a past sudden loss of vision in one eye or an inherited retinal disease
- A curved, painful or lumpy erection — Peyronie's disease needs an examination
- Erectile dysfunction with low libido, tiredness and loss of body hair — testosterone should be measured first
List every medicine you take and answer each question fully — the doctor's decision depends on it. Your answers are confidential; nothing goes to your regular doctor.
Prefer to listen? The Mobi Doctor podcast episode on erectile dysfunction.
Erectile dysfunction medication online: sildenafil, tadalafil and the other ED drugs — how the doctor chooses
European urology guidance puts the PDE5 inhibitors first for almost every man with erectile dysfunction. Sildenafil (the active ingredient of Viagra) is taken 30 to 60 minutes before sex, works for four to six hours, and is slowed by a heavy meal or alcohol. Tadalafil (Cialis) starts in a similar time but lasts up to 36 hours, which suits men who do not want to plan, and at 5 mg daily it works continuously and also eases prostate symptoms. Vardenafil is close to sildenafil; avanafil is the fastest to act, at 15 to 30 minutes. None of them causes an erection on its own — they let a normal response to stimulation happen — and they do not raise desire. The doctor starts at a middling dose (sildenafil 50 mg, tadalafil 10 mg) and adjusts from how the first attempts go.
Side effects are usually mild and pass within hours: headache, flushing, a blocked nose, indigestion, back or muscle ache with tadalafil, and a bluish tinge to vision with sildenafil. Stop and seek help the same day for sudden loss of vision or hearing, and go to an emergency department for an erection lasting more than four hours.
Do you need a prescription for Viagra in the EU?
Yes, almost everywhere. Sildenafil, tadalafil and the other PDE5 inhibitors are prescription-only in Spain, Germany, France, Italy, Portugal and the rest of the 14 countries, and the reason is the safety check above — the interaction with nitrates can be fatal, and undiagnosed heart disease is common in men with ED. The exception among the 14 is Ireland, where a pharmacist may supply sildenafil 50 mg after a consultation. Tablets sold on websites that ask no health questions are frequently counterfeit, with too much, too little or no sildenafil in them; the questionnaire exists so that a doctor takes the decision with your history in front of them.
Why the questionnaire asks so much about your heart
The lining of the small arteries in the penis is affected by the same process that narrows the coronary arteries, and because those arteries are smaller, erectile dysfunction typically shows up two to five years before angina or a heart attack does. That makes ED a reason to check blood pressure, blood sugar and cholesterol — the doctor will tell you if your answers suggest that. It is also why a man who gets breathless or has chest pain on light exertion is not given a tablet from a questionnaire: sex is exercise, and the exercise needs to be safe first. Alpha-blockers taken for the prostate and some HIV or antifungal medicines change the dose, which is why the questionnaire asks for every medicine you take.
What to expect — and what to do if the first tablet disappoints
Roughly seven men in ten respond to the first PDE5 inhibitor they try, but a good share of the apparent failures are timing, dose or nerves: the tablet taken after a large meal, too little stimulation, or too much alcohol. European guidance is to try the maximum tolerated dose on six to eight occasions before concluding that a tablet does not work, and then to switch to another — some men respond to tadalafil after sildenafil failed, or the other way round. If two have failed, the video consultation is the place to talk about the next options, which include a vacuum device and injection treatment, and about testosterone if libido is low.
Sudden-onset ED in a man who still wakes with erections is more often anxiety than a blood-vessel problem; the tablets still help, but psychosexual therapy helps more and lasts. Losing weight, stopping smoking, drinking less and exercising improve erections measurably within months and are the only treatments that also lower the cardiovascular risk that goes with ED.
Using the prescription at a pharmacy in Spain, Germany, Italy or anywhere else in the EU
The prescription is issued in English by an EU-registered doctor, names the active ingredient rather than a brand, and carries a verification code the pharmacist can check at mobidoctor.eu/verify. A prescription issued in one EU country must be recognised in another (Directive 2011/24/EU); the active-ingredient name is what makes that work at the counter. Dispensing is the pharmacist's decision under the rules of the country you are in, and depends on the medicine being available there. If you need a supply covering several months, say so in the questionnaire — the doctor decides the quantity. Generic sildenafil and tadalafil are stocked by ordinary pharmacies across the EU and cost a fraction of the branded price. The other conditions the Express Assessment covers — 13 in all, plus repeat prescriptions — are listed on the online doctor prescription page.
What is Erectile Dysfunction?
Erectile Dysfunction, or ED, refers to a medical condition in which you have trouble getting or keeping an erection that's required for sexual intercourse. It's normal for men to face this occasionally, but if it's happening often, it might be ED. This can be due to lots of different reasons, including health problems, emotional stress, or even certain lifestyle habits.
It is essential to understand why you are having ED. Only then can you choose the best way to treat it. Whether the root is in health conditions like diabetes or heart disease, emotional or psychological challenges, or lifestyle factors such as smoking or excessive alcohol consumption, understanding these aspects is the first step towards regaining control.
Symptoms of Erectile Dysfunction
Erectile dysfunction (ED) is when a man has trouble getting or keeping an erection firm enough for sex. It’s normal for this to happen sometimes, but if it happens a lot, it might be a sign of ED. Here are some common symptoms:
Trouble Getting an Erection
One of the main signs of ED is having difficulty getting an erection when you want to have sex. If this happens occasionally, it’s usually not a problem. But if it happens often, it could be a sign of ED.
Trouble Keeping an Erection
Some men with ED can get an erection, but it doesn’t last long enough to finish sexual activity. This can be frustrating and might make a person anxious about having sex.
Not Being Able to Get an Erection at All
In more serious cases, a man might not be able to get an erection at any time, even when he’s excited or trying to have sex.
Less Interest in Sex
ED can sometimes make a person feel less interested in sex. This might happen because of feeling embarrassed or stressed about the trouble with erections.
Feeling Upset or Worried
ED can also cause emotional symptoms like feeling embarrassed, sad, or worried. These feelings can make it even harder to deal with the problem, as stress can make ED worse.
It’s important to know that ED can happen for many reasons, like health problems (such as heart disease or diabetes), stress, or even feeling nervous. If you have these symptoms often, it’s a good idea to talk to a doctor. They can help determine what’s causing the problem and how to treat it.
Erectile Dysfunction Causes
Erectile dysfunction (ED) happens when a man has trouble getting or keeping an erection. Many different things can cause this, and it’s important to understand why it happens to get the right help. Here are some of the main causes of ED:
Physical Causes
Most of the time, ED is caused by health problems that affect the body. Some common physical causes include:
Heart Problems and Blood Flow Issues
If your heart isn’t working properly or your blood vessels are clogged, it can be hard for blood to flow to the penis, making it difficult to get or keep an erection.
Diabetes
Men with diabetes often have problems with ED because high blood sugar levels can damage the nerves and blood vessels that help with erections.
Obesity
Being overweight can affect blood flow and cause ED. It can also lead to other health problems, like high blood pressure, that can make ED worse.
Hormone Problems
Low testosterone or problems with other hormones can affect your body’s ability to perform sexually.
Nerve Issues
Diseases like Parkinson’s disease or multiple sclerosis can affect the nerves that control erections, leading to ED.
Injuries or Surgery
Injuries to the pelvic area or surgeries, such as those for prostate cancer, can damage the nerves or blood vessels involved in erections.
Medications
Some medicines, like those for high blood pressure or depression, can cause ED as a side effect. If this happens, you should talk to your doctor about other options.
Psychological Causes
Your mental health can also play a big role in causing ED. The brain needs to be involved in getting an erection, and if you're feeling stressed or worried, this can affect your ability to have one. Some psychological causes include:
Stress
Stress from work, school, or personal issues can reduce your interest in sex and make it harder to get an erection.
Anxiety
If you’re worried about your performance in bed, this anxiety can make ED worse. Fear of failing can lead to more problems during sexual activity.
Depression
Depression can make you lose interest in sex, and it can also stop your brain from triggering an erection.
Relationship Problems
Issues with your partner, like poor communication or feeling distant, can make it harder to feel close and cause problems with sexual performance.
Lifestyle Causes
The way you live your life can also lead to ED. Some habits can increase your risk, including:
Smoking
Smoking can damage your blood vessels and make it harder for blood to flow to the penis, causing ED.
Alcohol and Drugs
Drinking too much alcohol or using drugs can affect the way your body works and make it difficult to have an erection.
Lack of Exercise
Not staying active can lead to poor circulation and other health problems, making ED more likely.
Mixed Causes
Sometimes, ED is caused by both physical and psychological factors. For example, if a man has a health problem that causes ED, he might start to feel anxious about it, which can make the situation worse.
In short, erectile dysfunction can be caused by physical health problems, mental health issues, or lifestyle choices. If you are having trouble with erections, it’s a good idea to talk to a doctor to find out what might be causing the problem and how to treat it.
Read the full erectile dysfunction guide: symptoms, causes, tests and treatment
Sources: European Association of Urology — patient information on erectile dysfunction · EAU Guidelines on Sexual and Reproductive Health, current edition — erectile dysfunction
Start Express Assessment — €34 About 3 minutes to complete.
Dr. Chrysoula I. Liakou MD, PhD
Erectile dysfunction treatment online — your questions answered
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