Clinical services Health Information Sexual difficulties In men, sexual problems may include an inability to acquire or maintain an erection satisfactory for sexual intercourse (also called impotence or erectile dysfunction [ED]), a lack of interest in sex (diminished libido), premature ejaculation, or delayed or inhibited ejaculation. It is important for all men with these problems to seek advice from their doctor. These can be caused by limited blood flow, nerve damage, medications and psychological causes. Cigarette smoking, diabetes, and high blood pressure may all contribute to these problems Men aged 55 or older tend to have less firm erections, produce a smaller amount of semen, and have less intense ejaculations, with less need to ejaculate and a longer recovery period than younger men. Difficulty in getting an erection if you are under 40 and otherwise fit, is usually caused by stress or some other psychosomatic problem. It is only rarely due to a physical cause. However, erectile dysfunction can be a warning of the following, all of which need to be checked: hidden diabetes raised blood pressure (two thirds of men with raised blood pressure have got some erectile dysfunction) raised cholesterol underlying cardiovascular problems (64% of those men who have had a heart attack have had a warning up to 3 years previously in the form of erectile difficulties).