Scleroderma and Erectile Dysfunction Explained
Learn how scleroderma affects erections and explore safe, effective treatments through a UK pharmacist-led consultation.
Takes less than 2 minutes to complete 100% online
Scleroderma and Erectile Dysfunction: Understanding the Link and Treatment Options
Published: 14 October 2026
Scleroderma and erectile dysfunction are closely connected, with many men living with systemic sclerosis experiencing difficulty achieving or maintaining erections. This autoimmune condition causes blood vessel damage and tissue hardening throughout the body, including the small arteries that supply the penis. Understanding this link is important because effective treatments are available, and addressing erectile dysfunction can significantly improve quality of life for men with scleroderma.
Key takeaways
- Scleroderma damages blood vessels throughout the body, including those supplying the penis, leading to erectile dysfunction.
- PDE5 inhibitors like sildenafil and tadalafil are effective first-line treatments for most men with scleroderma-related ED.
- Always tell your prescriber about pulmonary hypertension treatments or nitrate medicines, as some combinations are unsafe.
- Lifestyle measures such as stopping smoking and staying active support vascular health alongside medical treatment.
- Online consultations at Cured Pharmacy offer discreet access to ED treatment after a UK prescriber review.
Why scleroderma and erectile dysfunction occur together
Scleroderma, also known as systemic sclerosis, is an autoimmune disease that causes the immune system to attack healthy tissue, leading to thickening and hardening of the skin and internal organs. The condition affects blood vessels throughout the body, causing them to narrow and become damaged [1]. This vascular damage is the primary reason why erectile dysfunction is common in men with scleroderma.
Erections depend on healthy blood flow to the penis. When sexually aroused, the arteries in the penis need to dilate and fill with blood to create and maintain an erection [2]. In scleroderma, the small blood vessels become narrowed and less flexible due to fibrosis (scarring) and endothelial dysfunction. This means less blood can reach the erectile tissue, making it difficult to achieve a firm erection even when sexual desire is normal.
Research shows that erectile dysfunction affects a significant proportion of men with systemic sclerosis, often appearing earlier than in men without the condition. The severity of ED can vary depending on how extensively the blood vessels are affected and whether other complications of scleroderma, such as fatigue or joint pain, are also present. Importantly, ED in scleroderma is a physical problem caused by vascular damage, not a psychological issue, though the emotional impact of living with a chronic condition can also play a role.
How scleroderma and erectile dysfunction are assessed
If you have scleroderma and are experiencing erectile dysfunction, it is important to discuss this with your GP or rheumatologist. They will take a detailed medical history, including the duration and severity of your ED, your current scleroderma treatments, and any other health conditions such as high blood pressure or diabetes that can also contribute to erectile problems [2].
Your doctor may perform a physical examination and arrange blood tests to check for other contributing factors, such as low testosterone, thyroid problems, or poorly controlled blood sugar. Because scleroderma affects multiple organ systems, your healthcare team will also consider whether complications such as pulmonary hypertension or kidney disease are present, as these can influence which ED treatments are safe for you.
In some cases, specialist tests such as penile Doppler ultrasound may be recommended to assess blood flow to the penis. This can help confirm that vascular damage is the cause of your ED and guide treatment decisions. Your rheumatology team may also review your current medications, as some drugs used to manage scleroderma or its complications can affect erectile function. Open communication with your healthcare providers is essential to ensure you receive appropriate, personalised care.
Questions your doctor may ask
During your consultation, expect questions about how long you have had erectile difficulties, whether you can achieve any erection at all, and whether you have erections during sleep or in the morning (which can help distinguish vascular causes from psychological ones). Your doctor will also ask about your scleroderma symptoms, current medications, smoking, alcohol use, and any cardiovascular risk factors. Being honest and thorough in your answers helps your healthcare team recommend the most suitable treatment options for you.
At a glance
Lifestyle measures for men with scleroderma and erectile dysfunction
While lifestyle changes alone may not fully resolve erectile dysfunction caused by scleroderma, they can support vascular health and improve your overall wellbeing. Stopping smoking is particularly important, as tobacco further damages blood vessels and worsens circulation problems [1]. If you smoke, speak to your GP about NHS stop-smoking services, which offer free support and treatments to help you quit.
Maintaining a healthy weight and staying physically active can also benefit blood vessel function. Regular exercise, within the limits of your scleroderma symptoms, helps improve cardiovascular fitness and may enhance blood flow. Eating a balanced diet rich in fruits, vegetables, whole grains, and healthy fats supports heart and vascular health. Limiting alcohol is advisable, as heavy drinking can worsen erectile dysfunction and interact with some medications [2].
Managing stress and maintaining good mental health are equally important. Living with a chronic condition like scleroderma can be emotionally challenging, and anxiety or low mood can affect sexual function. Consider speaking to a counsellor or joining a support group for people with scleroderma. Open communication with your partner about your feelings and any difficulties you are experiencing can also reduce performance anxiety and strengthen your relationship. These lifestyle measures work best alongside medical treatments and should be part of a holistic approach to managing both scleroderma and erectile dysfunction.
Treatment options for scleroderma and erectile dysfunction
The first-line treatment for erectile dysfunction in men with scleroderma is usually a PDE5 inhibitor, a type of medicine that helps increase blood flow to the penis [2]. These tablets work by relaxing the smooth muscle in the blood vessels of the penis, allowing them to widen and fill with blood when you are sexually aroused. PDE5 inhibitors do not cause an automatic erection; sexual stimulation is still needed for them to work.
The main PDE5 inhibitors licensed in the UK are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra) [3][4][5][6]. Each works in a similar way but differs in how quickly it starts to work and how long the effect lasts. Sildenafil and vardenafil are usually taken about an hour before sexual activity, while avanafil works more quickly, often within 15 to 30 minutes. Tadalafil can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a lower daily dose for men who prefer spontaneity.
Clinical studies have shown that PDE5 inhibitors can be effective in men with scleroderma-related erectile dysfunction, though response rates may vary depending on the extent of vascular damage [9]. Your prescriber will help you choose the most suitable option based on your individual circumstances, including your scleroderma treatment and any other health conditions. All PDE5 inhibitors are prescription-only medicines in the UK and require a consultation with a healthcare professional to ensure they are safe and appropriate for you.
Other treatment options
If PDE5 inhibitors are not effective or suitable, other treatments may be considered. Alprostadil, a medicine that can be applied as a cream (Vitaros) or given as an injection into the penis (Caverject), works by directly dilating blood vessels [7]. Vacuum erection devices, which use suction to draw blood into the penis, are a non-drug option. In some cases, referral to a specialist urology or sexual health service may be appropriate to discuss further options. Your GP or rheumatologist can guide you on the next steps if first-line treatments do not help.
Tell your prescriber everything
Always disclose all your scleroderma medications, especially treatments for pulmonary hypertension, heart problems, or blood pressure. This ensures your ED treatment is safe and effective for your individual situation.
Important safety considerations for scleroderma patients
Men with scleroderma need careful assessment before starting ED treatment because the condition can affect the heart, lungs, and blood vessels. PDE5 inhibitors are generally safe for most men, but they must never be taken with nitrate medicines (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called poppers, as this combination can cause a dangerous drop in blood pressure [3][4][5][6].
Some men with scleroderma are treated for pulmonary hypertension (high blood pressure in the lungs) with medicines such as riociguat or other pulmonary vasodilators. If you are taking any treatment for pulmonary hypertension, you must tell your prescriber, as some combinations are not safe. Similarly, if you take alpha-blockers for prostate symptoms or blood pressure (such as doxazosin or tamsulosin), a lower starting dose of PDE5 inhibitor is usually recommended to reduce the risk of dizziness or fainting.
Certain medicines used to manage scleroderma or its complications can interact with PDE5 inhibitors. For example, potent CYP3A4 inhibitors like ketoconazole or itraconazole (sometimes used for fungal infections) can raise PDE5 levels in the blood, requiring dose adjustments. Your prescriber will review all your current medications during the consultation to check for interactions. Never stop or change a prescribed medicine without advice from your doctor. If you experience chest pain during sex, an erection lasting more than four hours, or sudden loss of vision or hearing, seek urgent medical help immediately.
Getting treatment through Cured Pharmacy
Cured Pharmacy is a GPhC-registered online pharmacy offering discreet access to ED treatments after a clinical consultation. If you have scleroderma and erectile dysfunction, you can complete an online health questionnaire that is reviewed by a UK-registered prescriber. The prescriber will assess whether a PDE5 inhibitor is safe and suitable for you, taking into account your scleroderma, current medications, and any other health conditions.
If approved, your treatment is dispensed by our pharmacy team and delivered in plain, unmarked packaging to your home. We stock a range of ED medicines, including generic and branded options, so you and your prescriber can choose the one that best fits your needs and budget. All consultations are confidential, and our pharmacists are available to answer any questions you may have about your treatment.
It is important to continue seeing your GP or rheumatologist for regular reviews of your scleroderma and overall health. Online services like Cured Pharmacy are designed to complement, not replace, your existing care. If your ED does not improve with treatment, or if you develop new symptoms, contact your doctor for further assessment. Managing scleroderma and erectile dysfunction together requires a coordinated approach, and we are here to support you as part of your healthcare team.
Why choose Cured Pharmacy
Cured Pharmacy combines clinical expertise with convenience and discretion. Our UK-registered prescribers have experience assessing men with complex health conditions, including autoimmune diseases like scleroderma. We offer transparent pricing, fast delivery, and ongoing support from our pharmacist team. Whether you are starting ED treatment for the first time or looking for a more convenient way to access your regular prescription, we are here to help you manage your sexual health with confidence.
When to get urgent help
- Erection lasting more than 4 hours (priapism) – go to A&E immediately
- Sudden loss of vision or hearing after taking ED medication – seek urgent medical help
- Chest pain during or after sexual activity – call 999
- Severe dizziness or fainting after taking ED treatment – seek same-day medical advice
- New or worsening breathlessness, especially if you have pulmonary hypertension – contact your rheumatologist or GP urgently
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 14 October 2026]
- National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 14 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 14 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 14 October 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 14 October 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 14 October 2026]
- Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 14 October 2026]
- Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. (1998). Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338(20), 1397–1404. https://pubmed.ncbi.nlm.nih.gov/9580646/ [accessed 14 October 2026]
Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.
Take the First Step Today
Start your journey to better health today.
- Reviewed by UK-based prescribers
- Takes under 3 minutes
- Discreet Packaging
Start Your Journey To Better Health Today
Once you complete a short online assessment you will be able to choose your preferred treatment from safe medically approved options tailored to you.
Start My Assessment Log in to Your AccountAvailable Treatments
Pricing Disclaimer: Prices on some pages may not be up to date — the live pricing table below and pricing shown during consultation are official current prices and take precedence over any other figures on the site.
Trusted by thousands
Real people, real results
“Fabulous service and quick delivery”
“Felt the effects of these after about 5 days. Erections are better and can get aroused and ready easier”
“Excellent value and brilliant customer service”
“I received excellent service and everything went well. The order arrived quickly and in perfect condition. It's working very well! Thank you to the whole team for the great work!”
“Delivery was good, the product lived up to expectations.”
Get Treatment in 3 Steps
Common Questions
Can't find your answer? Our UK pharmacists review every consultation and can help.
Can scleroderma cause erectile dysfunction?
Yes, scleroderma can cause erectile dysfunction by damaging the small blood vessels that supply the penis, reducing blood flow needed for erections.
Are PDE5 inhibitors safe for men with scleroderma?
PDE5 inhibitors are generally safe for men with scleroderma, but a prescriber must review your full medical history and current medications, especially if you have pulmonary hypertension or take nitrates.
Will treating my scleroderma improve my erectile dysfunction?
Managing scleroderma well can support overall vascular health, but ED caused by existing blood vessel damage usually requires specific treatment such as PDE5 inhibitors.
Can I take sildenafil if I have scleroderma-related pulmonary hypertension?
You must not take sildenafil or other PDE5 inhibitors if you are on riociguat or certain other pulmonary hypertension treatments; your prescriber will check this during your consultation.
How quickly do ED treatments work for men with scleroderma?
Sildenafil and vardenafil work in about 1 hour, avanafil in 15–30 minutes, and tadalafil in at least 30 minutes; response may vary depending on the extent of vascular damage.
What should I do if PDE5 inhibitors do not work for me?
If PDE5 inhibitors are not effective, speak to your GP or rheumatologist about other options such as alprostadil, vacuum devices, or referral to a specialist.
Can I use ED treatment long-term if I have scleroderma?
Yes, PDE5 inhibitors can be used long-term under medical supervision; regular reviews with your GP or rheumatologist are important to monitor your overall health.
Should I tell my rheumatologist about my erectile dysfunction?
Yes, discussing ED with your rheumatologist or GP is important so they can assess the cause, review your medications, and recommend safe, effective treatment options.
Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)