What causes erectile dysfunction (ED)?

There are multiple causes. Psychogenic causes include stress, depression, and anxiety. Clinical causes are either hypogonadism or vascular. Hypoganadism is when there is either too little testosterone, or some other hormone is competing with testosterone. Vascular causes can occur from chronic hypertension or diabetes. Certain medications can cause ED as well.
Stress and emotional issues can certainly cause erectile dysfunction; but if you are older, ED may be indicative of a medical problem. In this video, I will explain how erectile dysfunction could be caused by a vascular issue.
Harris H. McIlwain, MD
The most common causes of erectile dysfunction are:
  • diabetes
  • neurologic impairment
  • prescription medications
  • pelvic injury
  • psychological disorders
  • peyronie’s disease
  • vascular disease
  • hormonal imbalance
"Normal" erectile function involves a complex relationship between neurologic, vascular, hormonal and psychological components. To attain and maintain a firm erection requires inflow of blood (arteries) and reduction of blood outflow (veins). Diseases (for example hypertension, diabetes, heart disease) and risk factors (for example smoking, obesity) that affect the function of arteries and veins may have a negative impact on erectile function.
The most common cause of erectile dysfunction (ED) is damage to nerves, arteries, smooth muscles and fibrous tissues, often as a result of disease. Diseases that contribute to ED include diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and neurologic disease.

Surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder and pelvis can lead to ED by harming nerves, smooth muscles, arteries and fibrous tissues of the corpora cavernosa.

In addition, many common medicines -- blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants -- can produce ED as a side effect.

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure can cause ED. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.
Erectile dysfunction (ED) affects more than half of American men over age 50. Causes include:
  • aging
  • diabetes
  • high blood pressure
  • low testosterone levels
  • smoking
  • certain medications
The good news is that the problem is almost always treatable.

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More often than not, the cause of erectile dysfunction (ED) is physical rather than emotional or psychological. Erections require a precisely timed sequence of events in the body. Nerves must fire on cue and blood vessels must be healthy and able to provide good blood circulation. Any health problem that inhibits good nerve or blood vessel function or reduces blood circulation to the penis has the potential to cause sexual problems.

Some of the key causes of ED include:
  • Underlying disease: Diabetes is a common cause of ED. About 35% to 50% of men with diabetes experience ED. But other health conditions can contribute, too. Diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, neurologic disease or alcoholism is believed to be the underlying cause in about 70% of ED cases.
  • Injuries: Any incident that damages the nerves or blood vessels going to and from the penis can lead to erection problems. This includes injury to the penis, spinal cord, bladder, prostate or pelvis.
  • Medications: Antihistamines, antidepressants, blood pressure medications, tranquilizers, appetite suppressants and certain ulcer drugs have been known to cause ED side effects.
  • Surgical complications: Surgical procedures or radiation treatments that affect nerves and blood vessels in the prostate, bladder or pelvic region can result in erectile problems.
  • Unhealthy habits. Smoking, excess weight, heavy drinking and a lack of exercise can significantly increase the risk of erection problems because these unhealthy habits affect both heart and blood vessel health.
  • Stress. Emotional issues are a less common cause of ED, but stress, anxiety, depression, low self-esteem and fear of sexual failure may be the cause of about 10% to 20% of cases. These feelings can also compound ED from other causes.
  • Testosterone deficiency. Although low testosterone is a less common cause of ED, a simple blood test can check levels.

You might feel uncomfortable bringing up your sex life with your doctor, but sexual troubles are worth investigating. A healthy sex life is important, and getting to the root of your problems might also reveal undetected but important health issues you need to treat.

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Common diseases that cause ED include:
  • diabetes—causes nerve and artery damage;
  • thyroid disorders—affect hormone production, in men this relates to their testosterone levels;
  • hypercholesterolemia—fosters atherosclerosis, blood vessel decay, and causes erectile dysfunction through its influence on the vascular system;
  • vascular diseases (atherosclerosis, hypertension)—restrict blood flow producing the rigidity of the penis;
  • kidney disease—produces chemical changes that affect hormones, circulation, nerve function, and energy levels;
  • neurological diseases (stroke, MS, Alzheimer's and Parkinson's)—interrupt the transmission of nerve impulses that stimulate an erection.
Jan L. Shifren, MD
Reproductive Endocrinology
In the past, most cases of erectile dysfunction were considered psychological, the result of such demons as performance anxiety or more general stress. Although these factors do cause some cases of erectile dysfunction, healthcare providers think that 70% of cases can be traced to age-related changes or a physical condition that hampers blood flow, nerve functioning, or both. Such conditions include diabetes, kidney disease, atherosclerosis, vascular disease, multiple sclerosis, and alcoholism. Less frequently, erectile dysfunction is the result of injury to the nerves and vessels that serve the genitals or a disease that causes scarring of penile tissue.

Unhealthy habits can also raise a man's risk of erectile dysfunction. A study in The Journal of Urology showed that smoking raises the risk of erectile dysfunction by 50%, while being obese increases risk by 90%. Men who were both overweight and sedentary were two-and-a-half times as likely to have erectile dysfunction as were active men of normal weight.

But thinking of erectile dysfunction as either psychological or physical can be misleading. These forces are usually intertwined. In fact, more than 80% of men with erectile dysfunction caused by an underlying physical illness develop psychological issues that further hamper erections.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)

Nobody wants to talk about it, but almost every man experiences it at some point in their life - the inability to get or maintain an erection. In fact, new research shows that Erectile Dysfunction affects more than half of men over the age of 60, and nearly 20% of men over the age of 20. So why aren't they talking about it?

Experts say that most men blame themselves, thinking that emotions are at the root of the problem. But most cases of ED result from medical problems such as high blood pressure, diabetes, obesity and smoking, which is one of the reasons (beyond keeping your sex life healthy) that it's important to address it.

Dr. Michael Roizen, MD
Internal Medicine
As you might have guessed, a lot of research has been done on what causes erectile dysfunction, and, as is the case with cancer, heart disease, and so many other conditions, there isn't one single factor to blame. Rather, many things can cause the erectile rocket boosters not to fire—including hormone problems, trauma to the area (like that caused by poor-fitting bicycle seats, which block off the blood supply to the penis), alcohol, some prescription drugs, and obesity.

But the biggest cause of erectile problems is fleeting levels of nitric oxide due to vascular disease. The way blood flows throughout your body (which is largely determined by the hardening of your arteries) determines your body's ability to maintain and sustain an erection. In fact, erectile disorders are actually precursors of heart problems, so if you or your partner is experiencing erectile problems, it's important to seek treatment, not just to improve what happens when you're lying down in bed but also to make sure that the next time you're lying down isn't on a surgeon's table.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.