What Causes Erectile Dysfunction?

It isn't always a natural part of the aging process. See how to reverse ED and take control of your sex life.

A man with erectile disfunction is in bed, head in hand, wondering what causes ED. Is it age-related or blood-flow problems?

Medically reviewed in August 2020

Updated on March 1, 2021

Many men associate virility with overall health, so it's no wonder that the idea of diminished virility or erectile dysfunction (ED) can be a dismal thought. It can be frustrating if anything gets in the way of a full, satisfying sex life. Understanding what causes erectile dysfunction, how to prevent it and how to treat it—whether naturally or with your healthcare provider’s help—can help you take control of your sexual health and satisfaction through the years. 

Most men experience some aspect of ED—the inability to get or maintain an erection—at some point in their lives. Research shows that more than half of men over the age of 60, and nearly 20 percent of men over the age of 20, are affected. If that's true, why don't more men talk about it? 

The fact is that many men blame themselves for the issue, thinking that emotions are at the root of the problem. In most cases, however, ED is caused by medical problems—such as high blood pressure, diabetes, obesity, and smoking. 

"In the past, most cases of erectile dysfunction were considered psychological, the result of such demons as performance anxiety or more general stress," says Jan Shifren, MD, an associate professor at Harvard Medical School. While these factors do cause some cases of ED, about 70 percent of erectile disfunction cases are caused by age-related changes or a physical problem that interferes with blood flow, nerve function, or both. 

The upside for men and their partners? Most causes of ED can be reversed or treated. 

What causes erectile dysfunction? 
The causes of ED are varied. Countless muscles, tissues, veins, nerves, and arteries are involved in the natural processes that lead to an erection, so any time this complex sequence of events is interrupted, ED can result. 

Certain surgeries and injuries can cause erectile dysfunction. It can also be caused by diseases that affect the tissues, nerves, or arteries involved in erections. These conditions include diabetes, kidney disease, vascular disease, and neurological disease. Some medications, such as blood pressure medication, antihistamines, and antidepressants may have ED-related side effects. For 10 to 20 percent of men, the culprits are psychological factors such as stress, depression, anxiety, and low self-esteem. Sometimes a combination of physical and psychological factors contribute to ED.

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