Erectile Dysfunction

What causes erectile dysfunction? Let’s explore.

There’s no one cause of erectile dysfunction. But here’s what to consider when rooting out the cause of your ED.
A white man wearing a red shirt and black shorts stands against a blue wall holding a pickleball racket while yellow balls fly at him.

Key Points:

  1. Sexual desire is a multifaceted process that involves both the brain and body. Causes of erectile dysfunction (ED) can be medical, psychological or lifestyle related.
  2. Health conditions, including heart disease, diabetes, sleep apnea and high cholesterol, can contribute to ED risk. Addressing the underlying condition can help resolve ED.
  3. Treating ED can include prescription medications like Cialis and Viagra. But lifestyle changes can also reduce the odds, too.

Erectile dysfunction (ED) is a common condition. Sometimes called impotence, ED is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse.

Erectile dysfunction may affect as many as one-third of all people with penises. That means around 30 million people in the United States alone experience ED. Its frequency increases with age—but ED is not considered an expected part of the aging process. Instead, the condition has a wide range of possible causes.

Here, we help you evaluate what may be at the root of your (or a partner’s) erectile dysfunction. Plus, how Dr. B can help you get erectile dysfunction pills online with a discreet $15 consultation.

What is the leading cause of erectile dysfunction?

There’s no one cause of erectile dysfunction. Sexual arousal is a highly complex process. It relies on hormones, muscles, emotions and brain activity to work together.

Here’s how erections happen:

  • Sensory stimulation in the brain sends messages to the blood vessels of the penis.
  • The muscles in the corpora cavernosa (a pair of chambers that run the length of the penis) then relax, letting blood flow in to fill the spaces.
  • The increased blood pressure expands the penis and creates an erection.
  • The erection is maintained with the help of another membrane (tunica albuginea), which traps blood in the corpora cavernosa.

ED can occur suddenly or over time when something interrupts even one of these steps. That's why it can be challenging to determine the root cause—or causes.

What are some medical causes of ED?

In one study, scientists discovered a genetic risk factor in the human genome associated with erectile dysfunction. This suggests a genetic component. But various acute and chronic health conditions can come with ED as a side effect.

Medical factors linked to ED include:

  • Diabetes. An estimated 35%-75% of people with diabetes (especially type 2) will develop ED during their lifetime. It’s thought that a lack of blood sugar control causes damage to nerves and blood vessels.
  • Medications. Prescription drugs like anti-anxiety medications, antidepressants, blood pressure medications and chemotherapy agents can increase the likelihood of ED.
  • Drinking alcohol. Chronic heavy alcohol consumption can permanently damage nerves and blood vessels, increasing the risk of ED.
  • Nerve problems. Neurological issues caused by conditions like heavy metal poisoning, diabetes, spinal cord injuries and nerve damage can contribute to ED.
  • Hormones. Imbalances of hormones like prolactin and thyroid, or those taken for prostate cancer, can cause ED. Low testosterone can also contribute—but it’s rarely the root cause.
  • Obesity. Significant weight can negatively affect blood vessels, lower testosterone levels, and diminish body image.

Trouble with erections is also common after a vasectomy—the surgery that prevents sperm from mixing with semen. But there’s no evidence that the procedure causes impotence.

There’s also recent evidence of a possible connection between COVID-19 and ED.

What are some mental causes of ED?

Because sexual stimulation starts in the brain, some psychological conditions can trigger ED. These include:

  • High stress levels. Stress hormones like epinephrine and cortisol can reduce blood flow to the penis.
  • Anxiety. Anxiety can raise tension in the muscles and increase blood pressure. This negatively impacts the relaxation needed to achieve erection.
  • Depression. Often closely linked with anxiety, depression can cause negative thought patterns that may trigger or worsen ED.
  • Relationship issues. Problems with communication or conflict within a relationship can make it difficult to relax with your partner.

What lifestyle factors contribute to ED?

Some lifestyle factors can lead to health conditions that trigger or worsen ED.

Lifestyle causes of ED can include:

  • Drug use. Both prescription and recreational drugs can increase risk. These include antidepressants, blood pressure drugs or recreational drugs like amphetamines and cocaine.
  • Smoking. Cigarette smoke inflames blood vessel linings, which can affect the erection process. Nicotine/smoking may also lower testosterone levels, libido and sex drive—which can encourage ED.
  • Heart disease. Heart conditions and ED both involve blood flow issues. So ED is often a common warning sign of heart disease.
  • High cholesterol. High cholesterol is often related to underlying conditions that can cause ED, including diabetes and heart disease.
  • Sleep disorders. Sleep disturbances and conditions like sleep apnea may alter hormones and blood vessels, encouraging ED.

Can ED happen in younger men?

Older people are more often affected by ED. As they age, people often need more stimulation to achieve an erection. And their erections may not become fully firm. But ED isn’t an assumed part of the aging process.

And young men aren’t immune to ED. A 2013 study found that 1 in 4 new cases of erectile dysfunction occur in those under 40. The causes of erectile dysfunction in your 20s and 30s are thought to be more often psychological than physiological. So if you’re dealing with a lack of erections or lost sensitivity, erectile dysfunction may be at play.

Can erectile dysfunction go away?

In most cases, it’s possible to reverse ED by addressing lifestyle factors and finding the right prescription medication. Even when the condition isn’t completely curable, lessening symptoms is possible. So if you’ve wondered, “If I stop drinking, will my ED go away?” you’re headed in the right direction.

Changes to lifestyle factors that can reverse ED include:

  • Quitting smoking
  • Exercising regularly
  • Drinking less alcohol
  • Eating healthier, especially if you suffer from cardiovascular issues or diabetes

Prescription erectile dysfunction treatments can increase blood flow in the penis to help maintain an erection. In most cases, health experts recommended using erectile dysfunction medicine in addition to addressing any medical or psychological root causes.

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Capogrosso, P., et al. (2013). One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice. The Journal of Sexual Medicine.

Chu, N. V., et al. (2002). Erectile dysfunction and diabetes. Current Diabetes Reports.

Gerbild, H., et al. (2018). Physical activity to improve erectile dysfunction: A systematic review of intervention studies. Sexual Medicine.

Gu, Y., et al. (2022). Erectile dysfunction and obstructive sleep apnea: A review. Frontiers in Psychiatry.

Jorgenson, E., et al. (2018). Genetic variation in the SIM1 locus is associated with erectile dysfunction. Proceedings of the National Academy of Sciences of the United States of America.

Mahmoud, M., et al. (2022). The impact of smoking on sexual function. BJU International.

Nunes, K. P., et al. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology and Hypertension.

Sansone, A., et al. (2021). Addressing male sexual and reproductive health in the wake of Covid-19 outbreak. Journal of Endocrinological Investigation.

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