An erection seems like a simple thing, but it actually requires a long and complicated chain of processes involving the brain, hormones, emotions, nerves, muscles and blood vessels. To understand these processes, read our article “How Do Erections Work?”
What Causes ED?
There are many different factors, both physical and psychological, that can interfere with these processes, and some are signs of serious medical conditions. That’s why it’s important to consult a doctor if you are experiencing erectile dysfunction.
The major causes of erectile dysfunction include:
- Vascular/circulatory problems (vasculogenic ED)
- Anemia and low hemoglobin levels
- Neurological and nerve disorders
- Benign prostatic hyperplasia (BPH)
- Prostate cancer
- Vitamin or hormonal deficiencies, including low testosterone
- Inflammatory bowel disease (IBD), including Ulcerative colitis (UC) and Crohn’s disease
- Psychological problems such as anxiety, stress, PTSD, and depression
- A venous leak (venogenic ED)
- Side effects of prescription medications
- Drug or alcohol abuse
Many of the causes of ED are associated with aging, so it’s natural that the percentage of men suffering from erectile dysfunction is higher in older age groups. However, in recent years the number of younger men suffering from ED has increased dramatically. According to the Cleveland Clinic, 52% of men experience erectile dysfunction at some point in their lives. It affects 40% of men age 40, and 70% of men age 70.
The underlying cause(s) of your ED will help your doctor determine the most suitable treatments.
Physical Causes of Erectile Dysfunction
Abuse of alcohol or recreational drugs. Excessive use of alcohol or drugs can cause permanent to the nerves that carry impulses to the penis, and may also affect testosterone levels.
Cardiovascular conditions. The penis requires a healthy blood supply to become erect. Here are some of the conditions that can limit blood flow:
- high cholesterol
- heart disease
- high blood pressure (hypertension)
- metabolic syndrom
A good strategy to minimize your chances of experiencing erectile dysfunction is to eat a heart-healthy diet and get regular aerobic exercise.
Hormone imbalances and vitamin deficiencies. A hormone or vitamin deficiency can interfere with the chemical signals that are critical to the erection cycle.
Medications. Medications can interfere with the erection cycle in many ways. There are several classes of drugs which may cause problems:
- alpha-adrenergic blockers, including tamsulosin (Flomax)
- beta-blockers, such as carvedilol (Coreg) and metoprolol (Lopressor)
- cancer chemotherapy medications, such as cimetidine (Tagamet)
- central nervous system depressants, such as alprazolam (Xanax), diazepam (Valium), and codeine
- central nervous system stimulants, such as cocaine or amphetamines
- diuretics, such as furosemide (Lasix) and spironolactone (Aldactone)
- serotonin re-uptake inhibitors or SSRIs (Prozac, Paxil)
- synthetic hormones, such as leuprolide (Eligard)
See our article on “Drugs That Can Cause ED.”
Neurological and nerve disorders. Damage to the nerves interferes with the signals that are essential to the erection cycle:
- Alzheimer’s disease
- brain or spinal tumors
- multiple sclerosis
- Parkinson’s disease
Nerve damage can also be caused by surgery or radiation treatments for other conditions. See “Physical Damage,” below.
Obesity. There is a strong correlation between obesity and ED. Obese men are likely to have circulatory problems, and lower levels of testosterone.
Peyronie’s disease. Scarring may damage the corpora cavernosa and prevent them from inflating with blood.
Physical damage to nerves, blood vessels, or the penile tissues, resulting from accidents, surgery, or radiation treatments. Treatments for prostate cancer, including surgery and radiation treatments, often result in erectile dysfunction. In some cases, nerves or blood vessels will eventually recover, but in other cases they may never heal, resulting in permanent erectile dysfunction. Talk to your surgeon, urologist, or oncologist before treatment to understand the risks.
Rheumatoid Arthritis. Swelling from arthritis may limit the blood flow in the penis.
Sleep disorders. A study in 20221 found an association between poor sleep patterns and erectile dysfunction, but did not establish a causal link.
Another clinical study showed a weak association between sleep apnea and lower testosterone levels and erectile dysfunction2. In patients with obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) therapy may improve erectile function; however, the improvements are less than those shown with common oral medications for ED3.
Smoking or other tobacco use. Smoking can cause a plaque build-up in the arteries (atherosclerosis), which interferes with blood flow to the penis.
Venous leak. A venous leak allows blood to leak, preventing the corpora cavernosa from becoming fully inflated. Venous leaks may be caused by Peyronie’s disease, diabetes, or even severe stress.
Psychological Causes of Erectile Dysfunction
Psychological issues can be very distracting and prevent feelings of arousal. Stress and anxiety can also trigger the release of adrenaline, which interferes with erections in several ways.
Some of the conditions that can cause or contribute to ED include:
Anxiety, including performance anxiety. Men who are suffering from ED for physical reasons may also experience performance anxiety.
Depression. Depression can cause or contribute to ED. There is a simple online self-assessment to help you determine in you are suffering from depression.
PIED (Porn Induced Erectile Dysfunction), caused by frequent viewing of pornography and frequent masturbation. (See our article, “Does Porn Cause Erectile Dysfunction?“)
Porn Addiction – See PIED
PTSD (Post Traumatic Stress Disorder)
Once your doctor identifies the cause of your Erectile Dysfunction, they will be able to recommend appropriate treatment for your condition.
- Wu, Xu; Zhang, Yuyang; Zhang, Wei; Liu, Guodong; Jiang, Hui; Huang, Houbao; Zhang, Xiansheng. “The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective, Controlled Cohort.” Original Research & Reviews Epidemiology & Risk Factors. Sept 2022; volume 19, issue 9, P1387-1396.
- Wittert, Gary. “The relationship between sleep disorders and testosterone in men.” Asian Journal of Andrology. Mar-Apr 2014; 16(2): 262–265.
- Husnu, Tokgoz; Ersoz, Akyurek; Bulent, Erol, Tacettin, Ornek; Remzi, Altin; Bulent, Akduman; Aydin, Mungan. “Obstructive sleep apnea syndrome and erectile dysfunction: does long term continuous positive airway pressure therapy improve erections?” African Health Sciences. Mar 2015; 15(1): 171–179.