What Causes Erectile Dysfunction?

Research suggests that erectile dysfunction is very common, and it becomes more likely as you get older. [1, 2] But what actually causes it?

There isn't one simple answer. A wide range of things can affect your erections, from physical health conditions to your mental health. Here, we take a closer look at the main causes, so you can understand more about the condition and how you can start treating it.

Article summary

• Most cases have a physical cause. Erectile dysfunction is often down to blood flow, and it's closely linked to conditions like high blood pressure, diabetes and heart disease. It can even be an early warning sign of those problems.
• Your mind matters too. Stress, anxiety, depression and relationship problems can all affect your erections, and they sometimes need a different kind of help, like therapy.
• It's very treatable. Most men find something that works for them. Getting help early is worth it, both for your sex life and your wider health.

How an erection works

When you're aroused, your body releases nitric oxide. This triggers a chemical called cyclic guanosine monophosphate, which relaxes the muscles and blood vessels in your penis.

That lets blood flow into two columns of spongy tissue called the corpora cavernosa. As they fill with blood, you get an erection. If anything gets in the way of that blood flow, those nerve signals, or your hormones, you can find it hard to get or keep an erection. [1, 2]

Physical causes

High blood pressure

High blood pressure, also called hypertension, can affect your erections in a few ways. Over time, it can damage the walls of your arteries, which can stop enough blood flowing into your penis. It can also stop the smooth muscles in your penis relaxing when they need to, which lowers blood flow even more.

Some blood pressure medicines can play a part too. Beta-blockers can affect nerve signals, and blood thinners can reduce the force of blood flow to your penis. [3]

Atherosclerosis and heart disease

Atherosclerosis is when plaque builds up in your arteries. This narrows your blood vessels and limits the blood that can reach your penis, which makes erections harder to get and keep.

There's an important link here. Erectile dysfunction can be an early warning sign of heart disease or cardiovascular disease, sometimes before you notice anything else. [4] If you spot it early, you have time to make lifestyle changes and start treatment. So it's worth taking seriously, not just for your sex life but for your heart health.

High cholesterol

Like atherosclerosis, high cholesterol can harm your sexual health. It affects how well your arteries work, which can reduce blood flow to your penis and stop you keeping an erection.

Diabetes

If you have diabetes, your risk of erectile dysfunction is higher. High blood sugar over a long time can damage the nerves, veins and arteries around your penis, which lowers the quality of your erections. [5]

Erectile dysfunction can also be harder to treat if you have diabetes. Some treatments can interact with heart medicines that people with diabetes often take. If you have both, it's best to speak to your GP about your options.

A few other health conditions can affect your erections.

• Multiple sclerosis and other neurological diseases. A spinal cord injury, MS, or other nerve damage can interrupt the signals your body needs to get an erection.
• Chronic kidney disease. This can affect your hormones, blood flow and energy levels, all of which play a part.
• Metabolic syndrome. This is a group of issues, including high blood pressure, high blood sugar and extra weight around your middle. Together they raise your vascular risk factors and make erectile dysfunction more likely.
• Enlarged prostate. An enlarged prostate is common as men get older. The extra pressure on your pelvic area can restrict blood flow and make erections more difficult.
• Peyronie's disease. This penile disorder causes scar tissue to build up, which can lead to curved or painful erections.
• Venous leaks. This is when your tissues can't hold blood in the way they should, so an erection doesn't last.

Hormones and low testosterone

Low testosterone can come from stress, an underactive thyroid, or a problem with your testes. Because your testosterone levels affect the chemicals that boost blood flow when you're aroused, low levels can make it more difficult to achieve a firm erection.

Lifestyle choices and other causes

Your sexual performance can also be impacted by surgery or injury, certain medicines, and alcohol consumption. [6] If you think any of these factors could be impacting your health, speak to your doctor for further advice and options.

Mental and emotional causes

Not all erectile dysfunction is physical. When the cause is in your mind rather than your body, it's sometimes called psychogenic erectile dysfunction. Because medical treatments only deal with the physical side, these causes are often best helped with sex therapy or changes around you. [7]

Stress and anxiety

Stress and anxiety can affect your erections. This includes performance anxiety, where worry about sex makes things more difficult. When you're stressed, your blood vessels can tighten, which reduces blood flow to your penis.

There can be a cycle here too. One negative experience can lead to worry about the next time, which then makes it harder again. If stress is affecting your sex life, simple steps like breathing exercises or mindfulness before sex can help you relax.

Depression and relationship problems

Depression can cause erectile dysfunction in much the same way as stress and anxiety, and it often changes with how you're feeling day to day. Some antidepressants can affect erections too, so if you notice changes after starting them, speak to your GP rather than stopping on your own. [7]

Relationship problems can also play a part. Tension, comparing your performance to others online, poor communication or feeling disconnected from your partner can all affect your sex life. Talking things through, sometimes with support from a professional, can make a real difference.

When to get help

Erectile dysfunction now and then is normal. But if it keeps happening, it's worth speaking to someone, both to help your sex life and because it can be a sign of something else, like heart disease.

Treatment options

The good news is that there are plenty of treatment options, and most men find something that works. What suits you depends on the cause, so it's essential to get proper advice first.

PDE-5 inhibitors

The most common treatments are PDE-5 inhibitors, short for phosphodiesterase type 5 inhibitors. They don't cause an erection on their own. You still need sexual arousal for them to work. They may also cause side effects.

Other options

If tablets aren't right for you, there are other routes.

• Vacuum devices. A vacuum pump, also called a vacuum penis pump or vacuum constrictive device, draws blood into your penis to create an erection.
• Testosterone supplementation. If a blood test shows low testosterone, your doctor might suggest this.
• Urethral suppositories. These are small pellets of medicine placed into the tip of your penis.
• Shock wave therapy. This newer treatment uses gentle sound waves to improve blood flow.
• Penile implants. For some men, surgery to fit penile implants is an option when other treatments haven't worked.

Whatever treatment you choose, healthy changes help. Stopping smoking, drinking less, and doing regular cardiovascular exercise can all improve your blood flow and your overall health. These steps also lower your risk of heart disease, which is closely tied to erectile dysfunction. [2]

Final thoughts

Erectile dysfunction is common, and it usually has a clear cause, whether that's your blood flow, your hormones, your mental health or a mix of things. Most causes can be treated, and getting help early can also flag up problems like heart disease before they get worse.

If erectile dysfunction is affecting you, you don't have to put up with it. You can find out which treatment could be suitable for you using the links at the bottom of this page, or speak to a healthcare professional who can guide you through your options.

Find out which treatment may be suitable for you with MedExpress.