What is the cause of erectile dysfunction (ED) in men?

The most common cause of ED in men over 50 is atherosclerotic vascular disease, accounting for about half of all the cases in men that age. Psychological causes are more common in men under 40, though achieving an erection is now accepted as a marker of the general overall health of younger men as well as those over 50.

Erectile dysfunction (ED) can be caused by any condition that impairs blood flow to the penis, interferes with the nerves that supply messages and sensation to the penis, or interrupts the function of the hormones needed to moderate the processes of desire and sexual function. Psychological factors like anxiety, stress and depression can also play a role in causing ED.

PHYSICAL
  • Diabetes
  • Hypertension (High Blood Pressure)
  • Heart disease
  • Atherosclerosis (Another name for Clogged Arteries)
  • Hypercholesterolemia (High cholesterol)
  • Obesity
  • Neurological Conditions (e.g., Parkinson’s disease, Multiple Sclerosis (MS))
  • Alcohol
  • Smoking Tobacco
  • Illegal Drugs (e.g., Cocaine, Marijuana, Barbiturates, Narcotics like Heroin)
  • Sleep Disorders (e.g., Insomnia, Narcolepsy)
  • Peyronie’s disease (Scarring that causes the penis to have a sharp angle)
  • Treatments for prostate cancer (e.g., Radiation and Surgery can cause ED)
  • Surgery that injures nerves in the pelvic region or the spinal column
  • Trauma damaging nerves anywhere in the spinal column or the pelvis
  • Trauma damaging muscles or vessels of the penis
  • Prescription Medications (e.g., meds used to treat High Blood Pressure, Allergies, Pain, Depression, Anxiety, Ulcers, and so on. The list is long!)   
  • Over-The-Counter Medications (e.g., Antihistamines, Sudafed, Anti-inflammatory Medications)
Psychological
  • Depression: Depression is recognized as having effects far beyond mood. It can compromise someone’s immune system or even increase the likelihood of having a heart attack. Erectile dysfunction can affect someone with depression even when he is in a stable and loving relationship. Unfortunately, the drugs used to treat depression can cause erectile dysfunction, as well. The good news is that erectile dysfunction medications work whether the difficulty is from the depression itself or from the medications.
  • Anxiety: People think of Performance Anxiety (worry about “performing” sexually) but anxiety over any issue that is distracting can lead to erectile dysfunction.
  • Stress: Stress can be job-related, money-related, or the result of marital problems, among other factors.
  • Loss of Desire: This is called loss of libido by doctors. It means that a person no longer desires sexual intimacy as they once had. Hormone changes as in low testosterone can cause erectile dysfunction, but so can so can neurological or psychological conditions, medications, or relationship issues. The reason should be investigated to resolve the issue. Erectile dysfunction (ED) drugs will not work for many of these patients. A person must feel a desire for sex to kick off the process that allows the medications to function properly.
  • Sense of Inadequacy: Feeling bad about oneself (Low Self Esteem) can stem from a man being unable to fulfill the role he believes gives him value as a man. It can be a failure to provide as he hoped for his family, an inability to gain acceptance in a peer group, or being unable to engage in sexual intimacy with a spouse or partner.
  • Guilt: Guilt over having an affair, losing the family’s money, having a hidden compulsion like gambling or drug use, or being unable to satisfy a partner, as examples, can all interfere with being able to get aroused or engage in sex.
Getting an erection is a complex biological process. So many things have to go right for men to achieve a strong erection that it is a wonder it happens at all. For starters, a man’s hormones must be released on demand (almost instantly), his arteries need to carry 6 times the normal amount of blood to the penis with perfect efficiency, his nervous system’s commands must be transmitted without a hitch, and his mind must be working in perfect harmony with his body. That’s a lot to ask. If a man has difficulty getting the kind of erection he and his partner expect, it may be because a problem is brewing and Erectile Dysfunction (ED) is the first sign.  

As funny as it sounds, paying more attention to the strength of your erection could save your life. Because the blood vessels of the penis are small, serious underlying conditions often manifest themselves first with ED. According to “The Artery Size Hypothesis” those small vessels are more likely to reveal changes long before slightly larger arteries in the heart are affected. That’s why changes in the penis are a warning sign that heart disease may be on the horizon. Men are fortunate that these tiny vessels are responsible for something as visible as an engorged penis. If a failing erection is like the check engine light going off in a car, then the body has chosen the perfect place to put that sign.   

There are 8 conditions commonly associated with both erectile dysfunction (and also heart disease):  
  • Diabetes
  • High cholesterol
  • Smoking
  • High blood pressure
  • Family history of heart disease
  • Age (ED under age 70, and especially under age 50)
  • Obesity
  • Depression
Therefore, ED could be an early indication of high cholesterol, diabetes, hypertension, depression, sleep disorders, or hormonal imbalances.

A study in The Journal of the American Medical Association (JAMA.2005;294(23):2996-3002) found that erectile dysfunction was a significant predictor of heart disease. In a landmark study, 4247 men over the age of 55, who did not have erectile dysfunction (ED), were followed for five years checking them every three months for the development of erectile dysfunction (ED) and heart disease.  2420 men (57%) reported developing erectile dysfunction within 5 years. Over the follow-up period of five years, 11% of the men who developed erectile dysfunction (ED) experienced a cardiac event. It was a much greater percentage than men in the study who did not develop ED.

About 40% of people in the US die from cardiovascular disease, and nearly 50% of the deaths due to coronary heart disease happen in men who never had a warning like chest pain or shortness of breath. The development of erectile dysfunction is a warning for some men that heart disease is on the horizon.

The authors in the above study warned, “It is estimated that more than 600,000 men aged 40 to 69 years in the United States develop erectile dysfunction annually. Our data suggest that the older men in this group have about a 2-fold greater risk of cardiovascular disease than men without erectile dysfunction. With 70% to 89% of sudden cardiac deaths occurring in men and with many men not having regular physical examinations, this analysis suggests that the initial presentation of a man with erectile dysfunction should prompt the evaluating physician to screen for standard cardiovascular risk factors and, as appropriate, initiate cardioprotective interventions.”

Now, you know why we strongly recommend blood tests, education, and developing a sound working relationship with all your healthcare providers.

Lastly, there are many reasons a man might develop ED, and many are easily reversible. Medications, lack of sleep, poor exercise habits, smoking, excess alcohol, and even prolonged bike riding all can contribute to ED (erectile dysfunction), to name just a few. So, if you or your partner notice a change, it is great that medication can improve the symptom, but it is vital that everyone consider all the possible reasons it occurred in the first place.