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Erectile dysfunction causes—these are the usual suspects

If you have trouble getting or keeping an erection, it’s likely linked to at least one of four factors: a physical cause, a medication you’re taking, a psychological issue, or a consequence of your lifestyle. If you’re experiencing ED, talk with a healthcare provider. They’ll help you find the solution that’s right for you—and potentially catch other health problems before they become severe.

Self Written by Michael Martin
Reviewed by Dr. Mike Bohl, MD, MPH

Getting (and maintaining) an erection requires a surprising amount of things to go right. Your brain sends a signal through your nerves and hormones, to your blood vessels and muscles before an erection can even happen. If one thing goes wrong in that complicated exchange between your cardiovascular and nervous system—plus your hormone levels, blood vessels, and even your mood—the result can be erectile dysfunction. 

But don’t panic. Many causes of erectile dysfunction (ED) are treatable with medication and simple lifestyle changes. It’s important to know the root cause of your erectile dysfunction to treat it in the most effective way possible.

Vitals

  • An erection is a complicated thing, requiring collaboration among several bodily systems at once.
  • When something’s off in one of those body systems, erectile dysfunction (ED) can result.
  • Several health conditions—and prescription and over-the-counter medications—can cause erectile dysfunction.
  • Lifestyle changes—including exercise, a healthy diet, and limiting alcohol and recreational drugs—may improve ED.

What is erectile dysfunction?

ED occurs when you can’t get or keep an erection sufficient for a satisfying sex life. That might include erections that don’t last as long as you want or aren’t as firm as you’d like. ED is the most common sexual dysfunction. In fact, it’s estimated that more than 30 million American men have experienced erection problems at some point (Nunes, 2012).

Erectile dysfunction is sometimes an early warning sign of more serious problems like hypertension, diabetes, and cholesterol. That’s why we call ED your body’s “check engine light.” The blood vessels in the penis are smaller than the rest of the body, especially the blood vessels that lead to the heart and brain. So ED can be the first sign of high cholesterol or high blood pressure before a blockage causes more serious problems, like a heart attack or stroke.

If you have existing risk factors for heart disease (diabetes, obesity, family history of heart problems, high cholesterol), it may be time for a checkup of the old ticker. Improving blood flow and heart health can result in better, more frequent erections.

What causes ED?

Physical causes

A healthy erection requires healthy blood flow. Erectile dysfunction can be related to health conditions that impair blood circulation. These include:

  • Heart disease
  • High cholesterol
  • High blood pressure (hypertension)
  • Atherosclerosis
  • Diabetes
  • Obesity
  • Metabolic syndrome
  • Multiple sclerosis
  • Parkinson’s disease
  • Sleep disorders
  • Peyronie’s disease

Medications

Many commonly used prescription and over-the-counter medications can cause erectile dysfunction. They can decrease libido, interfere with normal blood flow, or even cause absent seminal emission (a lack of semen upon ejaculation) or retrograde ejaculation (in which semen backs up into the bladder during orgasm). Medications that might cause ED include:

  • SSRIs (a class of antidepressants known as selective serotonin reuptake inhibitors)
  • Beta blockers
  • Anti-hypertensives
  • Diuretics (commonly known as “water pills”)
  • Antifungals, such as ketoconazole
  • Antihistamines, which can be used to treat the symptoms of allergies or reflux
  • Non-steroidal anti-inflammatory drugs, such as ibuprofen
  • Muscle relaxants

If you’re experiencing ED, tell your healthcare provider about the medications you’re taking. A frank discussion can lead to alternative medications or treatments and a better discussion about ED. Just remember that you should never stop taking a prescription medication without the supervision of a healthcare provider.

Psychological causes of ED

Anxiety, depression, and sleep

Mental health can be a major contributor to ED. Depression is often associated with sexual dysfunction—and some researchers suggest that if you’re experiencing one, you should be screened for the other (Atlantis, 2012). Both depression and anxiety are common in men with ED. So are sleep disorders like insomnia (Jankowski, 2008).

Relationship troubles

If you and your partner have been at odds lately—whether you’ve been spending less time together or having heated arguments—it’s natural that overall tension can spill over into bed, potentially affecting your ability to have an erection.

Performance anxiety

You might be worried that you don’t measure up—either physically, skill-wise, or otherwise—leading to performance anxiety around sex. It’s a common phenomenon, with the common effect of ED.

Lifestyle causes of ED

Being sedentary

A sedentary lifestyle is a major risk factor for erectile dysfunction. According to a study published in the Journal of Sexual Medicine, men who were inactive or moderately active (30 to 149 minutes of physical activity a week) had 40–60% higher odds of ED compared with active men who got 150 or more minutes of physical activity weekly (Janiszewski, 2009).

Poor diet

A diet that’s good for your heart is also good for your erection. Fatty, fried, processed, and low-fiber foods lead to heart disease because they cause high blood cholesterol levels. Over time, that can damage and narrow the arteries, decreasing blood flow throughout the body. This creates problems both north and south: The penis relies on blood flow to become erect. One of the best diets for heart and erection health is the Mediterranean diet, which emphasizes fruits and vegetables, fish and other lean protein, whole grains, and olive oil. According to a study published in the American Journal of Medicine, eating the Mediterranean diet can help prevent the development of ED (Widmer, 2015).

Alcohol abuse or overuse

“Whiskey dick” is an uncomfortable memory for many of us. Over the long term, moderate alcohol consumption doesn’t increase your risk of ED (Wang, 2018), but chronic heavy drinking can damage the liver, heart, and nerves and reduce testosterone—all of which can lead to ED and sexual performance issues.

Drug use

Recreational drug use has been implicated in ED. That includes:

  • Amphetamines
  • Barbiturates
  • Cocaine
  • Marijuana
  • Methadone
  • Nicotine
  • Opiates

Recreational drugs affect the central nervous system. They can also cause serious damage to blood vessels, and any damage to blood vessels or normal blood flow will eventually cause erectile dysfunction. If you suspect you’re using recreational drugs too often, talk with your healthcare provider. You can take control of the situation, improving your sex life, and overall health in the process.

What treatments are available for ED?

Oral medications for ED are highly effective. Several are available, including Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). 

If low testosterone is responsible for your ED, testosterone replacement therapy (TRT) can boost your testosterone levels via injection, a wearable patch, or gel applied to the skin. For some men with ED, using a device such as a penis pump, cock ring, or—in severe cases—a surgically placed penis implant has been effective in restoring sexual function.

Some men have found natural remedies for ED to be effective. Some studies have shown that certain supplements (such as DHEA, ginseng, L-arginine, L-carnitine, and yohimbe) may be helpful. Read everything you want to know about natural remedies for ED here.

Your erections will be best when you’re healthy. Making simple lifestyle changes, such as getting regular exercise, eating a healthy diet, quitting smoking, and limiting your alcohol consumption, might be enough to improve ED.

If you’re experiencing ED, it’s a good idea to talk with a healthcare provider. They’ll help you find the solution that’s right for you—and potentially catch other health problems before they become severe.