10 causes of erectile dysfunction

The main causes of erectile dysfunction are physiological and psychological.


An erection requires a delicate hormonal balance and a healthy physical response by the heart and brain.  An inability to get or maintain an erection can be a sign that this process has been interrupted by an underlying medical or emotional condition.  There are many specific conditions that can cause erectile dysfunction. Here are the 10 main causes.


1. Heart conditions and cardiovascular disease.  Research has shown that erectile dysfunction can be a sign of underlying cardiovascular or heart disease. In fact, erectile dysfunction precedes two-thirds of cardiovascular disease cases. The small blood vessels in the penis are often the first to become blocked in men who have atherosclerosis or high cholesterol.  Therefore, erectile dysfunction should prompt a visit to the doctor as it may be a sign of a more serious issue.

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2. High cholesterol and high blood pressure.  A study by Johns Hopkins University found that mice who were fed a high cholesterol diet showed signs of erectile dysfunction. In fact, high cholesterol can disrupt nitric oxide metabolism, which is important for the muscles in the penis to relax during an erection.  High blood pressure can directly damage the cells lining blood vessels leading to inflammation, remodling and atherosclerosis (hardening of the blood vessels).  This in turn can disrupt blood flow to the penis, leading to ED.


3. Metabolic disorders (obesity, diabetes). It is well known that obesity is a significant risk factor for erectile dysfunction. In fact, 79% of men with erectile disorders have a BMI over 25 kg/m2 independent of their age.  Men with diabetes have a three-fold higher risk of developing erectile dysfunction.


4. Low testosterone. Testosterone levels naturally decrease as we age, which explains why men over the age of 50 are more likely to suffer from erectile dysfunction.  But in some cases, testosterone levels may be the consequence of other conditions such as metabolic syndrome, obesity, and diabetes. Testosterone replacement therapies are available and can help with ED if you do have low testosterone


5. Tobacco and alcohol. Studies have shown that smoking tobacco increases the risk of erectile dysfunction because it hampers nitric oxide metabolism.  The relationship between tobacco and erectile dysfunction is dose-dependent, with men who smoke more than 10 cigarettes a day being at a higher risk of developing ED.  Excessive alcohol consumption can also disrupt sexual performance.  A study by the National Institute of Mental Health and Neurosciences in Bangalore, India found that among 100 men at an alcohol rehab center, 72% had sexual dysfunction.  


6. Medications. There are various medications that may induce erectile dysfunction. These include blood pressure medications (such as diuretics), antidepressants, antihistamines, anti-inflammatory drugs, Parkinson’s disease drugs and medications to treat prostate cancer.


7. Depression. Patients who are depressed often lose interest in sex.  They may also experience a lack of energy and low self-esteem.  This can have a serious effect on healthy erections.


8. Stress. A stressful lifestyle and a hectic daily schedule can result in erectile dysfunction.  That’s particularly true for younger men who may find it hard to cope with work stress while balancing a relationship.


9. Sleep disorders. A good night’s sleep is critical for optimal health and that includes healthy erections.  Studies have shown that patients with obstructive sleep apnea had a higher prevalence of erectile dysfunction (47% to 80%).  Similarly, insomnia was found to be accompanied by erectile dysfunction due to a decrease in testosterone production. 


10.  Other causes. Additional causes of sexual disorders include Parkinson’s disease, Peyronie’s disease, prostate cancer and trauma to the penis or testicles.

Erectile dysfunction is a complex disorder and sometimes the causes may not be immediately obvious.  If you experience problems with maintaining or getting erections, speak to your doctor as soon as you can.



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  2. Musicki, B., Liu, T., Lagoda, G. A., Strong, T. D., Sezen, S. F., Johnson, J. M., & Burnett, A. L. (2010). Hypercholesterolemia-induced erectile dysfunction: endothelial nitric oxide synthase (eNOS) uncoupling in the mouse penis by NAD(P)H oxidase. The journal of sexual medicine, 7(9), 3023–3032.
  3. Shindel, A. (2011). Is Obesity a Further Cardiovascular Risk Factor in Patients with Erectile Dysfunction?. Yearbook of Urology, 2011: 151-152.
  4. Maiorino, M. I., Bellastella, G., & Esposito, K. (2014). Diabetes and sexual dysfunction: current perspectives. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 95–105.
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  6. Kovac, J. R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L. I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10), 1087–1092.
  7. Arackal, B. S., & Benegal, V. (2007). Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian journal of psychiatry, 49(2), 109–112.
  8. Fecik, S. (1998). Drug-induced sexual dysfunction. Medical Update for Psychiatrists, 3/6: 176-181.
  9. Baldwin, D. (2001). Depression and sexual dysfunction. British Medical Bulletin, 57/1: 81-99.
  10. Reed-Maldonado, A. B., & Lue, T. F. (2016). A syndrome of erectile dysfunction in young men?. Translational andrology and urology, 5(2), 228–234.
  11. Cho, J., & Duffy, J. (2019). Sleep, Sleep Disorders, and Sexual Dysfunction. The World Journal of Men's Health, 37/3: 261.
  12. Research Connects Poor Sleep Quality and Nocturia with Erectile Dysfunction, Low Testosterone and Increased Risk of Death - May 20, 2018. (2019). American Urological Association MediaRoom. Retrieved October 15, 2019, from <>

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