10 causes of erectile dysfunction

The main causes of erectile dysfunction are physiological and psychological.


An erection requires a delicate balance of hormones and healthy physical responses by the heart and brain. When men are unable to get or maintain an erection, it’s often a sign that some of these processes may be disrupted. But there are many reasons for erectile dysfunction. Here are the 10 main causes.


1. Heart conditions and cardiovascular disease. Research has shown that erectile dysfunction could be a sign of cardiovascular diseases and heart conditions. In fact, erectile dysfunction preceded 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 disorders should be examined by a doctor as they may be a sign of a more serious issue such as heart attack or stroke.

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2. High cholesterol and high blood pressure. A study by the Johns Hopkins University found that mice who were fed a high cholesterol diet showed signs of erectile dysfunction. That’s because hypercholesterolemia disrupts nitric oxide metabolism which is important for the muscles in the penis to relax during an erection. Similarly, the condition was shown to agitate the cells lining the blood vessels.


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 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 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.  


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 disorders is dose-dependent with men who smoke more than 10 cigarettes a day at a higher risk of erectile dysfunction. Excessive alcohol consumption can also disturb sexual performance. A study by the National Institute of Mental Health and Neurosciences, Bangalore, found that among 100 men at a de-addiction center, 72% had sexual dysfunction.  


6. Medications. There are various medications that may induce erectile dysfunction. They include diuretics and blood pressure medications, 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. Stressful lifestyles including 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 whilst balancing relationships.


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 an imbalance in testosterone production. In other words, it’s likely that sleep disorders hamper testosterone production and thus increase the risk of erectile dysfunction.


10.  Other causes. Additional causes of sexual disorders include Parkinson’s and Peyronie’s disease, prostate cancer and traumas 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 immediately.



  1. Jackson G. (2013). Erectile dysfunction and cardiovascular disease. Arab journal of urology, 11(3), 212–216.
  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.
  5. Rajfer J. (2000). Relationship between testosterone and erectile dysfunction. Reviews in urology, 2(2), 122–128.
  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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