What is erectile dysfunction (ED)?

The main causes of erectile dysfunction include low testosterone and other medical conditions


Erectile dysfunction is about more than the lack of an erection. It’s defined as the inability to get or maintain an erection for satisfying intercourse. Sexual satisfaction is a critical part of the diagnosis because symptoms can be much more diverse than not ‘getting it up’. For example, some men may experience a change in their erection or even the amount of semen they produce. A sudden absence of morning erections could also be a warning sign of underlying erectile dysfunction.

Erectile dysfunctions affect around 30 million men in the U.S. and it is the second most common sexual disorder after premature ejaculation. Although a poor libido can be a symptom, many men with erectile dysfunction have a healthy libido, but their bodies won’t react accordingly.

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Main causes of erectile dysfunction

Although the causes tend to vary from patient to patient, it is well established that hypertension, cardiovascular conditions, and diabetes are primary reasons for erectile dysfunction. There’s a strong association between age and erectile disorders with the risk increasing 1.2% per year for those aged 40 to 49 years, and 4.6% per year for men between 60 to 69 years.


Although it’s not considered a life-threatening condition, it seriously hampers life satisfaction. It could also be an indicator of other diseases such as heart conditions. The majority of erectile dysfunction cases (80%) are related to vascular problems such as hypertension, atherosclerosis, and diabetes.


We now know that low testosterone levels are partially to blame for erectile dysfunction. Levels of the hormone drop naturally as we age. A study, which followed men for four years, found that as testosterone levels decreased, erectile dysfunction worsened. Luckily, there are ways to boost your hormone levels naturally through diet, physical activity, and stress reduction.


Importance of the vascular endothelium

To get a healthy erection, the tissue that lines the penis blood vessels – the vascular endothelium – needs to be in good working order. Even small changes could affect an erection. Endothelial dysfunction has been shown to disrupt the ability of the smooth muscles that line the penis to relax. Consequently, an erection cannot occur. One study found that the endothelium was disrupted in patients with erectile dysfunction who did not have a cardiovascular condition or diabetes. This shows just how important the vascular endothelium is for promoting an erection.


If you experience erectile dysfunction, consult your doctor.  



  1. Cohan, P., & Korenman, S. (2001). Erectile Dysfunction. The Journal of Clinical Endocrinology & Metabolism, 86/6: 2391-2394.
  2. Johannes, C.B., Araujo, A.B., Feldman, H.A., Derby, C.A., Kleinman, K.P., and McKinlay, J.B. Incidence of erectile dysfunction in men 40 to 69 years old: Longitudinal results from the Massachusetts male aging study.  Journal of Urology, 163/2: 460-463.
  3. Echeverri Tirado, L., Ferrer, J., & Herrera, A. (2016). Aging and Erectile Dysfunction. Sexual Medicine Reviews, 4/1: 63-73.
  4. El-Sakka, A., & Hassoba, H. (2006). Age Related Testosterone Depletion in Patients With Erectile Dysfunction. Journal of Urology, 176/6: 2589-2593.
  5. Kaya, C., Uslu, Z., & Karaman, I. (2005). Is endothelial function impaired in erectile dysfunction patients?. International Journal of Impotence Research, 18/1: 55-60.

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