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The Main Causes Of ED In Men | Explained By The Experts

Donald Grant
Dr Donald GrantMB ChB DRCOG MRCGP Dip.orth.medGP & Clinical Advisor

Reviewed on 22 Nov 2023

Erections are caused by increased blood flow to the penis. This causes the erectile tissue within the penis to expand and harden. This process is triggered when a man becomes sexually aroused, which causes the brain to send the necessary signals to the nerves in the penis.

Anything that interferes with this process could lead to erectile dysfunction (ED). This could be physical problems with the nervous system or blood circulation, or it could be a psychological issue, such as depression. Anything that affects a man’s libido (sexual desire) can eventually lead to erectile dysfunction. Any loss of libido will make it more difficult to trigger or sustain an erection.

ED sufferers: you are not alone

For many, erectile dysfunction can be an uncomfortable topic, especially for the younger generation. It is important to remember that millions of other men are affected by the same problem and that it is very treatable.

If you are suffering from erectile dysfunction it is recommended to seek medical advice as it could be a symptom of an underlying health issue. Addressing the problem directly with your GP will help to ensure a prompt and satisfactory solution.

While there are many misconceptions, old wives’ tales, and downright fibs about what causes ED — there are even more actual reasons for a man to suffer from this common condition. Below we’ll take you through some of the common causes of ED — a couple will probably surprise you!

Common physical causes of ED

It is estimated that over 80% of cases of ED are caused by physical factors. Physical causes of erectile dysfunction stem from four main types of health condition. These are:

  • Vasculogenic - these are conditions that affect the flow of blood to the penis. Examples of this include cardiovascular disease, diabetes & high blood pressure.
  • Neurogenic - these conditions affect the nervous system, which consists of the brain, the nerves, and the spinal cord. Examples of this include multiple sclerosis, Parkinson’s disease, a spinal injury or disorder & stroke.
  • Hormonal - these conditions affect the levels of hormones in the body. Examples of this include Cushing's syndrome, hypogonadism, overactive thyroid gland & underactive thyroid gland.
  • Anatomical - these conditions affect the physical structure of the penis. An example is Peyronie's disease (the condition affects the tissue of the penis).

Physical injury or surgery to the penis, pelvis, or surrounding area may also lead to erectile dysfunction. Approximately 15-25% of men who experience a severe head injury are also thought to suffer from erectile dysfunction as a result.

Overwhelmingly people experience ED due to physical conditions — with it being estimated that up to 70% of all ED cases are caused by a physical condition. More on some of the most common ones below.

Vasculogenic conditions

Vasculogenic conditions that commonly lead to erectile dysfunction include:

  • Diabetes - a condition where the blood glucose levels are too high. This can affect both the blood flow and the nerve endings in the penis, which also makes it a neurological condition
  • Hypertension (high blood pressure) - where your blood pressure is higher than the recommended levels
  • Cardiovascular disease - a condition that relates to the heart or the blood vessels. For example, atherosclerosis, which is a hardening of the arteries. There is a strong link between cardiovascular disease and erectile dysfunction. It will likely be the first cause your doctor checks for when diagnosing the condition.

Diabetes & ED

Men with diabetes are up to three times more likely to experience ED during their lifetime than those who do not suffer from the metabolic disorder.

Part of being diabetic is that you have high levels of glucose in your blood. Because of these high levels, diabetes can cause damage to your blood vessels and nerve fibres. This can then restrict the flow of blood into your penis, which can, in turn, lead to ED.

Neurogenic conditions

Neurogenic conditions that commonly lead to erectile dysfunction include:

  • Parkinson’s disease - this condition interferes with the brain’s coordination of the body, resulting in problems with walking, talking and hand movements
  • A stroke - This occur when the blood supply to the brain is temporarily interrupted
  • Multiple sclerosis - this condition affects balance and movement.

Hormonal conditions

Hormonal conditions that commonly lead to erectile dysfunction include:

  • Hyperthyroidism (overactive thyroid) - this condition is caused by too much thyroid hormone being produced
  • Hypothyroidism (underactive thyroid) - this condition is caused by too little thyroid hormone being produced
  • Hypogonadism - this condition relates to the level of testosterone in the body. People who suffer from hypogonadism will have abnormally low levels of testosterone
  • Cushing’s syndrome - this condition affects the amount of cortisol in the body.

Psychological causes are more common among young men

A recent study suggested that erectile dysfunction is more common among young men than previously believed. The study showed that 26% of adult males under the age of 40 had been affected by erectile dysfunction in some way, with almost half of those suffering from severe ED. This rate is comparable to the erectile dysfunction experienced by older men.

The feeling of sexual arousal starts in the brain. Psychological conditions such as anxiety or depression can interfere with this process. Among younger men, erectile dysfunction is more likely to be caused by psychological issues rather than physical ones.

The most common psychological issues that can lead to erectile dysfunction are:

  • Depression - feeling extremely sad for a prolonged period of time
  • Anxiety - an overwhelming sense of fear, unease or worry.

In many cases, erectile dysfunction can have both physical and psychological causes. For example, someone with diabetes may find it difficult to achieve or sustain an erection, which could lead to feelings of anxiety about the situation. These physical and psychological factors could trigger an episode of ED.

Other psychological causes of erectile dysfunction could stem from emotional issues. For example:

  • A lack of sexual knowledge
  • Stress
  • Relationship issues
  • Previous sexual problems
  • Past sexual abuse
  • New relationships
Alcohol is a leading cause of ED

Environmental & other causes of ED

Other potential causes of erectile dysfunction include:

  • Binge drinking
  • Tiredness
  • Using illegal substances, such as cocaine, heroin and cannabis
  • Cycling

Erectile dysfunction sufferers who cycle for prolonged periods (over 3 hours per week) are recommended to try a cycle-free period to see whether this helps to improve their erectile problems. Riding in the correct position using a properly fitted saddle will help minimise the risk of developing ED from cycling.

Other factors that can increase your risk of developing erectile dysfunction include:

  • A lack of exercise
  • Obesity
  • Smoking
  • High cholesterol

Most men at some point in their lives will experience some form of erectile dysfunction. If the problem becomes persistent (occurring more than half the time) or is causing you or your partner distress, then medical advice should be sought. For those men whose erectile dysfunction stems from a psychological issue, therapy may be required.

Smoking & ED

We all know that smoking is bad for us, with Cancer Research reporting in August 2017 that over 25% of all deaths in the UK could be attributed to smoking. But did you know that smoking cigarettes can also lead to ED?

Cigarettes contain thousands of different chemicals, with nicotine being the principal among them. Nicotine narrows the blood vessels and arteries of all those who absorb it — this includes the blood vessels carrying blood to the penis. Nicotine essentially restricts the flow of blood to the penis, meaning that smokers can find it harder to get a healthy erection.

Food & drink

A healthy diet is something that many people either aspire to. However, not everyone eats as well as they could do. In 2017, the Office for National Statistics report, Statistics on Obesity, Physical Activity and Diet, England 2017, advised that only “26% of adults ate the recommended 5 or more portions of fruit and vegetables a day in 2015.”

Consuming an excessive amount of alcohol, full-fat dairy products, red meat, and food with high sugar contents are some of the dietary habits that could increase your chances of getting ED.

Follow a healthy, balanced diet and exercise regularly to keep your body as fit as possible.

Medicinal side effects

The side effects that come from taking certain medications are the cause of around a quarter of all ED cases.

Drugs used to treat mental ailments are among the common medicines which cause ED — antipsychotics and antidepressants both being examples of this.

However, they are not alone; treatments for high blood pressure (antihypertensives and diuretics), high cholesterol (fibrates), cancer (cytotoxics) and stomach ulcers (H2-antagonists) also can cause ED.

Treating erectile dysfunction & impotence

Treating the causes of erectile dysfunction will likely help to resolve the problem. For some, this will involve making lifestyle changes, whereas, for others, their treatment may require medication. It isn’t recommended to ignore ED, as it potentially could be a sign of another underlying health problem.

Lifestyle changes - eating a healthy diet, losing weight and getting more exercise will help to minimise the problems posed by erectile dysfunction. Stopping smoking and reducing your alcohol intake can also help with ED.

Therapy - a therapist or mental health professional may help to resolve the psychological issues that may be causing your erectile dysfunction. Ensuring you have good communication with your sexual partner is also essential.

Medication - if the cause is physical then medication may be required. Oral phosphodiesterase-5 (PDE5) inhibitors, like Spedra which you can buy online, can be used to help treat ED. These medicines work by interfering with the action of nitric oxide in the body. Nitric oxide helps to dilate the blood vessels in the penis, which will increase the blood flow to the penis and produce an erection. New generic ED treatments, such as Sildenafil, Tadalafil, & Vardenafil are a cheap and effective option to treat erectile dysfunction in men of all ages.

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You can also use branded Viagra to treat ED or try Viagra Connect, a new over-the-counter ED treatment.

Vacuum devices - If medication has proved unsuccessful, other treatments, such as vacuum constriction devices (VCD), may be considered. This form of treatment involves placing a cylinder over the penis, which will create a vacuum inside leading to an erection. A constrictive band is then placed around the base of the penis to help preserve the erection. The band should not be worn for periods longer than 30 minutes.

Surgery - is usually considered a last resort option. Erectile dysfunction surgery involves the implantation of a penile prosthesis. This option should only be considered should all other strategies fail.

There are many different causes of ED, some of which are in your control and some of which are not. Thankfully, there are also a number of treatments for ED. These include cognitive behavioural therapy (CBT), sex therapy, medication, and physical treatments. The important thing is that whatever the cause of your ED, or the course of action you take to address it, do not let it go untreated.

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