The Independent Pharmacy

Everything You Need To Know About The Causes Of Erectile Dysfunction

Andy Boysan
Andy BoysanBPharmDirector & Superintendent Pharmacist

Reviewed on 13 Jun 2022

Although erectile dysfunction more commonly affects people between the ages of 40 and 70-years-old there are a number of causes that can mean it impacts men of all ages.

It can seem distressing and embarrassing, but having erection trouble isn’t necessarily something to worry about. There are many reasons that men can fail to get an erection, including stress, tiredness, anxiety.

To help put your mind at ease, this guide outlines the main causes and symptoms of erectile dysfunction, symptoms, possible treatments, and more.

How does erectile dysfunction occur?

A man gets an erection when he becomes sexually aroused. This occurs when the brain sends signals to increase the flow of blood to the penis, which causes it to get bigger and then harden. When the brain’s nervous system is unable to send these signals, or there is an issue with blood circulating to the penis, erectile dysfunction can occur.

What causes erectile dysfunction?

Causes for erectile dysfunction typically fall into one of two categories: physical or psychological. The most common physical causes of erectile dysfunction include:

  • The blood vessels going to the penis narrowing (hence decreasing blood flow)
  • High blood pressure or hypertension
  • A hormone imbalance (i.e. low testosterone)
  • Complications after surgery or injury

The most common psychological causes of erectile dysfunction include:

  • Stress
  • Performance anxiety
  • Depression
  • Relationship problems
  • Guilt

Some men will only experience problems with achieving an erection in certain situations.

For example, you may still wake up in the morning with an erection or you may be able to get hard when masturbating but have trouble achieving an erection during sexual activity with a partner. If this is the case, it is highly likely that the underlying cause of your erectile dysfunction is psychological.

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What are the symptoms of erectile dysfunction?

The main symptoms of erectile dysfunction include trouble getting an erection, trouble maintaining an erection, and reduced sexual desire.

It’s common to confuse premature ejaculation (where arousal, orgasm, and ejaculation all occur rapidly) as a symptom of erectile dysfunction. However, premature ejaculation is a separate issue to the inability to get and maintain an erection.

Can some drugs or medications cause erectile dysfunction?

Prescription drugs for a pre-existing medical condition can affect hormones, nerve and blood circulation, and can, therefore, cause erectile dysfunction. Some of the prescription and over-the-counter medications that can cause impotence include:

  • Drugs for diuretics and high blood pressure
  • Antidepressants
  • Antihistamines
  • Non-steroidal anti-inflammatory drugs
  • Parkinson's disease medications
  • Antiarrhythmics
  • Muscle relaxants
  • Prostate cancer medications
  • Chemotherapy drugs

If you are taking a medication in any of the above categories and are experiencing erectile dysfunction, it’s advisable to consult your GP. In the meantime, do not stop taking the drug for your pre-existing medical condition. If problems with erectile dysfunction continue, your GP may be able to advise on taking a more suitable treatment that does not conflict with any other prescription medicine you are taking.

Are there risk factors that can increase the chances of erectile dysfunction?

As outlined above, the narrowing of blood vessels going to the penis is one of the most common physical causes of erectile dysfunction. There are a number of risk factors that increases the chances of this happening, including:

  • Getting older
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Alcohol
  • Drug abuse
  • Obesity
  • Parkinson’s disease

If any of the risk factors above apply to you, it’s possible that your GP may be able to suggest some lifestyle changes that will help you achieve an erection. For example, you may be able to get support for losing weight, quitting smoking or reducing your alcohol intake; all of which can help reduce the symptoms of erectile dysfunction at the same time as improving your overall health.

Erectile dysfunction treatments

There is a wide range of treatments for erectile dysfunction. The treatment best suited to you will depend on the underlying cause of your impotence.

Cause of erectile dysfunction

Best treatment

Narrowing of blood vessels in the penis.

Erectile dysfunction tablets such as Viagra, Cialis or Tadalafil.

High blood pressure, obesity, excessive alcohol intake.

Lifestyle changes as discussed with your GP.

Side effects caused by combining erectile dysfunction treatments with other prescribed medications.

Change medicines after discussion with your GP.

For most men, oral medications are a popular, effective, and safe treatment for erectile dysfunction for most men. Available in tablet form, these include:

It’s important to note that the medications listed above vary in dosage, effectiveness, and can cause dangerous side effects when mixed with other prescription drugs. For more information, take a look at our best erectile dysfunction pills.

Are there things you can do to help with erectile dysfunction?

If you are experiencing trouble with achieving and maintaining an erection, changes in lifestyle may help. Losing weight, quitting smoking and/or alcohol, regular exercise, and reducing stress and anxiety are all lifestyle changes commonly recommended by doctors to men who have erectile dysfunction.

Should you go to see your doctor about erectile dysfunction?

Yes, it can be embarrassing to speak to someone about erectile dysfunction. However, the best way to identify the cause of any problem is by seeing a GP.

If you don’t want to speak to someone face-to-face, Viagra Connect is now available from online pharmacies. To get the medicine you require, you’ll need to complete an online consultation for review by a registered pharmacist. This will determine whether the medication is safe for you to take — and if it is, you’ll be sent a discreet package containing the erectile dysfunction pills to your door.

How does a GP diagnose erectile dysfunction?

To diagnose erectile dysfunction, your GP will ask you questions about what you are experiencing. These questions will focus on your symptoms, physical health, mental health, lifestyle, and use of medication.

Your GP is also likely to ask you about your sexual history. If this is the case, it’s important to be open and honest. If you are more comfortable speaking to a male GP, you will be able to make this request at your surgery.

Questions about your sexual health will focus on previous and current sexual relationships, your sexuality, and whether the problem only occurs when you engage in sexual activity with a partner (i.e. do you still wake up in the morning with an erection and can you achieve an erection while masturbating).

Your GP may also carry out a physical examination to assess cardiovascular health among other issues.

Can riding a bicycle cause erectile dysfunction?

According to a recent study by the Harvard Medical School, it’s possible that riding a bike for a long time could cause temporary erectile dysfunction for some men.

This is because the seat of a bike puts constant pressure on the perineum (the area between a man’s genitals and the anus), which, in the process, damages nerves and compresses arteries that can cause erectile dysfunction problems.

If you regularly ride a bike, there are several things that you can do to reduce your risk of erectile dysfunction. These include:

  • Ensuring you have a V-shape saddle that supports your perineum
  • Lowering the handlebars so you lean forward and reduce pressure on your perineum
  • Wearing padded shorts
  • Taking regular breaks on longer rides

As soon as you notice any pain, soreness or numbness in your perineum, it’s important to stop riding immediately and take a break.


Erectile dysfunction is a common issue that many men have to deal with. If you are experiencing symptoms, the good news is that there are treatments that can improve your quality of life. Now that you know more about the causes of erectile dysfunction, we recommend speaking to your GP or a registered pharmacist before you decide which of the common treatment options covered in this article.


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