Understanding What Causes Erectile Dysfunction

What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED), also referred to as impotence, is the persistent inability to achieve or maintain an erection (a rigid or semi-rigid penis that is firm enough for satisfactory sexual intercourse or sexual activity).

It is not uncommon for a man to have occasional problems with erections. However, if erectile dysfunction is an ongoing issue, it may be cause for concern, and it is recommended to seek medical advice.

Although erectile dysfunction is distressing for many individuals, this condition can be treated with medical intervention. Because certain risk factors can contribute to ED, men with erectile dysfunction should seek a proper diagnosis and treatment based on the root cause.

Note: Erectile dysfunction and premature ejaculation are two separate problems that may occur together. Premature ejaculation is when a man ejaculates before he or his partner wants him to, while erectile dysfunction (ED) is when a man has trouble getting or maintaining an erection.

Continue reading to learn more about erectile dysfunction—what causes it and the various treatment options available.

Prevalence of ED

ED is a common condition that affects more than 50% of men. Its prevalence increases with age—around 40% of men experience ED by age 40, and 70% of men experience ED by age 70.

Complications of Untreated Erectile Dysfunction

Untreated ED can lead to low self-esteem, anxiety, and depression. Poor sexual performance and lack of self-confidence can also contribute to strained relationships. Importantly, problems with getting and keeping an erection can be a sign of potentially serious underlying health problems, like diabetes and heart disease, that should be diagnosed and treated.

It can be difficult to diagnose and treat erectile dysfunction because men with ED are often embarrassed to talk about their sexual dysfunction and sex life. However, seeing a doctor is important to determine what is contributing to ED symptoms. Sometimes, treatment for an underlying health condition can improve symptoms associated with erectile dysfunction. There are a variety of treatment options available, ranging from surgical treatment to oral prescription drugs.

What Are The Main Causes of Erectile Dysfunction?

Sexual arousal in men is a complicated multi-step process that involves muscles, blood vessels, nerves, hormones, and emotions. A problem with any of these can make it difficult for a man to get an erection and keep an erection. The causes of erectile dysfunction can be broadly classified as:

Vascular erectile dysfunction is due to conditions that affect the blood vessels (heart disease, high blood pressure, diabetes, and high cholesterol).
Neurogenic erectile dysfunction occurs due to nerve damage and neurological conditions (trauma, surgery, radiation therapy, spinal stenosis, multiple sclerosis, or stroke).
Hormonal erectile dysfunction can result from low testosterone (hypogonadism), thyroid disorders, and elevated prolactin levels.
Psychogenic erectile dysfunction occurs due to psychological causes (thoughts, feelings, and behavior).

Physical Causes of ED

Cardiovascular Issues

Cardiovascular causes can affect blood flow to the penis, including:

High blood pressure
High cholesterol
Atherosclerosis (blocked blood vessels)
Cardiovascular disease (heart disease)

Metabolic and Endocrine Disorders

Certain medical conditions can damage blood vessels and nerves that are needed for achieving an erection. Examples include:

Obesity
Diabetes
Metabolic syndrome (high blood pressure, high cholesterol, high blood sugar, and excess body fat around the waist)

Neurological Conditions

Neurological conditions such as multiple sclerosis and Parkinson’s disease can affect nerve function and the ability to obtain and keep erections.

Hormonal Imbalances

Low testosterone (hypogonadism) can cause erection problems. Meta-analysis of studies has shown that men with severe hypogonadism have a significant reduction in penile rigidity and frequency of erections. Unfortunately, there is not enough data to determine what level of low testosterone induces erectile dysfunction.

Medication Side Effects

Side effects of prescription medications can contribute to erectile dysfunction. Examples include certain antidepressants and anti-anxiety drugs (SSRIs), antihistamines, medications used to treat high blood pressure (beta-blockers, 5-alpha reductase inhibitors), Parkinson’s disease medications, opioid pain medicines, chemotherapy, hormonal therapies, treatments for an enlarged prostate, and prostate cancer drugs.

Medical Treatments

Radiation therapy or surgery in the pelvic area or near the spinal cord can cause erection problems in men.

Other Medical Conditions

Health conditions that can affect erectile function include:

Peyronie’s disease (scar tissue formation in the penis)
Chronic kidney disease
Sleep disorders
Injuries to the nerves and blood vessels that control erections

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Psychological Causes

Stress and Anxiety

Research suggests that stress and anxiety can play a major role in the development of erection problems. Psychological stress from ED can create a vicious cycle–performance anxiety worsens ED, leading to further stress and avoidance of sexual activity. This cycle, paired with poor communication between partners, can cause relationship conflicts.

Depression and Other Mental Health Disorders

Depression, anxiety, and other mental health conditions can cause erectile dysfunction. Also, ED can cause depression and anxiety. It can be challenging to determine which condition is the cause and which is the effect. For this reason, comprehensive and concurrent treatment of erectile dysfunction and mental health symptoms with psychotherapy and counseling is vital.

Relationship Issues

Relationship problems can be a significant cause of erectile dysfunction (ED) by contributing to stress, anxiety, and negative emotions. This can directly impact a man's ability to achieve or maintain an erection. Poor communication, unresolved conflicts, lack of intimacy, and feeling unattracted to your partner are all potential relationship factors that could lead to ED.

Lifestyle and Other Factors

Obesity and Diet

An unhealthy diet and obesity (excess body weight) can contribute to erectile dysfunction. Studies show men with abdominal obesity have a 30-90% higher risk of ED. Given that obesity is a known risk factor for ED, losing weight and following a Mediterranean diet can significantly improve symptoms and help restore sexual function.

Lack of Exercise

Men who do not get regular physical activity are at risk of a host of health problems, including high blood pressure, high cholesterol, diabetes, and obesity. These are all risk factors for erectile dysfunction as they can affect blood flow to the penis. Moderate to vigorous aerobic physical activity, including pelvic floor exercises (Kegels), has been shown to reduce the risk of ED and can help with weight loss.

Alcohol and Substance Abuse

Heavy alcohol consumption and use of other types of substances (drugs such as cocaine, heroin, and marijuana) damage blood vessels and decrease nitric oxide levels. This leads to reduced blood flow to the penis, potentially causing erectile dysfunction.

Smoking

Tobacco use is a known risk factor for erectile dysfunction. Smoking can also damage blood vessels in the penis and lower nitric oxide levels leading to erectile dysfunction.

Diagnosis of Erectile Dysfunction

Medical History and Physical Examination

A doctor, typically a urologist or a specialist in sexual medicine, can diagnose erectile dysfunction based on your medical history and physical examination.

Blood Tests and Other Diagnostics

Doctors may order blood and urine tests to check testosterone levels, cholesterol, and glucose levels to identify signs of diabetes or heart disease.

An ultrasound may also be necessary to visualize the blood vessels and identify any problems with blood flow in the penis.

Psychological Evaluation

A mental health evaluation can help identify psychogenic causes of erectile dysfunction, such as depression, anxiety, or relationship difficulties.

Treatment Options for Erectile Dysfunction

Depending on the cause and severity of erectile dysfunction, several treatment options for ED are available. Some of the prescription drugs and devices used to treat erectile dysfunction are listed below.

Lifestyle Modifications

Your healthcare provider may recommend healthy lifestyle changes to treat erectile dysfunction, including:

Eating a healthy diet
Getting regular exercise
Losing weight or maintaining a healthy body weight
Stopping smoking
Reducing or stopping alcohol intake
Avoiding recreational drug use

Treatment of Underlying Health Conditions

If your doctor identifies risk factors that can potentially cause ED, the first thing they will do is treat those health problems. Treatment of these underlying health conditions may improve your ability to get an erection and keep an erection.

Oral Medications

Prescription drugs called PDE-5 inhibitors are commonly used to treat erectile dysfunction. Examples include Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil). These oral medications (tablets) enhance nitric oxide levels, improving blood flow to the penis.

Low levels of testosterone male hormone, can cause ED. Testosterone replacement is used to treat erectile dysfunction in some men, either alone or in combination with other treatments.

Injectable Medications

Injectable treatments for erectile dysfunction, such as alprostadil (Caverject), involve injecting the medication at the base of the penis with a fine needle. Alprostadil is also available in suppository form (brand name Muse), which is inserted into the penis. Men should be properly trained on injection techniques to avoid complications like priapism (prolonged erection)

Vacuum Pumps and Penile Implants

A penis pump is a vacuum erection device that pulls blood into the penis, making it erect. A tension ring that accompanies the vacuum pump is placed around the base of the penis to help maintain the erection long enough to have sexual intercourse.
Penile implants are devices that are placed surgically in the penis. A penile implant consists of an inflatable or bendable rod that helps keep the penis firm.

Psychological Counseling and Therapy

Stress, anxiety, and depression are known causes of erectile dysfunction (ED). Erectile dysfunction can cause problems in a couple’s sex life, which can lead to stress, making it a vicious cycle. A psychologist or counselor can provide individual or couples counseling to help manage stress, anxiety, depression, or other mental health problems. Counseling may also help when the sexual dysfunction is due to performance anxiety.

Surgical Interventions

In some men, doctors may recommend vascular surgery to increase the flow of blood into the penis; however, this is a technically difficult operation that is not always successful. Vascular surgery is rarely performed and is usually reserved for younger men with trauma-related ED.

Frequently Asked Questions about Erectile Dysfunction Causes and Treatment

Why Is Blood Flow To The Penis Important?

A series of events need to take place for an erection to occur. The first is psychosexual stimulation, which is driven by the male sexual desire or libido. When a man’s mind is sexually stimulated, it sends signals to the penis. These signals from the nervous system relax the muscles and blood vessels that supply blood to the penis. This, in turn, causes increased blood to flow into the penis, engorging it with blood, which is what causes an erection. After orgasm, the penis returns to the usual state of blood flow and becomes flaccid (soft). For this reason, a healthy blood supply to the penis is a critical factor in getting and maintaining an erection.

How Do You Fix Erectile Dysfunction?

The first step in fixing erectile dysfunction (ED) is to reduce your risk factors for this condition and treat any health conditions that may be causing it. This includes proper diagnosis and treatment of conditions such as diabetes, high blood pressure, obesity, and heart disease, which can increase your risk of ED. Treating these conditions can help restore erectile function.

Lifestyle changes such as avoiding tobacco products and illicit drug use and drinking alcohol in moderation can also help to maintain good erectile function. Stress can lead to ED, so keeping it under control can reduce your risk of ED due to psychological causes.

What Is The Fastest Way To Cure Erectile Dysfunction?

While medications like Viagra and Cialis work quickly, long-term solutions include lifestyle changes, treating underlying conditions, and therapy for psychological factors. In addition, it is important to follow your doctor’s recommendations and prescribed treatment for underlying medical conditions that may be contributing to ED.

Find out: How Much Viagra Can I Take Safely?

What Is The Main Cause of Erectile Dysfunction?

The most common cause of erectile dysfunction is a condition that affects blood flow to the penis, for example, cardiovascular disease, peripheral artery disease, high blood pressure, diabetes, high cholesterol, Peyronie disease, smoking, and alcohol use.

Can Erectile Dysfunction Be Cured?

Yes, erectile dysfunction can be cured. ED treatment depends on the underlying cause and may include lifestyle changes, medications, the use of penile devices, surgery, and/or psychological counseling.