What causes erectile dysfunction and what can you do about it?

What causes erectile dysfunction?

A variety of factors can cause or contribute to erectile dysfunction, including your physical health (the health of your penis, cardiovascular system, etc.) and well-being (getting sick can be a reason for ED), your mental health, certain lifestyle choices, and even your use of certain medications or substances.

Because sexual arousal in men is a rather complex process, it can sometimes be difficult to pinpoint a specific cause.

Sexual arousal starts in your brain, but it also involves your nervous system, muscles, and blood vessels. It can even be influenced by factors such as your emotions and the production of certain sex hormones.

If a problem develops that involves either of these things, erectile dysfunction may be a possible consequence.

Generally, the causes of erectile dysfunction can be divided into three main categories: physical causes, psychological causes, and drugs or substances.

While each of these categories has its own set of contributing factors, many erectile dysfunction cases have causes from multiple categories.

Here's an overview of each category, as well as the specific issues that may cause or contribute to ED:

Physical causes of ED

Erectile dysfunction is often caused by physical health factors, including factors that affect blood flow and nerve function.

Since an erection is all about healthy blood flow, it's common for cardiovascular health problems to affect your sexual health and erectile function.

Common physical causes of erectile dysfunction include heart disease, atherosclerosis (clogged arteries), high cholesterol and hypertension, or high blood pressure. These problems can all affect your cardiovascular health and may limit blood flow to your penis.

Other forms of vascular diseases can also reduce blood flow and make it harder to get or maintain an erection.

There is also a link between stomach problems and ED.

Another common physical cause of ED is type 2 diabetes, which can damage your arteries and nervous system. This can lower blood flow to your penis and affect your ability to feel physical sensation, including in your penis and surrounding tissue.

Obesity and metabolic syndrome can cause changes in blood pressure, body composition, and cholesterol, leading to ED.

Conditions that damage your nervous system can also cause or contribute to ED. This includes multiple sclerosis (MS), but also localized injuries to the nerves around the penis, spinal cord and pelvis due to surgery, radiation or accidental damage.

Finally, certain lifestyle factors that affect your physical health may affect your risk of developing erectile dysfunction.

Habits like smoking, for example, may increase your risk of developing ED by damaging your cardiovascular system. Excessive alcohol consumption is also associated with a higher risk of sexual dysfunction, including ED.

Psychological causes of ED

In many cases, erectile dysfunction is due to psychological problems, especially in men under the age of 40. Because sexual arousal starts in the brain, psychological conditions can be an important factor in the development of ED.

A variety of mental health issues can take a toll on your erections, libido, and overall sexual health, including common issues like depression and anxiety.

Sometimes these mental health issues are specific to sex. For example, many men develop a form of anxiety called sexual performance anxiety that can lead to extreme nervousness before or during sex.

Others may feel guilty about having sex or worry about certain sexual activities.

In addition to depression and anxiety, stress can also be an important factor in erectile dysfunction. When stress is severe or chronic, it can interfere with the signals that your brain sends to let extra blood flow to your penis, making it harder to get and keep an erection during sex.

While it can sometimes be difficult to determine the specific cause of your erectile dysfunction, it's always worthwhile. Left untreated, ED can contribute to worsening stress and anxiety, as well as low self-esteem, relationship problems, and reduced quality of life.

We've discussed these causes and the impact they can have on your sexual performance in our full guide to the psychological causes of ED and How to Break the Performance Anxiety Cycle.

What treatment options are available?

Erectile dysfunction can be frustrating to deal with, especially if it prevents you from having a satisfying sex life. However, almost all cases of ED can be treated.

Treatment for erectile dysfunction begins with an accurate diagnosis. You can get these by making an appointment with your doctor, talking to an erectile dysfunction doctor online, or talking to a male reproductive health specialist such as a urologist.

In many cases, diagnosing erectile dysfunction requires little more than a physical exam, a brief discussion about your medical history, and an overview of your symptoms.

Depending on the severity of your ED, your overall sexual function, and other factors, you may benefit from one of the following treatment options.

Erectile dysfunction medications

Various medications are used to treat ED, including oral ED medications such as sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®).

These drugs work by increasing blood flow to your penis, making it easier for you to get and keep an erection when you are sexually aroused. Most oral ED medications can be taken 30 to 60 minutes before sex, making them easy to use on a night out or at home.

You can learn more about these medications, their effects, and how to use them in our guide to the most common ED treatments and medications.

It's important to know that ED medications may interact with other commonly used medications, including some used to treat high blood pressure and cardiovascular disease. We've covered these in our guide to common interactions with sildenafil.

We offer brand names and generic versions of various ED medications, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.

psychotherapy

If ED is caused by a psychological problem, such as anxiety, depression, or sex concerns, psychotherapy may be helpful.

Various forms of psychotherapy are used to treat psychological ED, including cognitive behavioral therapy (CBT) and sex therapy. The goal of therapy is to help you overcome feelings that affect your ability to have sex and develop systems to control these feelings in the future.

Depending on the underlying cause of your ED, you may benefit from therapy alone or with the use of ED medications.

Testosterone Replacement Therapy (TRT)

As you get older, it's normal for your testosterone levels to drop gradually. As a result, many men develop symptoms of low testosterone levels, such as weaker erections and decreased interest in sex, in their 30s, 40s, or 50s.

Related reading: What can cause erectile dysfunction at age 30, Erectile dysfunction at age 40, ED at age 50

While it's still possible to get an erection with low testosterone levels, many men with low testosterone levels feel less sexually excited and experience a decline in things like morning wood.

If you have low testosterone levels and ED, your doctor may suggest testosterone replacement therapy (TRT). This treatment consists of using artificial testosterone to bring your testosterone levels back to the normal range.

TRT can cause side effects and is not suitable for everyone. However, if you have low testosterone levels and find that it's affecting your sexual performance, it may be an option worth considering.

Changes in your habits and lifestyle

When erectile dysfunction is caused by a lifestyle factor, such as restricted exercise, an unhealthy diet, or obesity, changing your habits and lifestyle can help improve your sexual function and reduce the severity of your ED.

As we explained in our guide to the best ways to protect your erection naturally, habits such as regular exercise, a diet high in fruits and vegetables, and plenty of healthy sleep can have a noticeable positive effect on your sexual health.

It can also help overcome bad habits, for example by limiting your alcohol intake or quitting smoking.

Which ED treatment is best?

When choosing an erectile dysfunction treatment, you should take your time. There are tons of options available, and while none are perfect, some may suit you better than others.

There is no “best” erectile dysfunction treatment for everyone. Because several factors can cause or contribute to erectile dysfunction, it's important to identify what may affect your sexual health and then choose a treatment that suits your specific symptoms and needs.

It's important to know that many of the over-the-counter ED “treatments” sold in gas stations, convenience stores and online not only don't work but are often not safe.
These products are often marketed as “male enhancement pills” that can treat ED, increase sexual stamina, and improve just about every aspect of your sexual performance. They usually contain a mix of herbal ingredients and make big claims about their efficacy and results.

While not all of these products are outright scams, many of them have been found to contain unlabeled, unsafe ingredients, including hidden pharmaceutical ingredients created under unsafe conditions.

You can learn more about these products and the risks associated with their use by scrolling through the FDA's list of contaminated sexual enhancement products.

Before starting treatment, it is important to tell your healthcare provider about any medications or supplements you are currently taking and to familiarize yourself with the common side effects of ED treatments.

What's next after finding the cause of your ED?

Once you know more about erectile dysfunction, its risk factors, and possible causes, you'll be much better able to assess your own erectile dysfunction and take action.

If you've recently experienced any of the symptoms of ED, it may be worth asking your healthcare provider for help.

If you choose to seek help, make sure to provide your healthcare provider with as much information as possible about your symptoms, such as when they started, how often they occur, and the impact that ED has on your sexual function.

Another option is to seek help online. Through our telehealth platform, you can consult a licensed healthcare provider and access ED medications such as sildenafil and tadalafil after an online private consultation.