Top Causes of Erectile Dysfunction & How to Prevent It

Erectile dysfunction (ED), also called impotence, is the inability to get and maintain an erection during sexual intercourse. Currently, it’s estimated to affect one-third of the male population worldwide.

While not a life-threatening condition, ED may significantly affect a man’s mental health and self-esteem, generating more anxiety and worsening the problem.

It can be caused by different reasons, both physical and psychological. In this article, we’ll list possible conditions that may cause ED and other risk factors that increase the chances of it happening.

What Are the Causes of Erectile Dysfunction?

Both physical and psychological reasons can cause ED. In many cases, it results from unhealthy habits kept for too long, while in others, it can be a symptom of other more dangerous conditions or diseases [1].

Usually, ED is only a temporary inconvenience that disappears after the condition causing it is cured or treated. Research indicates that it is more prevalent in men of older age, and at least 52% of men between 40 and 70 years old have experienced it at some point [2].

With younger men, the statistics vary a lot, but ED rarely occurs due to physical factors and is mainly caused by psychological disorders.

Let’s look at the many factors that can lead to ED.

1. Cardiovascular Problems

Cardiovascular disease, arrhythmia, arterial stenosis, high blood pressure, and other conditions can considerably affect your sexual life. Good blood circulation is required for an erection. If the heart isn’t pumping blood adequately to the whole body, it’s probable that it doesn’t pump enough blood to the penis to cause an erection.

ED caused by cardiovascular conditions is called ‘vasculogenic’ and is the most common reason for organic erectile problems in men of every age [6]. In fact, in many cases, cardiovascular diseases are diagnosed after men seek treatment for ED.

Studies suggest that high cholesterol and triglycerides are closely related to the appearance of ED [3].

Hypertension has also been listed as a common risk factor in men that suffer from ED. Not only due to the condition itself but also because of the medications commonly used to treat it.

3. Diabetes

Diabetes is closely related to being overweight, and it usually appears due to weight increase, lack of exercise, and poor nutrition.

Erectile dysfunction is 3.5 times more prevalent in men with diabetes than without [4]. Some research also shows that men with diabetes tend to experience ED up to 15 years earlier than non-diabetic men; other papers only list it as a risk factor for men over 40 [5].

4. Nerve & Neurological Disorders

Among the conditions that affect the nervous system, we can list Parkinson’s disease, Alzheimer’s, epilepsy, multiple sclerosis, strokes, and brain tumors, among others. These disorders commonly have ED as a symptom [6].

This is because the brain plays an integral part in male sexual arousal, so anything that affects it will inevitably impact your sex drive.

5. Urological Conditions

Certain ailments directly affect the pelvic area, making them more likely to have ED as a symptom or side effect. Some of these are prostatitis, prostate cancer, or pelvic trauma.

Infections in the lower urinary tract are also listed as a condition strongly associated with ED. Fortunately, these cases tend to cause only temporary ED until the cause is treated [7].

6. Injuries or Surgeries

Some injuries, mainly when they’re located in the pelvic area or the spinal cord, can prevent blood from flowing freely into the penis. Traumatic spinal cord or brain injuries can also cause ED if nerves are affected [8].

This may also happen in the aftermath of certain surgeries. In many cases, there are no physiological affectations in the penis, but nervous signals are prevented from reaching it.

7. Low Testosterone or Other Endocrine Problems

The endocrine system provides the body with hormones, which are crucial to make it work properly. Testosterone is a hormone directly related to sexual arousal, and low counts may lead to decreased libido and difficulty in getting or maintaining erections [9].

Furthermore, research indicates that low testosterone is associated with several other health problems, mainly obesity, metabolic symptoms, type 2 diabetes, and CVD risk [10].

8. Mental & Emotional Problems

Everyday anxiety and stress are, unfortunately, common in men’s lives and can cause ED. Worrying too much about your sexual performance beforehand also adds to the problem [11].

Anxiety disorders — such as PTSD, social anxiety, OCD, and panic disorder — put men at a much higher risk of developing ED [12].

Other mental conditions, like sleep disorders or depression, may also provoke ED in the short and long term as a side effect of the stress they put on your mind [13, 14].

9. Drugs or Medications

Substance abuse can cause ED in the short and long term [15]. This is also true for some prescribed medications, like antidepressants, blood pressure medication, finasteride, antiepileptics, and more [16].

In addition, some medications can temporarily cause ED as a side effect until your body gets used to it, or you simply stop taking them. Also, radiation or chemotherapy treatments can end up causing ED in the long term [17].

10. Smoking

Another contributing factor to the appearance of ED is tobacco use, which restricts blood flow to veins and arteries [18]. Stopping the use use of tobacco, or reducing it significantly, has been shown to reduce the risk of experiencing ED. 

Smoking cigarettes for too long can also lead to complications in the cardiovascular system, which are considered by themselves causes of ED.

11. Peyronie’s Disease

Peyronie’s disease is a condition in which scar tissue, called plaque, is formed inside the penis. This takes a lot of time to build up, so it’s more common in older men. Studies indicate that each passing year increases the chances of PD developing in any man [19].

The scar tissue makes the penis curve, especially during erections. This curve can make erections painful, complicate the sexual act, and may lead to developing ED.

Preventing Erectile Dysfunction

Fortunately, you can prevent suffering from ED. Most ways to avoid it involve leading an overall healthier lifestyle, though there are other factors you should keep in mind.

Below are some steps you can take to enhance your sexual life and reduce the chances that you’ll deal with ED.

1. Maintain a Healthy Weight

Being overweight can lead to ED and many other health issues. During a study, about one-third of 110 obese men with ED were able to get rid of the condition [20].

Another study showed a much higher prevalence of ED in men that were overweight or obese [23].

2. Stay Active

Staying in shape and working out regularly keeps your heart healthy, improving blood flow. According to a study, 160 minutes of weekly exercise decreases erectile problems [21]. Aerobic activity of moderate-to-vigorous intensity seems to be most beneficial [22].

3. Get Proper Sleep

Sleep — or a lack of — plays a huge role in our overall health, including sexual health. Disrupted or insufficient sleep and sleep disorders such as obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are linked to ED [24].

Emphasize proper sleep, whether that means getting enough or treating a disorder, and get on the road to better functioning.

4. Improve Mental Health

Reducing stress, anxiety, and depression can help improve arousal and reduce the likelihood of ED.

Maintain balance and find a healthy mental state through Jacobson’s progressive muscle relaxation training, meditation, biofeedback, and yoga [25]. Mindfulness meditation can keep your life in equilibrium and is linked to a reduction of fear linked with sexual activity [26].

Medications for Erectile Dysfunction

Your ED may be caused by something that’s out of your control or as a side effect of other medications. That’s why a healthcare professional may prescribe you some of the following oral medicines to help you get and maintain an erection.

• Sildenafil: Sold under the brand name Viagra, this medication treats ED and pulmonary arterial hypertension.
• Vardenafil: This medication treats ED by increasing blood flow to the penis during sexual stimulation.
• Tadalafil: Sold under the brand name Cialis, it will help you deal with ED, pulmonary arterial hypertension, and benign prostatic hyperplasia.
• Avanafil: Sold under the brand name Stendra, Avanafil is a PDE5 inhibitor — like Vardenafil — and will help you deal with ED by increasing blood flow to the penis during sexual stimulation.

Conclusion: List of Causes of Erectile Dysfunction

Though much more prevalent in older men, ED has been observed in men of many age groups. It has many causes, but most of them are interrelated and are the cause of keeping an unhealthy lifestyle.

It’s important to note that failure to perform sexually once or twice does not indicate ED at all. It also doesn’t suggest that there’s an underlying condition. Not every case of ED means you have an untreated chronic disease.

Still, if the issue is recurring, we recommend seeking professional help, especially to discard serious conditions as a cause.

---

References Used

1. Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., … & Hellstrom, W. J. (2016). Erectile dysfunction. Nature reviews Disease primers, 2(1), 1-20.
2. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of urology, 151(1), 54-61.
3. Wei, M., Macera, C. A., Davis, D. R., Hornung, C. A., Nankin, H. A., & Blair, S. N. (1994). Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction. American journal of epidemiology, 140(10), 930-937.
4. Defeudis, G., Mazzilli, R., Tenuta, M., Rossini, G., Zamponi, V., Olana, S., … & Gianfrilli, D. (2022). Erectile dysfunction and diabetes: a melting pot of circumstances and treatments. Diabetes/Metabolism Research and Reviews, 38(2), e3494.
5. Ludwig, W., & Phillips, M. (2014). Organic causes of erectile dysfunction in men under 40. Urologia internationalis, 92(1), 1-6.
6. Jackson, G. (2013). Erectile dysfunction and cardiovascular disease. Arab journal of urology, 11(3), 212-216.
7. Carson, C. C. (2002). Urological and medical evaluation of men with erectile dysfunction. Reviews in Urology, 4(Suppl 3), S2.
8. Cuenca, A. I. C., Sampietro‐Crespo, A., Virseda‐Chamorro, M., & Martín‐Espinosa, N. (2015). Psychological impact and sexual dysfunction in men with and without spinal cord injury. The journal of sexual medicine, 12(2), 436-444.
9. Rastrelli, G., Corona, G., & Maggi, M. (2018). Testosterone and sexual function in men. Maturitas, 112, 46-52.
10. Wang, C., Jackson, G., Jones, T. H., Matsumoto, A. M., Nehra, A., Perelman, M. A., … & Cunningham, G. (2011). Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes care, 34(7), 1669-1675.
11. Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of consulting and clinical psychology, 54(2), 140.
12. Velurajah, R., Brunckhorst, O., Waqar, M., McMullen, I., & Ahmed, K. (2022). Erectile dysfunction in patients with anxiety disorders: a systematic review. International journal of impotence research, 34(2), 177-186.
13. Heruti, R., Shochat, T., Tekes‐Manova, D., Ashkenazi, I., & Justo, D. (2005). Association between erectile dysfunction and sleep disorders measured by self‐assessment questionnaires in adult men. The journal of sexual medicine, 2(4), 543-550.
14. Liu, Q., Zhang, Y., Wang, J., Li, S., Cheng, Y., Guo, J., … & Zhu, Z. (2018). Erectile dysfunction and depression: a systematic review and meta-analysis. The Journal of Sexual Medicine, 15(8), 1073-1082.
15. Arackal, B. S., & Benegal, V. (2007). Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian Journal of Psychiatry, 49(2), 109.
16. Higgins, A., Nash, M., & Lynch, A. M. (2010). Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug, healthcare and patient safety, 2, 141.
17. Madan, R., Dracham, C. B., Khosla, D., Goyal, S., & Yadav, A. K. (2020). Erectile dysfunction and cancer: current perspective. Radiation Oncology Journal, 38(4), 217.
18. Cao, S., Yin, X., Wang, Y., Zhou, H., Song, F., & Lu, Z. (2013). Smoking and risk of erectile dysfunction: systematic review of observational studies with meta-analysis. PloS one, 8(4), e60443.
19. Bilgutay, A. N., & Pastuszak, A. W. (2015). Peyronie’s disease: a review of etiology, diagnosis, and management. Current sexual health reports, 7(2), 117-131.
20. Evans, M. F. (2005). Lose weight to lose erectile dysfunction. Canadian family physician, 51(1), 47.
21. Gerbild, H., Larsen, C. M., Graugaard, C., & Josefsson, K. A. (2018). Physical activity to improve erectile function: a systematic review of intervention studies. Sexual medicine, 6(2), 75-89.
22. Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2017). Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. British Journal of Sports Medicine, 51(19), 1419-1424.
23. Pizzol, D., Smith, L., Fontana, L., Caruso, M. G., Bertoldo, A., Demurtas, J., … & Veronese, N. (2020). Associations between body mass index, waist circumference and erectile dysfunction: a systematic review and META-analysis. Reviews in Endocrine and Metabolic Disorders, 21(4), 657-666.
24. Cho, J. W., & Duffy, J. F. (2019). Sleep, sleep disorders, and sexual dysfunction. The world journal of men’s health, 37(3), 261-275.
25. Pakpahan, C., Agustinus, A., & Darmadi, D. (2021). Comprehensive intersystemic assessment approach to relieve psychogenic erectile dysfunction: A review. Open Access Macedonian Journal of Medical Sciences, 9(F), 189-196.
26. Jaderek, I., & Lew-Starowicz, M. (2019). A systematic review on mindfulness meditation–based interventions for sexual dysfunctions. The Journal of Sexual Medicine, 16(10), 1581-1596.