What are the Risk Factors for Erectile Dysfunction?

Kristin Hall, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 11/16/2021

When you hear the dreaded words “erectile dysfunction,” do you think of it as a condition that only affects older men? While age is certainly a factor in determining your risk of experiencing ED, the reality is that erectile dysfunction can — and does — affect men of all ages.

Problems with sexual dysfunction can be difficult or embarrassing to talk about, especially for a man in the prime of his life.

However, ED is an issue that affects more guys than you might realize. In fact, according to the National Institute of Diabetes and Digestive and Kidney Diseases, an estimated 30 million men of all ages and backgrounds in the United States are affected by some degree of ED. 

There are several risk factors for erectile dysfunction, ranging from diseases and conditions that affect your blood flow or nerve function to lifestyle factors such as your weight, activity level and your use of certain medications, substances and illicit drugs.

Some of the most common risk factors for erectile dysfunction include:

  • Being overweight or obese

  • Using certain types of medication

  • Diseases that affect blood flow, such as heart disease and type 2 diabetes

  • Conditions that affect your nerve function

  • Having a hormonal imbalance

  • Psychological conditions, such as anxiety and/or depression

  • Use of alcohol or illicit substances

  • An unhealthy diet that affects your health

  • Using tobacco or other products that contain nicotine

  • Living a sedentary lifestyle with limited physical activity

  • Certain types of cancer

  • Age

Below, we’ve covered these risk factors for ED more in depth.

We’ve also shared actionable tactics that you can use to reduce your risk of developing ED, as well as treatments that you can use to improve your sexual performance if you’re experiencing ED right now.

What Is Erectile Dysfunction?

Before we get into details, let’s clear up something important — namely, what is and isn’t viewed as erectile dysfunction.

Erectile dysfunction is a condition in which you either can’t get an erection that’s firm enough for sex, or can’t maintain an erection firm enough for sex. It can occur in the short term, or continue as a long-term problem that affects your sex life for several months or years.

Our detailed guide to erectile dysfunction provides more information about how erections work, as well as the signs you might notice if you’re prone to ED.

What Is the Main Cause of Erectile Dysfunction?

The main cause of erectile dysfunction is poor blood flow to the erectile tissue that’s inside your penis.

Erections are all about healthy blood flow. When you feel sexually aroused, blood flows into the corpora cavernosa — a pair of soft, sponge-like areas of tissue that run along the length of your penis. As blood flows in, pressure builds, causing your penis to become firm and erect.

When blood can’t flow through your blood vessels into your penis, or when the erectile tissue in your penis can’t properly store blood that’s flowing in, you might find it hard to get or maintain an erection. 

Because most of the men you see in Viagra® commercials are white-haired senior citizens, it’s easy to assume that erectile dysfunction is an issue that only affects older men.

While age does play a role in your risk of developing ED, not everyone affected by ED is in their 60s, 70s or 80s. In fact, research shows that a significant percentage of men affected by ED are barely even over the hill, or even firmly into their middle age.

In a study published in the Journal of Sexual Medicine, researchers reported that around one in every four newly diagnosed ED cases is a man aged 40 or younger.

Furthermore, data from the Massachusetts Male Aging Study shows that 52 percent of all men experience erectile dysfunction at some point in life, with 40 percent of men affected by age 40 and nearly 70 percent of men affected by the age of seventy.

Put simply, just about every guy is potentially prone to erectile dysfunction, even if they’ve only just broken into their 30s or 40s.

What Are the Risk Factors for Erectile Dysfunction?

Although ED is increasingly common, many men are unaware of the risk factors that can cause or contribute to it.

This is significant because many of the main risk factors for ED are preventable or reversible, or both. 

By taking the time to learn about the conditions, habits and other factors that can increase your risk of developing ED, you’ll be able to make healthy changes that can stop erectile dysfunction from developing or, if you already have ED symptoms, reverse it naturally.

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Independent Risk Factors for Erectile Dysfunction

An independent risk factor is a factor that’s shown to significantly increase your risk of facing a certain problem — in this case, ED — even when other risk factors are included. 

There are numerous risk factors from ED, ranging from physical health conditions to habits and lifestyle factors. Let’s take a closer look at the 10 major risk factors for erectile dysfunction listed above.

Being Overweight or Obese

Being overweight or obese can significantly increase your risk of many health issues, including erectile dysfunction. In fact, research from Poland has found that nearly 80 percent of men with ED have a body mass index, or BMI, in the overweight or obese (25+) range.

The same research found that being overweight is linked with a 1.5 times increase in the risk of developing ED, with obesity associated with a three-fold increase in ED risk. 

Now, this doesn’t mean that you need to look like a fitness model to avoid ED or enjoy optimal sexual performance. However, if you’re overweight or obese, bringing your weight down to the normal BMI range will likely have a positive effect on your erections and sexual health.

You can learn more about the link between obesity and sexual performance in our full guide to weight and ED

Using Certain Medications

Many prescription medications come with a long list of potential side effects. For some, erectile dysfunction is one of these. 

A range of medications can affect your sexual performance by either causing or contributing to ED, including antihistamine medications, medications for high blood pressure, antidepressants, chemotherapy medications, medications for Parkinson’s disease and others.

Certain medications that reduce your levels of male sex hormones, such as antiandrogens, can also contribute to ED or a low sex drive.

If you develop ED after you start using medication, make sure to inform your healthcare provider about your symptoms. 

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Diseases and Conditions That Affect Blood Flow

As we mentioned above, strong erections are all about steady, reliable blood flow, particularly to the erectile tissue that’s located inside your penis.

Since blood flow is essential for optimal sexual function, any medical condition that reduces the function of your cardiovascular system has the potential to either cause or contribute to erectile dysfunction. 

Disease-based risk factors for ED include hypertension (high blood pressure), cardiovascular disease and atherosclerosis (clogged arteries). Diabetes mellitus, which can potentially harm your vascular system, is also associated with an elevated risk of ED.

When these conditions affect blood flow to your penis, they can make it harder for you to get or maintain an erection

Issues such as coronary artery disease can also limit your sexual stamina, making it harder to enjoy sexual intercourse even if you can get and stay hard. 

Medical Problems That Affect Nerve Function

Erections aren’t just about blood flow — they also depend on sexual stimulation, both mental and physical. When your nervous system doesn’t work effectively, you may find it more difficult to get and remain hard, even when you’re sexually aroused.

Several medical problems can cause nerve damage and erectile dysfunction, including type 2 diabetes and multiple sclerosis. Nerve damage can also occur as a result of injury to the area surrounding your penis, whether due to an accidental injury or trauma during surgery.

If you have one of these conditions, if you’ve injured your penis, pelvis or spinal cord, or if you have undergone surgery to treat prostate or bladder cancer, you may have an elevated risk of developing ED.

Hormonal Imbalances

Your hormones are involved in many essential bodily functions. When your levels of a certain hormone are too low, too high or out of sync with other hormones, it might start to affect your sexual desire, as well as your ability to achieve and maintain an erection. 

Numerous different hormones all play a role in your sexual desire and function, including male sex hormones, or androgens, such as testosterone.

In addition to testosterone, other hormones can affect your sexual function. Some of these can be disrupted by thyroid or pituitary issues. When this happens, you might feel less interested in sex or less able to stay hard. 

If you suspect you’re experiencing low testosterone, it’s best to talk to your healthcare provider about being tested for normal testosterone levels. 

Psychological Conditions

Sex and intimacy is just as psychological as it is physical, so mental health conditions such as anxiety or depression can potentially affect your ability to perform in bed.

Psychological risk factors for ED include depression, anxiety, guilt about sexual performance, worries about failing to please your partner, low self-esteem and stress, whether it’s linked to sexual performance or your life in general.

Some mental health conditions can also affect other aspects of your sexual function, such as your level of interest in sex or ability to reach orgasm. 

For example, research has found that men with depression can experience a reduced level of interest in sexual activity, as well as general feeling of sexual dissatisfaction.

Our guide to the psychological causes of ED discusses these risk factors for ED in more detail, as well as the steps that you can take to treat them. 

Drug and/or Alcohol Use

Not only can prescription medications increase your risk of dealing with ED — alcohol and illicit drugs can also affect your erectile function and sexual performance.

While most of us are familiar with whiskey dick — a form of short-term ED caused by drinking a lot of alcohol — fewer people are aware of the long-term impact that drinking alcohol to excess can have on your sexual health.

In a 2007 study, researchers found that 72 percent of men with alcohol dependence had one or more forms of sexual dysfunction, with premature ejaculation (PE), a low level of sexual desire and ED the most common.

Many recreational drugs are also associated with ED. Even marijuana use is linked with ED, as well as issues such as increased difficulty reaching orgasm.  

Unhealthy Diet

Your diet plays a significant role in your overall health and wellbeing, and a diet that contains too much salt, simple sugars or just an abundance of calories could affect your sexual health. 

The modern American diet is high in processed carbs, refined sugars, and unhealthy fat. Not only can this type of diet affect your health, but it can also contribute to obesity and inhibit the normal function of your vascular system. 

On the other hand, eating a balanced diet that’s rich in fruits, vegetables and lean sources of protein may help to promote optimal sexual function. 

In a 2020 study, researchers noted that men who showed healthy eating patterns, such as an adherence to the Mediterranean diet, showed a lower risk of experiencing erectile dysfunction when compared to their peers.

If you think your stomach issues are causing ED, you can read more about the connection in our blog.

Tobacco and Nicotine Use

We’re all familiar with the negative impacts of smoking, from its association with lung cancer to the effects it can have on your risk of experiencing a heart attack, stroke or developing chronic disease. 

Smoking can also have a serious negative impact on your erections. Not only is smoking one of the biggest risk factors for vascular diseases, but research shows that the nicotine in cigarettes can reduce sexual arousal and affect your erectile response to stimulation.

Put simply, smoking — as well as other habits that supply your body with nicotine — can increase your risk of developing ED. 

Sedentary Lifestyle

Finally, living a sedentary lifestyle is a major risk factor not just for erectile dysfunction, but also for other health conditions and diseases. 

According to the CDC, many people don’t get enough physical activity. In fact, one one in every four US adults meets the recommended guidelines for physical activity, with 31 million American adults above the age of 50 classified as inactive, meaning they do almost no exercise.

Being sedentary increases your risk of developing ED by contributing to type 2 diabetes, cancer and cardiovascular risk factors, such as high blood pressure and elevated cholesterol. 

It also increases your risk of being overweight or obese, both of which are linked to a higher risk of developing ED.

Related post: Can STDs Cause Erectile Dysfunction?

Erectile Dysfunction Symptoms and Signs

Like other sexual performance issues, erectile dysfunction can vary in severity. For some guys, it’s an occasional annoyance that pops up when they’re feeling stressed or anxious, or after an exciting night out that involves one or two drinks too many. 

Other men, on the other hand, may have severe erectile dysfunction that makes it hard to have any sex life at all. 

The signs of ED can start small, such as a weak erection every now and then. It’s important to seek treatment for erectile dysfunction if you notice these signs becoming more frequent, or if your ED symptoms start to become more severe. 

Most healthcare providers will diagnose you with erectile dysfunction if you meet one or several of the following criteria:

  • You can get an erection sometimes, but not every time you want to have sex

  • You can get an erection, but it’s either not firm enough to penetrate your partner, or doesn’t last for long enough to have satisfying sex

  • You can’t ever get an erection sufficient enough for sex, even when you feel sexually aroused and stimulated

Our guide to the symptoms of erectile dysfunction goes into more detail on these signs, as well as the steps you can take if you start to experience any of them. 

How to Reduce Your Risk of Developing ED

Erectile dysfunction is often an early warning sign that something isn’t quite right when it comes to your cardiovascular health, mental wellbeing or general lifestyle. 

If you’ve noticed the signs of erectile dysfunction, it’s often possible to turn things around with a few changes to your habits, lifestyle and personal health.

You can cut your risk of developing ED and maintain normal erectile function by living a healthy, balanced lifestyle. Try to keep yourself active, eat a nutritious diet and maintain a weight in the normal BMI range.

If you have any health conditions that could affect your erections, such as high blood pressure, heart disease or anything that leads to endothelial dysfunction, make sure to reach out to your primary care provider for help. 

They may perform a physical examination to check your general health and wellbeing, or refer you to a specialist for a more precise diagnosis and treatment. 

It’s also important to seek help if you have a mental health issue that could affect your erections and sexual performance. You can do this by contacting a mental health provider locally, or using our online mental health services

Many of the risk factors for ED grow in severity over time. During your 20s or 30s, they may only have a minor impact on your erections. By the time you reach your 40s or 50s, these factors can contribute to a serious degree of erectile dysfunction.  

Related read: how to fix erectile dysfunction at 20.

With the right combination of attention, treatment and lifestyle modifications, it’s usually possible to turn things around early and cut down your risk of developing ED later in life. 

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Bringing Awareness to the Risk Factors of ED

Erectile dysfunction is a common issue that affects men of all ages and backgrounds. Like many other sexual health issues, it can usually be prevented by sexual awareness, identifying the main risk factors for ED and taking quick, early action to treat them before they become severe.

If you’re already starting to experience ED, it’s important to take action quickly. You can find out more about treating ED by talking to your primary care provider or by assessing our selection of ED treatments online. 

As part of the treatment of erectile dysfunction, you may benefit from using medications such as sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®) or avanafil (Stendra®). 

You can learn more about treating ED and improving your sexual health in our guide to the most common ED treatments and drugs

13 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.