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What Causes Erectile Dysfunction and What Can You Do About It?

Kristin Hall, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 10/13/2021

Erectile dysfunction. 

These words are enough to make any man nervous. Erectile dysfunction is a highly personal problem that many men find embarrassing or shameful to talk about. Impotence, a fairly outdated term now known as ED, refers to the inability to get or stay hard. 

Men who fail to seek treatment for erectile dysfunction often feel as though they are alone in their suffering, but nothing could be further from the truth.

A study from the Cleveland Clinic on male aging found that as many as 40 percent of men experience some degree of erectile dysfunction by the time they reach 40, and the incidence rises as high as 70 percent by age seventy.

Erectile dysfunction is common, but many men fail to learn even the basics about exactly what causes it. 

The most common physical causes of erectile dysfunction are related to circulation and blood pressure. 

According to the American Family Physician, taking certain medications is also associated with causing or exacerbating ED. 

However, other triggers and underlying conditions may be at play:

  • Substance abuse 

  • Certain medications

  • Poor diet or obesity 

  • Certain medical conditions 

Let’s take a deeper look at the physical causes of ED.

Obesity

According to a Polish study published by the National Center for Biotechnology Information, 79% of men with a BMI qualifying as obese greater than 25kg are three times more likely to develop sexual dysfunction.

In fact, an article in the U.S. National Library of Medicine says that a diet high in saturated fats, trans fats, sugars and cholesterol could lead to heart disease or cardiovascular disease, diabetes, high blood pressure, or high cholesterol, all of which are risk factors for ED

Essentially, according to a review in the Central European Journal of Health, sugary foods, like soft drinks, can increase your risk of developing erectile dysfunction. 

These foods can cause your blood sugar to experience spikes and crashes, eventually affecting your ability to achieve an erection. 

Making lifestyle changes such as eating a healthy, balanced diet and keeping physically active could reduce your risk of erectile dysfunction, according to an article published in the Ethiopian Journal of Health Science.  

Circulatory Medical Conditions

Even with a healthy BMI, people with heart or circulatory conditions such as high blood pressure or poor circulation could develop sexual dysfunction. 

According to the American Heart Association, erectile dysfunction could act as a warning sign for heart problems such as potential heart attacks or strokes. 

The AHA also says that people in their study who had ED were more likely to develop coronary heart disease. 

Men who have known cardiovascular issues should speak with their healthcare provider before taking erectile dysfunction treatments due to a potential drop in blood pressure caused by the medication. 

Read about the relationship between ED medication and heart disease in our blog. 

Substance Abuse

According to a study published in the Indian Journal of Psychiatry, the risk of development of sexual dysfunction may be related to the rate of your alcohol consumption. 

The study found that of the 100 participants diagnosed with alcohol dependence, 72 participants experienced sexual dysfunctions, including erectile dysfunction.

Additionally, a study published in the Journal of Sexual Medicine says that illicit drug use can lead to decreased sexual desire and risk of erectile dysfunction. 

Drugs such as heroin, MDMA and amphetamines, along with alcohol, are typically the highest drug-related risk factors for erectile dysfunction.

Smoking cigarettes can also add to your risk of erectile dysfunction. According to an article in the book, Andrologia, men who smoke cigarettes are at an increased risk of erectile dysfunction than men who do not smoke. 

Because smoking limits blood flow, and erections require blood flowing to the penis, smoking may inhibit your chances of maintaining an erection. 

All in all, limiting your substance use could reduce your risk of developing ED.

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Medications

Certain medications may have undesired sexual side effects, such as erectile dysfunction. 

According to the US National Library of Medicine, the following types of medication may cause erectile dysfunction: 

  • Antidepressants

  • Antihistamines

  • High blood pressure medications

  • Medication for Parkinson’s disease

  • Chemotherapy 

  • Certain opiate pain killers

Be sure to talk to your healthcare provider about any medications you are taking to rule them out as the cause of erectile dysfunction.

Prostate Issues

Tumors due to prostate cancer can cause urology problems, which could lead to erectile dysfunction. 

In fact, according to research published in the World Journal of Men’s Health, prostate cancer itself can cause a reduction of sexual desire and even decrease the rate of sexual activity and sexual performance. 

Additionally, surgery to remove the prostate to treat this cancer could cause nerve damage, which in turn could increase erectile dysfunction frequency. 

Issues with an enlarged prostate, also known as benign prostatic hyperplasia, and its associated treatments, can even be a cause of erectile dysfunction. 

On the other hand, certain treatments for benign prostatic hyperplasia, such as Cialis, can actually serve a dual purpose and treat erectile dysfunction.

Learn more about how an enlarged prostate can cause erectile dysfunction in our guide. 

Other Health Conditions

Several other medical conditions may be causing your erectile dysfunction. Multiple sclerosis, Peyronie's disease (scarring in the penis), hormone imbalances such as low testosterone, and even kidney disease can lead to erection problems. 

Pinched spinal cord nerves due to injury, illness, heavy metal poisoning, or alcoholism may also play a role, according to

To narrow down these conditions as contributors to your ED, talk with your healthcare professional about any current or suspected underlying health conditions you may have. 

Mental Health Concerns 

In many cases, ED is rooted in psychological issues — especially in men under 40 years of age, according to the American Family Physician. 

Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. 

Mental health conditions like depression or anxiety can negatively impact your libido, making it more difficult for you to become aroused.

Stress can also be a major factor because it may interfere with your brain sending signals to allow extra blood to flow to the penis. 

In many cases, psychological issues develop into performance anxiety which, in and of itself, becomes a self-fulfilling prophecy.

Though it can sometimes be difficult to pin down the specific cause for your erectile dysfunction, it is always worth the effort. 

Left untreated, ED can contribute to worsened stress and anxiety as well as low self-esteem and relationship problems. 

Learn more about the psychological causes of ED in our blog.

What ED Treatment Options Are Available?

In many cases, diagnosing erectile dysfunction requires little more than a physical exam, a few blood tests and a review of your symptoms. 

Once you’ve determined the cause for your ED, you and your healthcare provider can decide on a form of erectile dysfunction treatment.

Here are some of the options:

  • Erectile Dysfunction Drugs – Prescription medications like sildenafil (Viagra®, generic Viagra), tadalafil (Cialis®) and vardenafil (Levitra®) 

  • Psychotherapy – For psychological causes of erectile dysfunction, psychotherapy can be beneficial. Cognitive-behavioral therapy (CBT) is a popular method because it helps address negative patterns of thought that can contribute to performance anxiety.

  • Vacuum Constriction Devices – An alternative to oral medications, vacuum constriction devices can create an erection using vacuum pressure — once an erection develops, a constriction band is placed around the base of the penis to maintain the erection.

  • Surgery – One of the more invasive treatments for erectile dysfunction, surgical options also exist. Inflatable devices or malleable rods can be surgically implanted on either side of the penis to help achieve an erection.

  • Lifestyle Changes – In cases where lifestyle factors such as obesity, unhealthy diet and lack of exercise play into erectile dysfunction, making health changes to your lifestyle may resolve the underlying conditions causing your symptoms.

Be sure to tell your healthcare provider about any drugs or supplements you may be taking and keep an eye out for side effects.

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Erectile Dysfunction: Next Steps

Having learned a great deal more about erectile dysfunction including its risk factors and causes, you should be equipped to assess your own erectile function.

If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor’s office. 

If you choose to seek help, give your healthcare provider as much information as you can about your ED symptoms including their frequency and severity as well as the onset. 

With your healthcare provider’s help, you can determine the best course of treatment to restore sexual function.

Erectile dysfunction may be an unpleasant condition that no one really wants to talk about, failing to acknowledge it won’t make the problem go away. 

Your best defense against health problems like this is to learn everything you can about it so you can tackle the problem at the root. 

If you’re ready to stop living in embarrassment about your sexual function, become an advocate for yourself and your own health and talk to your healthcare provider.

11 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.

  1. Agbanusi, et al. (2011, November). Effects of aerobic exercise in the management of erectile dysfunction: A meta analysis study on randomized controlled trials. Ethiopian journal of health sciences. Retrieved September 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275865/
  2. Arackal, B. S.; Benegal, V. (2007, April). Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian journal of psychiatry. Retrieved September 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917074/
  3. Bogdański, et al. (n.d.). Obesity--Significant risk factor for erectile dysfunction in men. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. Retrieved September 28, 2021, from https://pubmed.ncbi.nlm.nih.gov/24720114/
  4. Hyun, J. S. (2012, August). Prostate cancer and sexual function. The world journal of men's health. Retrieved September 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/
  5. Kovac, et al. (2015, December). Effects of cigarette smoking on erectile dysfunction. Andrologia. Retrieved September 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485976/
  6. Lakin, M., & Wood, H. (n.d.). Erectile Dysfunction. Disease Management . Retrieved September 28, 2021, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/erectile-dysfunction/
  7. Rew, K. T.; Heidelbaugh, J. J. (2016, November 15). Erectile dysfunction. American Family Physician. Retrieved September 28, 2021, from https://www.aafp.org/afp/2016/1115/p820.html
  8. U.S. National Library of Medicine. (n.d.). Drugs that may Cause Erection PROBLEMS: Medlineplus medical encyclopedia. MedlinePlus. Retrieved September 28, 2021, from https://medlineplus.gov/ency/article/004024.htm
  9. U.S. National Library of Medicine. (n.d.). Heart disease and DIET: Medlineplus medical encyclopedia. MedlinePlus. Retrieved September 28, 2021, from https://medlineplus.gov/ency/article/002436.htm
  10. Erectile dysfunction. Johns Hopkins Medicine. (n.d.). Retrieved September 29, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction
  11. Erectile dysfunction may be warning sign for more serious health problems. www.heart.org. (n.d.). Retrieved September 29, 2021, from https://www.heart.org/en/news/2018/07/11/erectile-dysfunction-may-be-warning-sign-for-more-serious-health-problems

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.

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