Despite being one of the most common intimate health conditions in men, few men know exactly what causes erectile dysfunction (ED). However, experiencing symptoms of erectile dysfunction could be an indicator that something else is wrong.
Many believe that ED is just a part of getting older. While it is particularly common in older men, it is not caused by ageing itself, but rather the health problems that are more common as we get older. Impotence often has an underlying cause, either mental or physical, that can affect men of any age.
Wonder what could be causing your ED? Keep reading to find out more.
A healthy cardiovascular system is key to being able to get and maintain an erection because erections require a healthy blood flow.
When you’re sexually stimulated, the blood vessels in your penis relax to allow for more blood flow. This blood is then trapped in spongy tissue in the penis (corpora cavernosa) which causes the penis to expand and become erect. However, if you have a condition that affects your cardiovascular system, this process is interrupted.
One of the leading causes of cardiovascular-related ED is atherosclerosis. This is caused by a buildup of plaque in the arteries, which narrows or blocks them. Over time, this can significantly impede blood flow, which puts you at an elevated risk of several conditions such as heart disease, strokes, heart attacks as well as impotence.
Atherosclerosis has several causes, including:
Whilst arguably some of the most prevalent risk factors for ED, one survey found that only 27% of men knew that impotence could be linked to high blood pressure or high cholesterol.
“Just under 3 quarters of men diagnosed with erectile dysfunction have high cholesterol.”
One study conducted clinical analyses on men who had been diagnosed with erectile dysfunction for at least 6 months. They found that 70% of men had high cholesterol levels and found that they were twice as likely to develop coronary heart disease.
In fact, ED is often an early indicator of an underlying heart condition. Another study looking at the relationship found that almost 50% of men were diagnosed with coronary artery disease around 1-3 years after developing ED symptoms.
Type 2 diabetes is another one of the most common causes of erectile dysfunction, with studies reporting prevalence as high as 80%. It is particularly prevalent because it hinders two key processes important for erections.
Like other cardiovascular diseases, diabetes can cause atherosclerosis. Diabetes is characterised by high blood sugar levels. Over time, excess blood glucose decreases the elasticity of blood vessels and narrows them. This limits blood flow, which affects erections.
Diabetes also damages your nerves, a phenomenon known as diabetic neuropathy. Being able to get and maintain an erection also relies on nerve impulses being conducted successfully in the brain, spine, and penis.
Sometimes referred to as neurogenic erectile dysfunction, impotence is common among men that have a neurological disorder. This affects people in a range of conditions, from dementia to epilepsy. One study found that up to 40% of men under care in a hospital for a neurological disorder reported having ED.
Some conditions linked to ED include:
These conditions affect the nervous system in a variety of ways.
Firstly, a lot of these conditions interfere with how your brain perceives sexual stimuli. This can affect how easy it is to feel sexual desire, which can cause low libido and make even getting an erection difficult.
Secondly, these disorders can disrupt the physical process. To trigger an erection, the brain perceives the sexual stimuli and sends neural signals through the spinal cord (the central nervous system) and to the pelvic nerves. The pelvic nerves are responsible for many key sexual functions, including orgasm, ejaculation and erectile function.
Being overweight puts you at an elevated risk of many conditions, but did you know it can also cause impotence? Research has shown that almost 80% of men with a BMI of 25 and over also have ED, and those with a BMI of 30 and over are over three times more likely to develop the condition.
“Obese men are three times more likely to develop erectile dysfunction.”
As we have learnt in the previous sections, healthy circulation is important for erectile function. Being overweight puts a significant strain on your body and heart, and some of the main complications are the leading causes of ED. You’re also at a particularly elevated risk if you have metabolic syndrome, the medical term for those who have been diagnosed with type 2 diabetes, high blood pressure and obesity.
Poor diet, such as too many fatty and sugary foods, and a sedentary lifestyle significantly impair your heart health, which ultimately can cause erectile dysfunction.
Some research has also linked low testosterone levels in obese men to impotence. Testosterone is the male hormone, and plays an important role in erectile function. Excess fat tissue, especially on the stomach, influences testosterone levels. Critically, belly fat converts more testosterone into oestrogen.
Alcohol affects our body in multiple ways, but it is notorious for its effect it has on your sex life - both short-term and long-term. This is because alcohol is a drug and due to the way it is distilled and fermented, is often high in calories and sugar.
High levels of alcohol use can cause ED in a few major ways.
Smoking has been linked to several long-term, serious health conditions. However, not many know that it is also linked to impotence.
One study investigated ED in 7,684 men aged 35-74. They found that around half of the men aged between 55-64 and 65-74 who smoked struggled with ED. They also found a significant correlation between the amount of cigarettes smoked a day with risk of ED.
There are two main ways that smoking causes ED.
The first is that the chemicals in cigarettes have a toxic effect on the circulatory system. Over time, smoking causes atherosclerosis which damages your blood vessels and can cause ED.
Nicotine is the main addictive drug in cigarettes, and that has also been found to interrupt healthy blood flow. This is because nicotine has an effect on the hormones responsible for the soft tissues in your penis. It causes them to rapidly contract which restricts blood flow.
Psychological ED is caused by a problem to do with your mental health. This could be general negative emotions (e.g. low self-esteem) or could be a chronic mental health disorder.
It’s notably more difficult to treat. However, going to therapy is a good way of tackling potential psychological causes, especially in the long-term.
Stress and anxiety are common causes of psychological ED. These feelings can be caused by your past, current or future life circumstances and affect the mind and the body in a plethora of ways. Stress and anxiety can cause changes in blood pressure, fatigue and affect other key processes that can all contribute to ED.
Another cause of ED under this category is called sexual performance anxiety (SPA), where men feel anxious about sex either because of their ED or because of other factors.
Depression can have a serious impact on your sexual health, and is a phenomenon that is underrepresented when it comes to men’s health. It is particularly prevalent in young men and could become a growing concern as fewer men seek mental health guidance.
“Men with erection problems are twice as likely to be diagnosed with depression.”
The relationship also goes both ways, as men with ED are at a high risk of developing a mental health disorder due to the negative emotions surrounding the condition. In fact, the risk of depression is double in men who struggle with ED, premature ejaculation or some other type of sexual dysfunction.
Studies have found that a pornography habit can cause erectile dysfunction, and since the term has been coined ‘porn-induced erectile dysfunction’ or PIED.
Experts are not exactly sure why, but many suggest that overconsumption results in desensitisation. In other words, the more you watch more porn, the less it makes you aroused because your brain has become accustomed to it.
Porn addiction is a difficult problem to overcome, and some men need specialist sex therapy to help with their problems.
There are several other medical conditions that can cause ED, such as:
Some of these conditions are quite rare, and it is more likely to be caused by a more common health problem. However, you should always monitor your health and consult your doctor if you develop sudden ED with no clear cause.
Certain prescription medicines can also cause erectile dysfunction. In fact, ED has been found to be a side effect of over 200 medicines.
This list includes, but is not limited to:
Recreational drugs such as marijuana, cocaine or heroin can also cause ED.
If you’re struggling with ED, check all the medicines you take and discuss with your doctor if you’re worried a medicine you take is causing your symptoms. You should always check the patient information leaflet when you start a new medicine.
Medically reviewed by Dr. Adrian Rawlinson
Written by our editorial team Last reviewed 01 May 2023