Erectile dysfunction (impotence) - Causes 

Causes of erectile dysfunction 

Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress.

It's important to identify the cause of erectile dysfunction and treat any underlying conditions.

Erections

When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden.

Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.

Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body).

Physical causes

There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:

  • conditions affecting the flow of blood to your penis – vasculogenic
  • conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic
  • conditions affecting your hormone levels – hormonal
  • conditions affecting the physical structure of your penis – anatomical

Injuries and surgery

Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction.

Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.

Vasculogenic conditions

Examples of vasculogenic conditions that cause erectile dysfunction include:

  • cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) 
  • high blood pressure (hypertension)
  • diabetes – a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition

Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.

Neurogenic conditions

Examples of neurogenic conditions that cause erectile dysfunction include:

  • multiple sclerosis – a condition that affects the body's actions, such as movement and balance 
  • Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
  • a spinal injury or disorder
  • stroke – a serious condition that occurs when the blood supply to the brain is interrupted

Hormonal conditions

Examples of hormonal conditions that cause erectile dysfunction include:

  • hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels 
  • an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced
  • an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced 
  • Cushing's syndrome – a condition that affects the production of a hormone called cortisol

Anatomical conditions

Peyronie's disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction.

Medicine 

In some men, certain medicines can cause erectile dysfunction, including:

  • diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease 
  • antihypertensives – such as beta-blockers, that are used to treat high blood pressure
  • fibrates – medicines used to lower cholesterol levels
  • antipsychotics – used to treat some mental health conditions, such as schizophrenia 
  • antidepressants –  used to treat depression and some types of pain
  • corticosteroids – medication that contains steroids, which are a type of hormone
  • H2-antagonists – medicines used to treat stomach ulcers
  • anticonvulsants – used to treat epilepsy
  • antihistamines – used to treat allergic health conditions, such as hay fever
  • anti-androgens – medication that suppresses androgens (male sex hormones) 
  • cytotoxics – medication used in chemotherapy to prevent cancer cells from dividing and growing

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. Alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Psychological causes

Possible psychological causes of erectile dysfunction include:

  • depression – feelings of extreme sadness that last for a long time
  • anxiety – a feeling of unease, such as worry or fear

Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction.

There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:

  • relationship problems
  • lack of sexual knowledge
  • past sexual problems
  • past sexual abuse
  • being in a new relationship 

Other causes

Other possible causes of erectile dysfunction include:

  • excessive alcohol intake 
  • tiredness
  • using illegal drugs, such as cannabis, heroin or cocaine

Cycling

Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.

Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.


Page last reviewed: 23/09/2014

Next review due: 23/09/2016

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Comments

The 6 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Jacqui Olliver said on 02 September 2014

This is an excellent and comprehensive article. Unfortunately we are never given a users guide to having sex, so most men have no idea how to rectify an erectile dysfunction problem once it has occurred.

Sex education in schools does not teach a man how to stay hard and in control, or a woman how to orgasm through intercourse. It is no surprise that so many people have these problems and require the help of an expert to learn how to control their sexual programs.

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Andy Ramirez said on 30 March 2013

There are quite a number of serious illnesses and medical problems that can contribute to the development of erectile dysfunction. Heart disease would be one of the most commonly cited conditions known for causing ED.

The heart is what pumps blood and the penis requires its chambers to be filled with blood in order to become erect. When the heart is not operating in the optimal manner then it can be difficult to maintain a full erection.

Other heart related issues such as high cholesterol and high blood pressure can contribute to erectile dysfunction causes.

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Robert Patrick said on 19 December 2012

Well some diet habits can help to get rid of erectile dysfunction.

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Robert Patrick said on 19 December 2012

Kegel exercise can help to treat erectile dysfunction.

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JoannaLane said on 06 August 2011

As the article mentions, hormonal problems can cause erectile dysfunction.
It is important here to mention how frequently these can occur following head injury (even mild). Symptoms may appear immediately after injury but in some cases it could take several years for them to manifest, meaning that sufferers may not recognize the connection.
In his paper 'High risk of hypogonadism after traumatic brain injury' (Pituitary 2006), Professor Agha of Beaumont Hospital, Dublin says that hypogonadism persists in 10 - 17% of long term survivors of traumatic brain injury.
According to Hohl's article 'Hypogonadism after TBI' (Arq. Bras. Endocrinol metabol., 2009) "the high incidence of TBI, [means that] post-TBI hypogonadism arises as a critical problem for public health."
It is likely that there are many thousands of undiagnosed sufferers of post-traumatic hypogonadism in the UK alone.

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Bryzer said on 13 October 2009

More information would be very helpful on the condition known as hypospadias. As a sufferer for over 50 years with recurring UTI's and ED more info would be useful to the hundreds of 1st, 2nd (me along with dorsal and chordee) and third degree sufferers.

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Increased risk

There are some things that can make erectile dysfunction more likely. These are very similar to the risks of cardiovascular disease and include:

Erectile dysfunction itself can also be a sign of cardiovascular disease.