Top Reasons for Erectile Dysfunction

Erectile dysfunction (ED) is common, has a diverse range of physical and psychological causes and treatments, and can have a huge impact on a man’s life. ED is the inability to attain or maintain an erection sufficient for penetrative sex. While having occasional difficulty getting an erection is common and normal, it’s time to talk to your doctor when it happens more than half the time.

ED affects approximately 30 million men in the U.S.¹, with about 25% of those affected under the age of 40.² While ED is treatable, according to a survey of six million men with ED, only one-quarter actually received treatment.³ ED treatment options include injectables (Trimix), medications to increase libido and treat ED, such as PT 141, and a range of oral ED medications.

While you and your doctor will ultimately determine which of these contributes to your symptoms, it helps to know the potential causes and treatment options. Here are the most common causes of ED.

1. Age

Unfortunately, age is a risk factor for ED that you can’t do much about. Despite researchers striving to have aging acknowledged as a chronic illness that leads to other chronic diseases, we still have a long way to go to fully understand why some people age faster than others. Antiaging research and potential treatment options to slow aging are expected to explode in the next few decades.

2. Weight

After completing a 14-year study, researchers found that obesity is an independent risk factor for ED.⁴ It directly contributes to ED and increases the risk of other chronic diseases. Carrying excess weight affects your cardiovascular and endocrine systems and puts you at risk for chronic diseases that may increase ED. Fat cells secrete chemicals that increase inflammation in the body. Excess inflammation makes it more difficult for blood vessels to dilate and constrict. This limits blood flow into the penis.

Obesity contributes to:⁵

• Leptin resistance which can affect reproduction and testosterone levels
• Decreased testosterone levels
• Damage to the inner lining of blood vessels
• Insulin resistance, which further damages blood vessels

Losing weight can improve erectile function. In one study, about one-third of men who had obesity and lost weight regained erectile function.⁶ Obesity causes increased inflammation, damage to blood vessels, and decreased testosterone. Talk to your doctor about a treatment plan for weight management to see if this may improve your ED symptoms.  

3. Nutrition

Good nutrition is essential for maintaining a healthy cardiovascular and endocrine system. Choose a diet that maximizes whole foods rich in nutrients, vitamins, minerals, and antioxidants. Consume fruits and vegetables every day. Choose healthy sources of fats and proteins. Researchers report that men who consume a low-fat, low-calorie diet improve their erectile function and testosterone levels.⁷

Make the following nutrients part of your diet:

• Folic acid: asparagus, avocados, spinach, lettuce
• Flavonoids: berries, onions, dark chocolate, bananas
• L-citrulline: watermelon, squash, pumpkin, and cucumber
• L-arginine: turkey, pork loin, and chicken
• Omega-3 fatty acids: fatty fish
• Zinc: oysters, crab, pumpkin seeds
• Antioxidants: pistachios, dark chocolate, berries, green tea

Dietary choices can impact your sexual health. If you already consume a healthy diet or find that your sex life needs an extra boost, try passion or tadalafil/oxytocin to help with your sex drive and erectile function.

4. Sedentary Lifestyle

A sedentary lifestyle can increase your risk for many chronic diseases that are associated with ED, and physical inactivity is an independent risk factor for ED.⁸ Exercise has many benefits for everyone, but especially for older adults. Here are some of the ways exercise can improve erectile function:

• Weight management
• Blood pressure control
• Cholesterol levels
• Blood sugar control
• Inflammation
• Boost testosterone levels

Many of these contributors to ED can be reversed through increased physical activity, especially when physical activity is combined with a nutritious diet such as a Mediterranean-style diet.⁹

5. Smoking

Eighty percent of ED cases are due to blood vessel damage.¹⁰ Men who smoke may almost double their risk of ED, according to results from the Massachusetts Male Aging Study.¹¹ The chemicals in cigarette smoke narrow blood vessels, decreasing blood flow. Because the erectile process relies on maintaining blood flow into the penis and trapping it to increase pressure and maintain an erection, this is especially problematic for men trying to get and maintain an erection.

6. Alcohol Intake

Alcohol is a diuretic and nervous system depressant. Diuretics cause increased urination, which can decrease blood volume and blood pressure. This decreases blood flow into the penis. Long-term excess alcohol consumption can also decrease testosterone production, which can cause ED and decreased sex drive.

Alcohol consumption doesn’t directly cause ED, but it can disrupt the communication between the brain, nervous, endocrine, and cardiovascular systems, leading to ED.

7. Underlying Health Conditions

ED and other sexual dysfunctions are common early symptoms of potentially serious chronic diseases that affect blood vessels, including:¹²

• Diabetes mellitus
• Cardiovascular disease
• High cholesterol
• High blood pressure

8. Medication Side Effects

Medications, both prescription and over-the-counter, can contribute to ED. Some of the known offenders are:¹³

• Antidepressants
• Blood pressure medications
• Antihistamines
• Opioid pain medication
• Anti-gastroesophageal reflux medications
• Anti-seizure medications
• Medications to treat Parkinson disease
• Antipsychotics
• Diuretics
• Cytotoxic
• Hormones
• Immunomodulators
• Anti-anxiety medications

9. Mental Health Issues

Depression, performance anxiety, and stress—can all contribute to ED. In the Male Massachusetts Aging Study, men with untreated depression were almost twice as likely to report ED than were men who did not have depression.¹⁴ Unfortunately, depression can increase the risk of ED, and ED can increase the risk of depression. Couples and sex therapy can be very helpful in breaking this cycle.¹⁵

Factors that increase the likelihood of a psychological cause of ED include a sudden onset of symptoms, intermittent function, decreased libido, and good quality self-stimulated or spontaneous erections.

10. Performance Anxiety

Men with depression or anxiety are more likely to have performance anxiety, negatively affecting erectile function. Men with depression more commonly focus on their sexual performance from a third-party point of view, which increases anxiety and worsens both erectile function and mood.¹⁵

11. Sleep Disorders

Lack of restful sleep can cause high blood pressure, obesity, and depression and contribute to ED. For example, obstructive sleep apnea causes temporary airway blockage that can cause you to wake up hundreds of times throughout the night. In a study of 100 men with obstructive sleep apnea, 47 men reported erectile dysfunction as well.¹⁶

Because poor sleep causes many of the physical and psychological conditions that contribute to ED, if you have one of the following conditions and ED, ask your doctor if they may be related.

• Snoring
• Obstructive sleep apnea
• Restless legs syndrome
• Insomnia
• Narcolepsy
• Nighttime pain
• Nighttime urination

12. Prostate Inflammation

About half of men with lower urinary tract symptoms, including prostate inflammation, have ED, and 10% have complete ED.¹⁷ Chronic prostate inflammation can cause painful ejaculation, which can cause ED. Medications used to treat prostate inflammation can also have sexual dysfunction as a side effect.

13. Prostate Cancer

As with prostate inflammation, prostate cancer and the medications used to treat the condition can increase your risk for ED and other sexual health conditions.

14. Sexually Transmitted Infections

Sexually transmitted infections (STI) can cause ED by causing urethral and prostate inflammation.

If you have an STI, seek treatment for yourself and your partner. This can reduce the spread of these infections and improve erectile function, overall sexual health, and fertility.

STIs associated with ED include:

• Chlamydia
• Gonorrhea
• Untreated human immunodeficiency virus (HIV)
• Hepatitis

15. Low Testosterone

In a subset of men, low testosterone may be the cause of ED. It may also be the link between depression and ED. If you have symptoms of low testosterone, such as decreased sex drive, ED, weight gain, and decreased energy, your doctor can determine whether low testosterone is the cause with a simple blood test. Testosterone replacement therapy can restore natural testosterone levels and improve your symptoms, including ED function.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References

1. Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. Mar 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bd

2. Capogrosso P, Colicchia M, Ventimiglia E, et al. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine. 2013/07/01/ 2013;10(7):1833-1841. doi:https://doi.org/10.1111/jsm.12179

3. Doherty K. Most men with erectile dysfunction don’t seem to get treatment. Medical Express. https://medicalxpress.com/news/2013-05-men-erectile-dysfunction-dont-treatment.html

4. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol. Jul 2006;176(1):217-21. doi:10.1016/s0022-5347(06)00589-1

5. Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. 5/ 2019;37(2):138-147.

6. Esposito K, Giugliano F, Di Palo C, et al. Effect of Lifestyle Changes on Erectile Dysfunction in Obese MenA Randomized Controlled Trial. JAMA. 2004;291(24):2978-2984. doi:10.1001/jama.291.24.2978

7. La J, Roberts NH, Yafi FA. Diet and Men’s Sexual Health. Sex Med Rev. Jan 2018;6(1):54-68. doi:10.1016/j.sxmr.2017.07.004

8. Selvin E, Burnett AL, Platz EA. Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine. 2007;120(2):151-157. doi:10.1016/j.amjmed.2006.06.010

9. La Vignera S, Condorelli R, Vicari E, D’Agata R, Calogero AE. Physical Activity and Erectile Dysfunction in Middle-Aged Men. https://doi.org/10.2164/jandrol.111.013649. Journal of Andrology. 2012/03/04 2012;33(2):154-161. doi:https://doi.org/10.2164/jandrol.111.013649

10. McMahon CG. Current diagnosis and management of erectile dysfunction. Med J Aust. Jun 2019;210(10):469-476. doi:10.5694/mja2.50167

11. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. Feb 2000;163(2):460-3.

12. McMahon CG. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia. 2019;210(10):469-476. doi:10.5694/mja2.50167

13. Rew KT, Heidelbaugh JJ. Erectile Dysfunction. Am Fam Physician. Nov 15 2016;94(10):820-827.

14. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosomatic medicine. 1998;60(4):458-465.

15. Makhlouf A, Kparker A, Niederberger CS. Depression and Erectile Dysfunction. Urologic Clinics of North America. 2007/11/01/ 2007;34(4):565-574. doi:https://doi.org/10.1016/j.ucl.2007.08.009

16. Gonçalves MA, Guilleminault C, Ramos E, Palha A, Paiva T. Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Medicine. 2005/07/01/ 2005;6(4):333-339. doi:https://doi.org/10.1016/j.sleep.2005.03.001

17. Braun MH, Sommer F, Haupt G, Mathers MJ, Reifenrath B, Engelmann UH. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “Aging Male” symptoms? Results of the “Cologne Male Survey”. Eur Urol. Nov 2003;44(5):588-94. doi:10.1016/s0302-2838(03)00358-0

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