What causes erectile dysfunction
Erectile dysfunction is a symptom. Something is causing it — and in most men it is more than one thing at once. Working out what, rather than reaching straight for a prescription, is what turns a sexual problem into useful health information.
- Causes covered
- 15
- Categories
- 8
- Cardiac warning
- 3–5 yr
- Often multifactorial
- Most
Of everything here, the cardiovascular link is the one that changes outcomes.
Erectile dysfunction is an independent predictor of heart attack and stroke, and it typically appears three to five years beforehand. If you read one page in this section, read that one.
ED and cardiovascular diseaseMost cases have more than one cause
The old split between 'psychological' and 'physical' ED has largely been abandoned. A minor vascular problem causes one bad night; the anxiety that follows becomes a second, independent problem. Treating only one of them usually disappoints.
Vascular
Metabolic
Diabetes
High glucose damages both the small blood vessels and the autonomic nerves that trigger an erection, and lowers testosterone alongside.
Read →Obesity
Adipose tissue converts testosterone to oestrogen, drives inflammation and insulin resistance, and impairs the endothelium.
Read →Sleep apnoea
Repeated overnight oxygen dips damage the endothelium and disrupt the nocturnal testosterone surge.
Read →Kidney & liver disease
Organ failure disrupts hormone balance, damages blood vessels and nerves, and brings a medication list that adds further problems.
Read →
Hormonal
Low testosterone
Testosterone maintains libido and supports the nitric oxide machinery in erectile tissue; deficiency reduces desire more than it reduces blood flow.
Read →Thyroid & prolactin
Thyroid hormone sets the metabolic rate of every tissue; prolactin suppresses the hormonal axis that produces testosterone.
Read →
Psychological
Performance anxiety
Anxiety activates the sympathetic nervous system, which constricts penile arteries — the exact opposite of what an erection requires.
Read →Depression & stress
Depression reduces central sexual drive and dopaminergic signalling; chronic stress raises cortisol and sympathetic tone.
Read →
Medication-related
Lifestyle
Structural & surgical
Prostate treatment
Surgery and radiation injure the cavernous nerves running alongside the prostate; hormone therapy removes the testosterone that drives desire.
Read →Peyronie's disease
Fibrous plaque forms in the tunica albuginea, preventing that part of the penis from expanding evenly during erection.
Read →
Neurological
Symptoms that need prompt attention
Erectile dysfunction itself is not an emergency. These are.
An erection lasting more than four hours
Go to an emergency department.
Chest pain, pressure or breathlessness during sex
Call emergency services, and tell them if you have taken an ED medication.
Sudden loss of vision or hearing
After taking an ED medication — seek care the same day.
Rapidly developing penile curvature or pain
See a urologist promptly; treatment options narrow over time.
Sudden, complete loss of erections in a young man
Warrants assessment rather than waiting it out.