The causes of erectile dysfunction fall into four groups: diseases that affect blood vessels, nerves or hormones; medicines; mental health and emotional issues; and lifestyle habits. Diabetes and heart and blood vessel disease are among the most common. Because erectile dysfunction (ED) can be an early sign of another health problem, it is worth having it assessed, not just treated.
What erectile dysfunction is
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes the symptoms as:
- getting an erection sometimes, but not every time you want to have sex;
- getting an erection that does not last long enough for sex;
- being unable to get an erection at any time.
Diseases and conditions that cause erectile dysfunction
The NIDDK lists the most common:
- Diabetes.
- Heart and blood vessel disease, including atherosclerosis, high blood pressure and stroke.
- Long-term conditions such as chronic kidney disease, obesity and chronic obstructive pulmonary disease.
- Hormone problems, such as low testosterone and thyroid imbalance.
- Nerve damage or disorders, such as multiple sclerosis, spinal cord injury and damage from pelvic surgery.
- Problems of the reproductive system, such as an enlarged prostate and Peyronie’s disease, a curvature of the penis.
Medicines that can cause erectile dysfunction
ED can be a side effect of many prescription and over-the-counter medicines. The NIDDK names:
- antidepressants;
- blood pressure medicines and diuretics;
- antihistamines;
- appetite suppressants;
- sedatives;
- ulcer medicines;
- some pain relievers;
- chemotherapy and hormone medicines.
Do not stop a prescribed medicine on your own. If you think one is affecting you, speak to the clinician who prescribed it.
Mental health and emotional causes
The NIDDK says these can cause ED or make it worse:
- anxiety, depression or stress;
- feeling isolated or lonely;
- low self-esteem, lack of confidence or a negative body image.
The American Urological Association (AUA) guideline says referral to a mental health professional should be considered for men with ED.
Lifestyle causes
The NIDDK lists four behaviors that may contribute:
- not getting enough physical activity;
- drinking too much alcohol;
- smoking;
- using recreational or illicit drugs.
Why the cause matters
The NIDDK puts it simply: ED “may be a symptom of another health problem.” The AUA goes further, saying men should be told that ED “is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment.”
For that reason the AUA guideline calls for a medical, sexual and psychosocial history, a physical examination and selected blood tests, including a morning testosterone level. Our guide to the symptoms of low testosterone explains how that test is interpreted.
Treatment depends on the cause
The AUA says men with ED should be told about the established options, with their benefits and risks: oral medicines known as PDE5 inhibitors, vacuum erection devices, alprostadil, penile injections and implant surgery. It also recommends lifestyle changes for men whose other health conditions affect erections.
Some newer treatments are marketed for ED with much less evidence behind them. See what the evidence says about the P-Shot and Bocox.
Frequently asked questions
What is the most common cause of erectile dysfunction?
The NIDDK lists diabetes and heart and blood vessel disease among the most common. Often more than one factor is involved.
Can stress alone cause erectile dysfunction?
Yes. The NIDDK says anxiety, depression and stress can cause ED or make it worse.
Can low testosterone cause it?
The NIDDK lists low testosterone among the hormone problems that can lead to ED. It is diagnosed with symptoms and morning blood tests.
Next step
If ED is affecting you, start with an assessment of the cause. You can read about testosterone replacement therapy at Beauté Medical Aesthetics, or book a consultation.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Erectile Dysfunction. Reviewed October 2024.
- American Urological Association. Erectile Dysfunction (ED) Guideline. 2018.
Double Board Certified Nurse Practitioner
Beauté Medical Aesthetics
