Table of ContentsView AllTable of ContentsCommon CausesDiseases and ConditionsLifestyle FactorsFrequently Asked QuestionsNext in Erectile Dysfunction GuideWhat Is Erectile Dysfunction?
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Table of Contents
Common Causes
Diseases and Conditions
Lifestyle Factors
Frequently Asked Questions
Next in Erectile Dysfunction Guide
When looking at the potential causes oferectile dysfunction, it’s important to understand that more than one factor is often involved. As the American Urological Association puts it, “erectile function is the result of a complex interplay between vascular, neurologic, hormonal, and psychologic factors.”
Keep this in mind as you read through the wide-ranging list of causes and risk factors for ED, which includes medications, health conditions, injury, smoking, and more.
Verywell / Joshua Seong
Only a healthcare provider can confirm the cause of your erectile dysfunction. Often, an underlying disease or condition is to blame (see below). But one or more of the following issues may also be at play.
Age
The good news: ED and other sexual problems don’t appear to be inevitable. Often the reason an older man begins having these issues is that he is also dealing with a chronic condition that increases the risk of ED, or because he engages in controllable lifestyle habits that put him at higher risk.
Medications and Treatments
Certain medications can interfere with nerve impulses or blood flow to the penis. According to areportfrom the Harvard Medical School, about 25% of men dealing with erectile dysfunction are having problems because of a medication they take. In fact, ED is one of the main reasons some men stop taking medication for conditions such ashigh blood pressureanddepression.
The list of drugs associated with impotence is long, and some medications are more likely to cause ED than others. If a drug you’re taking isn’t on the list that follows, but you’re grappling with impotence, check with your healthcare provider.
Medications and other treatments that increase the risk of impotence include:
Stress and Anxiety
Sometimes a man will experience anxiety about sexual performance that inhibits his ability to get an erection, possibly because of a bad sexual experience or a previous occurrence of ED. Similarly, if a man and his partner are experiencing trouble in their relationship, the emotional and mental stress can take a toll on sexual function.
Surgery
Any surgery that involves structures in the pelvic area can damage penile nerves, blood vessels, or both, which in turn can affect a man’s ability to get an erection or maintain one.
One common procedure associated with ED issurgery to treat prostate cancer, which makes sense given how close the prostate is located to the penis and important nerves.
Another type of surgery that sometimes increases the risk of impotence isbowel resectionfor treating colorectal cancer, in which a portion of the large intestine (colon) is surgically removed along with the tumor. Certain variations of this procedure are most likely to cause ED:
Injury
An injury to the nerves, arteries, or veins of the pelvis has the potential to cause sexual problems. Men with spinal cord injuries have increased rates of erectile and ejaculatory problems, for example.
Erectile dysfunction rarely occurs in isolation. It is often a result of another health concern.
Diabetes and Heart Disease
ED is common among men with bothtype 1 diabetesand type 2 diabetes.
The longer a man has had diabetes, the more likely it is that he’ll develop ED, especially if his blood glucose levels have not been well controlled.Complications of accompanying conditions such as high blood pressure and high cholesterol can also play a role in impotence. A man with diabetes who also smokes increases his risk of developing ED.
Heart disease and diabetes are often linked together, becausecoronary arterydamage is a complication of diabetes as well. Coronary artery disease can also affect sexual function on its own, but erectile dysfunction is nine times as likely in men who suffer from bothcoronary artery diseaseand diabetes than in men who have diabetes alone.
Erectile dysfunction is so prevalent in both coronary artery disease and diabetes that it could be considered arisk factor, or an early marker, for both. A man with new ED without evident risk factors for it should have a baseline heart work-up.
Diabetic Erectile Dysfunction Reversal
Hypertension
Given that an erection depends on adequate blood flow to the penis, it’s easy to see how any condition or medical problem affecting the heart and other structures in the cardiovascular system might have an impact on erectile function. This is particularly true forhigh blood pressure(hypertension).
Although scientists don’t understand exactly how this condition can lead to ED, one theory is that high arterial pressure in the small vessels of the penis may cause microscopic tears to the vessel walls. In the process of repairing these tears, the arteries become thicker and less able to supply needed blood to the spongy erectile tissues of the penis.
Other potential factors in hypertension that may play a role in ED:
Psychological Conditions
A number of psychological concerns are associated with sexual function problems in men. Depression, anxiety, post-traumatic stress disorder, and even issues with anger have all been related to problems with desire, erectile function, and ejaculation.
Other Concerns
There are a number of otherconditionsand diseases that can impact sexual function in men, leading to problems such as ED. Among these are:
Lifestyle Factors
Among the many potential causes of erectile dysfunction are quite a few that can be eliminated altogether.
Recreational Drugs
Over time, illegal and recreational drugs can cause serious damage to blood vessels, resulting in sometimes permanent erectile dysfunction.These include:
Bicycle Riding
When biking, a significant amount of a man’s weight rests on the perineum—the area of the body where the nerves and blood vessels of the penis pass—potentially causing injury to these structures. However, although riding has been associated with related erectile dysfunction, this form of exercise is more likely to be healthy than harmful for most men.
For one thing, most studies that have found a link between bicycle riding and ED have focused on men who spend long hours astride a bike,such as policemen who spend as many as 24 hours a week riding, and those who do long bike tours as amateurs or professionals.
According to theMassachusetts Male Aging Study (MMAS), a survey of more than 1,700 men between the ages of 40 and 70, “at least three hours of cycling per week were more likely to cause artery blockage and long-term damage.” That’s more riding than the average person tends to clock, but the results are something to think about if you ride for longer.
It’s worth noting that the MMSA also revealed that men who biked for three or fewer hours per week had a lower risk of developing ED, indicating bike riding as a form of moderate exercise might helppreventerectile dysfunction.
Your bike seat may matter as well. There are saddles that have a hole or groove down the middle where the perineum would otherwise rest, but a significant part of this area still lies under the weight of the body when using them.Researchhas found that “no-nose” seats, which have a wider rear for the sitting bones to rest on, may help prevent damage, perineal numbness, and problems with erectile function.
Masturbation Doesn’t Cause Erectile Dysfunction, But Is There a Link?
Causes or contributors to erectile dysfunction (ED) include:AgingDiabetesCertain medicationsPenile traumaSpinal cord injuryNeurogenic causes (such asdiabetic neuropathy)Penile micro-trauma or scarring (such asPeyronie’s disease)Cardiovascular disease (including hypertension)Psychological causes (including stress and depression)Surgery (including radical prostate and bladder surgery)Low testosteroneSmoking
Causes or contributors to erectile dysfunction (ED) include:
Age is a key risk factor: ED is four times more common in men over 60 than those over 40. Diabetic men are also at increased risk, with anywhere from 30% to 95% experiencing some degree of ED. Similarly, smokers are 1.5 times more likely to develop ED due to the progressive narrowing (stenosis) of the arteries.
Psychological factors are involved in up to 30% of all cases of ED. It’s often a catch-22 situation in which stress, anxiety, or depression not only interfere with the ability to achieve an erection, but the failure to achieve an erection leads to stress, anxiety, or depression. In cases like these, therapy may be needed.
Some researchers have theorized that aporn addiction can fuel unrealistic expectations about sex, which then triggers performance anxiety in real-life situations. The theory remains highly controversial. A 2015 review of studies in theJournal of Sexual Medicinecould find little evidence of an association between porn use and male sexual performance problems.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scranton RE, Goldstein I, Stecher VJ.Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. J Sex Med. 2013;10(2):551-61. doi:10.1111/j.1743-6109.2012.02998.xZippe C, Nandipati K, Agarwal A, Raina R.Sexual dysfunction after pelvic surgery. Int J Impot Res. 2006;18(1):1-18. doi:10.1038/sj.ijir.3901353Hess MJ, Hough S.Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35(4):211-8. doi:10.1179/2045772312Y.0000000025Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455American Urological Association.Erectile Dysfunction: AUA Guideline.Blood Pressure UK.Erectile dysfunction and high blood pressure.Guo D, Li S, Behr B, Eisenberg ML.Hypertension and male fertility.World J Mens Health. 2017;35(2):59-64. doi:10.5534/wjmh.2017.35.2.59Nunes KP, Labazi H, Webb RC.New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bdClavijo RI, Miner MM, Rajfer J.Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?Rev Urol. 2014;16(4):167-71.Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S.Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med. 2019;8(4)Correction to Lancet Diabetes Endocrinol 2019; published online March 1. doi:10.1016/ S2213-8587(19)30066-X. Lancet Diabetes Endocrinol. 2019;7(5):e5. doi:10.1016/j.jsxm.2017.03.129Shridharani AN, Brant WO.The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016;5(1):88-101. doi:10.3978/j.issn.2223-4683.2016.01.07Cleveland Clinic.Erectile dysfunction.Boston University School of Medicine. Sexual Medicine.Erectile dysfunction and bicycling.Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3Kupelian V, Hall SA, McKinlay JB.Common prescription medication use and erectile dysfunction: results from the BACH survey: association of prescription medication use with ED.BJU Int. 2013;112(8):1178-87. doi:10.1111/bju.12231DeLay KJ, Haney N, Hellstrom WJ.Modifying risk factors in the management of erectile dysfunction: a review.World J Mens Health.2016;34(2):89. doi:10.5534/wjmh.2016.34.2.89Nguyen HMT, Gabrielson AT, Hellstrom WJG.Erectile dysfunction in young men—a review of the prevalence and risk factors.Sex Med Rev. 2017;5(4):508-20. doi:10.1016/j.sxmr.2017.05.004Landripet I, Štulhofer A.Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?J Sex Med. 2015;12(5):1136-9. doi:10.1111/jsm.12853
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scranton RE, Goldstein I, Stecher VJ.Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. J Sex Med. 2013;10(2):551-61. doi:10.1111/j.1743-6109.2012.02998.xZippe C, Nandipati K, Agarwal A, Raina R.Sexual dysfunction after pelvic surgery. Int J Impot Res. 2006;18(1):1-18. doi:10.1038/sj.ijir.3901353Hess MJ, Hough S.Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35(4):211-8. doi:10.1179/2045772312Y.0000000025Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455American Urological Association.Erectile Dysfunction: AUA Guideline.Blood Pressure UK.Erectile dysfunction and high blood pressure.Guo D, Li S, Behr B, Eisenberg ML.Hypertension and male fertility.World J Mens Health. 2017;35(2):59-64. doi:10.5534/wjmh.2017.35.2.59Nunes KP, Labazi H, Webb RC.New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bdClavijo RI, Miner MM, Rajfer J.Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?Rev Urol. 2014;16(4):167-71.Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S.Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med. 2019;8(4)Correction to Lancet Diabetes Endocrinol 2019; published online March 1. doi:10.1016/ S2213-8587(19)30066-X. Lancet Diabetes Endocrinol. 2019;7(5):e5. doi:10.1016/j.jsxm.2017.03.129Shridharani AN, Brant WO.The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016;5(1):88-101. doi:10.3978/j.issn.2223-4683.2016.01.07Cleveland Clinic.Erectile dysfunction.Boston University School of Medicine. Sexual Medicine.Erectile dysfunction and bicycling.Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3Kupelian V, Hall SA, McKinlay JB.Common prescription medication use and erectile dysfunction: results from the BACH survey: association of prescription medication use with ED.BJU Int. 2013;112(8):1178-87. doi:10.1111/bju.12231DeLay KJ, Haney N, Hellstrom WJ.Modifying risk factors in the management of erectile dysfunction: a review.World J Mens Health.2016;34(2):89. doi:10.5534/wjmh.2016.34.2.89Nguyen HMT, Gabrielson AT, Hellstrom WJG.Erectile dysfunction in young men—a review of the prevalence and risk factors.Sex Med Rev. 2017;5(4):508-20. doi:10.1016/j.sxmr.2017.05.004Landripet I, Štulhofer A.Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?J Sex Med. 2015;12(5):1136-9. doi:10.1111/jsm.12853
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Scranton RE, Goldstein I, Stecher VJ.Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. J Sex Med. 2013;10(2):551-61. doi:10.1111/j.1743-6109.2012.02998.xZippe C, Nandipati K, Agarwal A, Raina R.Sexual dysfunction after pelvic surgery. Int J Impot Res. 2006;18(1):1-18. doi:10.1038/sj.ijir.3901353Hess MJ, Hough S.Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35(4):211-8. doi:10.1179/2045772312Y.0000000025Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455American Urological Association.Erectile Dysfunction: AUA Guideline.Blood Pressure UK.Erectile dysfunction and high blood pressure.Guo D, Li S, Behr B, Eisenberg ML.Hypertension and male fertility.World J Mens Health. 2017;35(2):59-64. doi:10.5534/wjmh.2017.35.2.59Nunes KP, Labazi H, Webb RC.New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bdClavijo RI, Miner MM, Rajfer J.Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?Rev Urol. 2014;16(4):167-71.Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S.Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med. 2019;8(4)Correction to Lancet Diabetes Endocrinol 2019; published online March 1. doi:10.1016/ S2213-8587(19)30066-X. Lancet Diabetes Endocrinol. 2019;7(5):e5. doi:10.1016/j.jsxm.2017.03.129Shridharani AN, Brant WO.The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016;5(1):88-101. doi:10.3978/j.issn.2223-4683.2016.01.07Cleveland Clinic.Erectile dysfunction.Boston University School of Medicine. Sexual Medicine.Erectile dysfunction and bicycling.Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3Kupelian V, Hall SA, McKinlay JB.Common prescription medication use and erectile dysfunction: results from the BACH survey: association of prescription medication use with ED.BJU Int. 2013;112(8):1178-87. doi:10.1111/bju.12231DeLay KJ, Haney N, Hellstrom WJ.Modifying risk factors in the management of erectile dysfunction: a review.World J Mens Health.2016;34(2):89. doi:10.5534/wjmh.2016.34.2.89Nguyen HMT, Gabrielson AT, Hellstrom WJG.Erectile dysfunction in young men—a review of the prevalence and risk factors.Sex Med Rev. 2017;5(4):508-20. doi:10.1016/j.sxmr.2017.05.004Landripet I, Štulhofer A.Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?J Sex Med. 2015;12(5):1136-9. doi:10.1111/jsm.12853
Scranton RE, Goldstein I, Stecher VJ.Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. J Sex Med. 2013;10(2):551-61. doi:10.1111/j.1743-6109.2012.02998.x
Zippe C, Nandipati K, Agarwal A, Raina R.Sexual dysfunction after pelvic surgery. Int J Impot Res. 2006;18(1):1-18. doi:10.1038/sj.ijir.3901353
Hess MJ, Hough S.Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35(4):211-8. doi:10.1179/2045772312Y.0000000025
Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455
American Urological Association.Erectile Dysfunction: AUA Guideline.
Blood Pressure UK.Erectile dysfunction and high blood pressure.
Guo D, Li S, Behr B, Eisenberg ML.Hypertension and male fertility.World J Mens Health. 2017;35(2):59-64. doi:10.5534/wjmh.2017.35.2.59
Nunes KP, Labazi H, Webb RC.New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bd
Clavijo RI, Miner MM, Rajfer J.Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?Rev Urol. 2014;16(4):167-71.
Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S.Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med. 2019;8(4)
Correction to Lancet Diabetes Endocrinol 2019; published online March 1. doi:10.1016/ S2213-8587(19)30066-X. Lancet Diabetes Endocrinol. 2019;7(5):e5. doi:10.1016/j.jsxm.2017.03.129
Shridharani AN, Brant WO.The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016;5(1):88-101. doi:10.3978/j.issn.2223-4683.2016.01.07
Cleveland Clinic.Erectile dysfunction.
Boston University School of Medicine. Sexual Medicine.Erectile dysfunction and bicycling.
Yafi FA, Jenkins L, Albersen M, et al.Erectile dysfunction.Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3
Kupelian V, Hall SA, McKinlay JB.Common prescription medication use and erectile dysfunction: results from the BACH survey: association of prescription medication use with ED.BJU Int. 2013;112(8):1178-87. doi:10.1111/bju.12231
DeLay KJ, Haney N, Hellstrom WJ.Modifying risk factors in the management of erectile dysfunction: a review.World J Mens Health.2016;34(2):89. doi:10.5534/wjmh.2016.34.2.89
Nguyen HMT, Gabrielson AT, Hellstrom WJG.Erectile dysfunction in young men—a review of the prevalence and risk factors.Sex Med Rev. 2017;5(4):508-20. doi:10.1016/j.sxmr.2017.05.004
Landripet I, Štulhofer A.Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?J Sex Med. 2015;12(5):1136-9. doi:10.1111/jsm.12853
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