Dr Clare Morrison

Article by Dr Clare Morrison

What Are The Causes Of Erectile Dysfunction?

Erectile dysfunction can be a bit of a taboo topic.  Research into erectile dysfunction treatment options has been difficult as a result of this stigma, as without knowledge of symptoms, or the diseases and conditions that patients also suffer from, it’s very difficult to find correlation or links between them.

The stigma associated with erectile dysfunction has also made it harder to research the exact number of sufferers. The NHS estimates indicate that 50 percent of men between 40 and 70 years old will suffer from erectile dysfunction at least once during their lifetime, while another study in the Journal of Sexual Medicine, found the prevalence of erectile dysfunction across all age groups to be around 40 percent. While the accuracy of these studies can still be questioned on the basis of the hesitance of sufferers to admit to it, these figures do give an idea of just how widespread the problem potentially is.

Fortunately, studies and investigations over the years have shown that there are a number of different causes for erectile dysfunction, providing further insight into the condition. Erectile dysfunction causes can be divided into two different general categories; the largest category is physiological causes, but there are also a significant number of psychological causes. These causes disable specific, yet often different, functions of the penis or surrounding area; impacting bodily functions such as blood flow, transmission of neural signals or hormone production.

In this article, we’ll take a closer look at the major causes of erectile dysfunction, to better understand the condition in general, and gain a greater insight into the various avenues of treatment that are available to patients.

Physiological causes

As touched upon in the introduction to this article, a number of physiological problems can affect a man’s ability to maintain an erection. These include chronic health problems, and the side effects of the intake of different substances. In each case, the specific erectile dysfunction symptoms are caused by one of a few specific anatomical phenomena, such as impairment of blood circulation to the penis, nerve/neurological damage, and the inhibition of hormone production or transportation.

These include:


Hypertension, or high blood pressure, can negatively affect a man’s ability to maintain an erection in a number of different ways. Primarily, hypertension prevents arteries in and around the penis from acting as they normally would, effectively preventing a sufficient level of blood to flow into the penis and cause an erection. At the same time, hypertension also prevents muscles in the penis from relaxing when necessary, also contributing to erectile dysfunction.

Unfortunately, the medication taken by many of those who suffer from hypertension can also contribute to erectile dysfunction. Beta-blockers can impair nerve signals that are necessary for an erection, while blood thinners can reduce the force of blood flow to the penis, making an erection that much more difficult to achieve.


Atherosclerosis is a condition that essentially constricts arteries, limiting the amount of blood that is able to pass through at any one time. Given the essential role of arterial blood flow to the achievement and maintenance of an erection, it’s clear that Atherosclerosis and erectile dysfunction often go hand in hand.
One potential silver lining of this connection is that erectile dysfunction can act as an early warning sign of Atherosclerosis; allowing time for lifestyle changes and treatment that may allow for further development of the condition to be slowed.

High Cholesterol

In much the same manner as Atherosclerosis, having high cholesterol can have a negative effect on the development of erectile dysfunction, as this condition is also able to damage and impair the function of arteries that are essential to maintaining an erection.


Some estimations put the odds of men with diabetes suffering from erectile dysfunction at 35 to 75 percent. The increased risk of erectile dysfunction in men with diabetes is put down to damage done to the nerves, veins and arteries around and within the penis, which control the occurrence of erections. The problem with dealing with erectile dysfunction that is suspected to be linked to diabetes, is that drugs commonly used in erectile dysfunction treatment can have a dangerous effect when combined with heart medication frequently taken by diabetics. This makes erectile dysfunction that much harder to deal with in these instance, trapping some patients between two equally undesirable scenarios.

Multiple Sclerosis (MS)

Instances of erectile dysfunction are more common with sufferers of Multiple Sclerosis. The cause is primarily from the nerve damage, and nerve impulse interruption, that is commonplace in Multiple Sclerosis. This kind of nerve damage or interruption can make erections difficult to predict or maintain.

Hormonal imbalance

If the production or balance of hormones present in a man’s body is tampered with by a medical condition, or certain drugs, then erectile dysfunction can be a side effect. Low levels of testosterone can be caused by a number of pathological conditions, including an excess amount of stress, hypothyroidism or hypergonadism, and can result in an impaired ability to maintain an erection. Low testosterone can cause a domino effect that inhibits or diminishes the release of nitric oxide in the muscles of the penis, meaning that the muscles do not relax, and that the blood needed to cause an erection is unable to enter the penis in the first place.

Surgery or injury

A number of surgeries and injuries to the groin, nervous or circulatory systems can also cause erectile dysfunction. After all, if nerve signals, hormones and a sufficient amount of blood are unable to reach the penis at the right time, sexual function will be impaired. For example, the removal of a testicular tumour could unwittingly result in nerve and muscle damage to the penis, making an erection that much harder to achieve.

Anatomical problems

On top of the pathological conditions and surgical side effects listed above, certain anatomical problems can have a negative impact on erectile function, some of which are genetic, while others are just a symptom of growing older. Prostate enlargement, for example, is commonly associated with hormonal changes in ageing men, can restrict blood flow, and therefore a man’s ability to maintain an erection, through pressure exerted by the enlarged prostate on the pelvic area.

Another common cause of erectile dysfunction in all age groups are venous leaks, a condition that amounts to tissue in the penis having difficulty in retaining blood, leading to short lived or ineffective erections in sufferers.

Some research has also shown links between erectile dysfunction and other physiologically distant pathological conditions. One study has linked erectile dysfunction with chronic periodontitis, which is an inflammation of the tissue surrounding the teeth, though the specific cause for this connection is currently unknown.

Drug induced

The most common substances associated with the promotion of erectile dysfunction are nicotine and alcohol, though they are far from the only ones to have such an effect. Indeed, the side effects of many prescription medications can also directly or indirectly result in difficulty maintaining an erection; there may be more than 200 types of prescription medication that could cause erectile dysfunction as a side-effect, depending on the metabolism and physiology of the patient in question.

The specific way in which these substances inhibit a man’s ability to maintain an erection varies. Excessive nicotine consumption/smoking contributes to arterial narrowing, while long-term alcohol consumption can instead result in widespread nervous system damage and hormone imbalances as a result of liver damage and testicular shrinkage. Many varieties of antidepressant have also been known to have a negative effect on the sex drive of users, either directly, or through a patient’s reaction to other side effects, such as nausea and excessive fatigue.


As well as having a negative psychological effect on the men who suffer from it, there are also many purely psychological causes for erectile dysfunction. One of the more unfortunate aspects of this crossover is that cause can feed directly into effect and vice versa. At the same time, the nature of the erectile dysfunction causes detailed below means that they can often be solved through non-medical means, whether through therapy, the use of placebos, or a simple change of environment or circumstances.


General stress can have a negative effect on the ability of a man to maintain an erection, regardless of whether the specific cause of these feelings is personal or professional. The annoyance for many sufferers of this particular cause of erectile dysfunction is that the effects can be so transient – stress levels tend to fluctuate over time in many people, so the problem can come and go. For the men unfortunate enough to suffer from chronic stress, erectile dysfunction can occur at any time.


Any form of anxiety can have a negative impact on man’s ability to perform sexually. Fear or performance anxiety are the most likely to occur in this instance. The kind of stress associated with anxiety often causes the constriction of blood vessels, which has an obvious negative effect on a man’s ability to maintain an erection. The problem with erectile dysfunction and sexual performance anxiety is that they can often become self-fulfilling prophecies – those that have suffered from one occurrence may fear the next, and the anxiety caused by this fear may directly lead to erectile dysfunction itself. In the same way, guilt caused by a perceived inability to fulfil a sexual partner may also directly lead to difficulty in maintaining an erection, further exacerbating an already embarrassing and stressful scenario.


Depression is another psychological condition that can result in erectile dysfunction in men, and in the same way as the other psychological conditions on this list, the severity of erectile dysfunction, or the presence of it all together, will generally fluctuate with the severity of a depressive episode.

However, one of the more insidious aspects of erectile dysfunction caused by depression is that, as mentioned above, some antidepressant medications can also cause or contribute to erectile dysfunction, making the whole situation a bit of a catch 22 for those suffering from depression. Some drugs and remedies for depression have less of an association with erectile dysfunction, so it’s definitely worth a conversation with your GP if you suspect that your current medication is having a negative effect on your sex life.

Relationship issues

Low self-esteem and confidence can affect a man’s ability to perform sexually, as can insecurities to do with said man’s choice of sexual partner. It’s also common for older men to feel a growing indifference to sex as they advance with age; the comparative drop in sexual arousal and thoughts makes achieving and maintaining an erection that much more difficult. As with any form of emotional distress, arguments and fights with partners can result in heightened stress and anxiety, potentially leading to associated problems like erectile dysfunction.


Erectile Dysfunction Treatment  

Dr Clare Morrison
Dr Clare Morrison
Experienced General Practitioner in Hampshire since 1995, with particular interest in Nutrition, Obesity and Smoking Cessation.
Originally published January 07 2015, updated July 08 2019