Causes of Erectile Dysfunction

Erectile dysfunction (ED) can be caused by physical problems, psychological factors, lifestyle habits, some medicines, or a mix of these. The most common physical causes affect blood flow, nerves or hormones, and ED is often the first sign of a condition such as heart disease, diabetes, high blood pressure or high cholesterol.

This article is general information, not medical advice. Outcomes vary between individuals. If you have ongoing erection problems, an Australian-registered practitioner can help work out the cause.

On this page

1. What is erectile dysfunction?
2. What causes erectile dysfunction?
3. Physical causes of erectile dysfunction
4. Psychological causes of erectile dysfunction
5. Lifestyle factors and medicines that can cause ED
6. Why ED can be an early warning sign of heart disease
7. Does erectile dysfunction get more common with age?
8. When should you see a practitioner about ED?
9. Treatment options a practitioner may consider
10. Frequently Asked Questions

What is erectile dysfunction?

Erectile dysfunction means not being able to get or keep an erection firm enough for sexual activity. It is also known as impotence, an older name for the same condition.

Symptoms of erectile dysfunction include difficulty:

• getting an erection

• keeping an erection

• having sexual intercourse, because the penis is not hard enough

• erections that are not as hard as they used to be

Erectile dysfunction does not include problems with ejaculation, fertility or libido. If your concern is about finishing too soon, read our guide to premature ejaculation instead.

What causes erectile dysfunction?

Erectile dysfunction has a range of causes, which can be physical, psychological or a combination of both. Sometimes it only happens in certain situations, and the cause is not always clear.

An erection depends on changes in blood flow within the penis in response to nerve signals. Anything that interferes with the blood vessels or the nerves can cause erectile dysfunction. That is why the causes below span the heart, the nervous system, hormones, mental health and daily habits.

ED is common. Healthdirect reports that more than 1 in 10 males cannot have erections, and that the problem becomes more common with age.

Physical causes of erectile dysfunction

Heart and blood vessel problems

Reduced blood flow to the penis is a major physical cause of ED. Atherosclerosis (clogging of the arteries), high blood pressure, high cholesterol and cardiovascular disease are all conditions that cause or contribute to erectile dysfunction. Healthy Male notes that the same mechanisms that control blood flow in the penis control blood flow throughout the body, which is why ED is often a sign of cardiovascular disease.

Diabetes and nerve conditions

Health problems that affect the nerves can cause ED, including spinal cord injury, Parkinson's disease and Alzheimer's disease. Diabetes is one of the chronic conditions that contribute to erectile dysfunction. Healthy Male reports that a man with diabetes is more than twice as likely to have erectile dysfunction as a man without it.

Hormone problems

Hypogonadism, where the testicles cannot make enough testosterone, is one cause of erectile dysfunction, and low testosterone levels in general are a contributing factor. Other hormonal problems that can cause ED include an underactive thyroid (hypothyroidism), growth hormone conditions and having too much cortisol. A practitioner may suggest a blood test if a hormone problem is a possibility. Burst Health offers a testosterone test that can be arranged online.

Prostate disease and its treatment

Prostate disease, and treatments for prostate cancer or an enlarged prostate, are among the problems with the male reproductive system that can cause erectile dysfunction (healthdirect). Healthy Male reports that prostate cancer treatment increases the likelihood of erectile dysfunction considerably, with 85% of men who have had prostate cancer experiencing ED.

Peyronie's disease

Peyronie's disease is scar tissue inside the penis that results in a curved penis, and it is a recognised cause of erectile dysfunction. Healthy Male describes it as a disorder of the connective tissue around the erectile tissue, which causes a curve or bend when the penis is erect. It occurs in around 3% of men and becomes more common with age. It commonly results in problems having intercourse.

Other health conditions

Obesity or metabolic syndrome and sleep disorders are also among the chronic health conditions that can contribute to erectile dysfunction. If weight is part of the picture, our guide on how to lose weight explains a realistic approach.

Psychological causes of erectile dysfunction

Anxiety and stress

Anxiety about sexual performance is a recognised psychological cause of ED. Performance anxiety is most common at the start of a new relationship, especially after previous problems with sexual performance. Stress is a cause in its own right.

Depression and other mental health conditions

Mental health conditions such as depression or anxiety can cause erectile dysfunction. Some medicines used to treat depression can also affect erections, which is covered in the medicines section below.

Relationship problems

Unresolved problems, conflicts or issues within a sexual and emotional relationship are a psychological cause of ED. Healthy Male adds that erectile dysfunction affects both people in a relationship, and that a psychologist or sexual health therapist can help both partners when ED is putting strain on the relationship.

Pornography and erectile dysfunction

A psychosexual therapist writing for Healthy Male suggests thinking of pornography like alcohol: for most people, occasional use is not a cause for concern, but it can be used as a coping mechanism or lead to addiction. Pornography use can contribute to problems with sexual function, including erectile dysfunction or delayed ejaculation. The problems described include performance anxiety from comparing oneself to unrealistic scenes, and needing more stimulation to become aroused than a partner provides.

Lifestyle factors and medicines that can cause ED

Smoking, alcohol and other substances

Alcohol, smoking and substance abuse are physical factors that can cause erectile dysfunction. Healthy Male lists smoking and alcohol use among the health problems that increase the risk of ED, and some recreational drugs, including nicotine, as contributing factors. Stopping smoking is one of the measures that may prevent some causes of erectile dysfunction.

Medicines that can cause erectile dysfunction

Some medicines used to treat high blood pressure, high cholesterol, depression or prostate cancer can cause erectile dysfunction. If you think a medicine is affecting your erections, raise it with the doctor who manages that condition rather than stopping the medicine on your own.

Lack of physical activity and excess weight

Healthdirect says there is evidence that some causes of erectile dysfunction can be prevented if you stop smoking, increase exercise, lose weight and eat healthy food. Healthy Male notes that ED is much less common in men who are healthy than in men who have a chronic disease, are overweight, smoke or do not exercise.

Why ED can be an early warning sign of heart disease

Erectile dysfunction is often the first sign of a medical problem such as cardiovascular disease, diabetes, high blood pressure or high cholesterol. Healthy Male describes ED as an early warning sign of serious disease that requires a full investigation to find the cause, and reports that men with erectile dysfunction are at higher risk than normal of coronary heart disease and stroke.

This is the main reason ongoing erection problems should not be ignored. Healthy Male points out that ignoring ED can mean missing an opportunity to prevent more severe disease. Diagnosing and treating these conditions early can help identify the causes of ED, and reduce the chance of complications from the conditions themselves.

Does erectile dysfunction get more common with age?

Yes. Healthy Male reports that more than half of Australian men over 50 have some form of erectile dysfunction, while under 40 the figure is up to 10% of men. The higher rates in older men are usually due to other health conditions or medicines, rather than ageing itself. In other words, age raises the odds of the causes above, but ED is not simply a part of getting older.

When should you see a practitioner about ED?

Many people have erection problems from time to time. Occasional problems may not need medical help, but if the problems continue, or you have any concerns, you should see a doctor.

To work out the cause, a doctor will ask about your sexual history, general health, relationships and your psychological relationship with sex. They will do a physical examination, and they may refer you for blood tests or imaging scans, or to a specialist such as a urologist.

Burst Health connects you with an Australian-registered doctor or nurse practitioner who assesses your answers and decides whether treatment is suitable for you. You can check whether you are eligible for an online ED assessment .

Finding the cause starts with a proper review, and Burst Health provides erectile dysfunction treatment online after an Australian-registered doctor or nurse practitioner has assessed your health, so check whether you are eligible.

Treatment options a practitioner may consider

Treatment follows the cause. A doctor will first treat any underlying condition that may be causing ED, and may recommend lifestyle changes such as eating a healthy diet and exercising regularly. Therapy, such as cognitive behavioural therapy or sex therapy, may be suggested where psychological factors are involved. Medical treatment options may be considered after assessment, and more than one treatment may be needed. Our guide to the symptoms, causes and treatments of erectile dysfunction covers this in more depth.

Frequently Asked Questions

What are the symptoms of erectile dysfunction?

The symptoms are difficulty getting an erection, difficulty keeping an erection, and problems having sexual intercourse because the penis is not hard enough. Erections that are not as hard as they used to be are another sign. Problems with ejaculation, fertility or sex drive are different conditions and are not part of erectile dysfunction.

What causes weak erections in men?

Weak erections usually come from something interfering with blood flow or nerve signals in the penis. Common causes include high blood pressure, clogged arteries, diabetes, low testosterone, smoking, alcohol, some medicines, and psychological factors such as anxiety, stress or depression. A doctor can check which of these applies to you, and whether more than one is involved.

Does erectile dysfunction go away?

Sometimes. Many people have erection problems from time to time, and ED can come and go. Healthy Male says you might be able to get back to normal erectile function by taking better care of yourself, with a healthy diet, regular exercise and less drinking and smoking. Where a health condition is the cause, a doctor treats that condition first, so ongoing problems are worth a medical check.

What can I do about erectile dysfunction?

The first step is to see a doctor, because ED is often the first sign of heart disease, diabetes or high blood pressure. Changes that may prevent some causes are stopping smoking, exercising more, losing weight and eating healthy food. A practitioner can then discuss therapy, treatment of an underlying condition or medical treatment options, depending on the cause.

How can a partner help a man with erectile dysfunction?

Healthy Male suggests picking a moment that is not in the bedroom, keeping the conversation about the two of you rather than blame, and encouraging a visit to the GP, with an offer to go along. It advises against pressure to sort it out straight away, and reminds couples that intimacy without penetrative sex is still intimacy. A psychologist or sexual health therapist can help both partners.

References

• healthdirect (Healthdirect Australia). Erectile dysfunction - symptoms and treatment.

• Healthy Male (Andrology Australia). Erectile dysfunction: Causes, diagnosis & treatment.

• Healthy Male (Andrology Australia). Peyronie's Disease: Bent penis causes & treatment.

• Healthy Male (Andrology Australia). Cit Carney. Could what turns you on be turning you off? How porn misuse can impact your sexual performance.

This article is general information only and does not replace individual medical advice. Please speak with a registered Australian healthcare practitioner about your own circumstances.