The Top 11 Causes of Erectile Dysfunction (ED)

One of the most frequent questions people have when they experience any form of erectile dysfunction (ED) is: “Why is this happening to me?” And the next question is: “How can I fix it?” 

There are many reasons why ED happens. And the good news is there are treatments that can help with your symptoms.

What is erectile dysfunction?

Erectile dysfunction, commonly referred to as ED, is the inability to reach or maintain an erection needed for satisfying sexual performance. If it has ever happened to you, you’re not alone: Up to 50 million men have ED in the U.S. 

Although ED can affect anyone after puberty, it’s most common in people over 40 years old. And it becomes even more likely each decade after that.

11 erectile dysfunction causes

Here, we’ll go over the top causes of ED. Read on to learn more.

1. Age

Just like with many health conditions, ED becomes more common as you age. If you’re in your 40s, you have a 40% chance of experiencing some form of ED. This risk goes up about 10% with every decade of life.

EXPERT PICKS: WHAT TO READ NEXT

• Is your medication causing erectile dysfunction (ED)? Learn more about which medications can lead to ED. 

• Alcohol and ED: Here’s why alcohol is a risk factor for ED in both the short and long term.

• Living with ED: People who have ED share tips for managing ED. Medication is just part of their strategy.

2. High body fat

Carrying extra weight, especially around the waist, can cause ED. It does this by raising your risk for high cholesterol, high blood pressure, and Type 2 diabetes. Having high body fat also lowers your testosterone level. And this can impact your sex drive and ability to maintain an erection. 

If you think high body fat may be causing your ED, connect with your healthcare team. They can help you understand how body fat may be playing a role in your ED and recommend treatment options. They may suggest changes to your physical activity and diet as well as medications. 

3. Diabetes

ED is one of the complications that you may have with diabetes. Because diabetes can damage the blood vessels in the body, this can lead to decreased blood flow for erections too. The longer you have diabetes, the more likely you are to experience ED.

ED caused by diabetes isn’t always a reversible problem. But by keeping your blood sugar levels in the normal range, you can decrease your risk for ED. 

4. Heart disease, high blood pressure, and high cholesterol

Experts are now understanding more about how ED and heart health are linked. Conditions like high blood pressure and high cholesterol can cause ED. Research has shown that some people with ED are often diagnosed with heart disease less than 5 years later. 

If you’re experiencing ED and have had no other health issues, you may want a healthcare professional to take a look at your heart. You might be able to prevent the development of heart disease by catching the warning signs early.

5. Smoking

Smoking and other tobacco use is connected to many health problems, including ED. The use of tobacco decreases blood flow throughout your entire body. This includes the blood vessels in the penis. If the blood supply is decreased there, it becomes much more difficult for you to achieve and maintain an erection. 

The effects of smoking may be reversible though. If you stop smoking, you’ll likely notice that your erections improve. Quitting smoking can be hard, but it’s never too late to try. Even if you’ve tried quitting before, help is always on hand. 

6. Medication side effects

Medication side effects cause at least 1 in 4 cases of ED. Many different medications can contribute to ED, including: 

• Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)

• Blood pressure medications, especially thiazide diuretics, beta blockers, loop diuretics, and spironolactone

• Antihistamines

• Acid reflux medications

• Opioid pain medications

This isn’t a complete list. If you’re having difficulty with erections and recently started a new medication, ask your pharmacist or primary care provider if the two could be connected.

7. Mental health conditions and performance anxiety

Your brain plays a big role in your ability to achieve and sustain an erection. If you’re under stress or experiencing difficulties with your mental health, your brain can have trouble releasing the hormones responsible for causing an erection. 

Examples of these stressors include things like:

• Depression

• Anxiety

• Relationship difficulties

• Grief

• Performance-related anxiety in the bedroom

• Traumatic past experiences

Often, there are both mental and physical health issues at play with ED. There’s support available to help manage these issues. A healthcare professional can help you figure out the best approach. When it comes to managing ED symptoms, your options can include:

• Counseling

• Psychotherapy

• Treatments for stress, anxiety, and depression

8. Prostate inflammation and prostate cancer

Prostate issues can lead to ED. The prostate is responsible for creating one of the components of semen. Long-term inflammation of the prostate or prostate cancer can cause painful ejaculation and difficulty achieving an erection. 

Benign prostatic hyperplasia (BPH), or an enlarged prostate, doesn’t cause ED. But the medicines used to treat it can. Be sure to talk with a healthcare professional if you have known prostate issues and are experiencing ED.

9. Sexually transmitted infections

Sexually transmitted infections (STIs) can lead to ED. Certain STIs can cause infections in the prostate gland, which can lead to symptoms of ED. These infections include:

• Chlamydia

• Gonorrhea

• HIV

• Viral hepatitis 

Most of the time, if you treat both the prostate infection and take steps to manage STIs, any issues with ED will resolve as well. If a prostate infection is left untreated, though, it can cause permanent damage. So it’s best to see a healthcare professional about it sooner rather than later.

10. Low testosterone

About 40% of men over 45 years old have lower-than-normal levels of testosterone, also known as “low T.” In addition to ED, low T can cause many different types of men’s health conditions including: 

• Hair loss

• Insomnia

• Low libido (sex drive)

• Depressed mood

The lower the level of testosterone, the more symptoms you may experience. This is very easy to identify with a simple blood test. And it can be managed with medications. Once testosterone levels are brought back to normal, most people will notice their ED symptoms get better or go away altogether.

11. Nerve problems

Conditions that affect your nerves or blood vessels can interfere with the communication between your penis and brain. These include:

• Parkinson’s disease

• Multiple sclerosis

• Stroke

• Injuries to the spinal cord or brain

ED is often permanent when the cause is neurological.

Quiz: Is it erectile dysfunction?

Medication treatments for erectile dysfunction

Phosphodiesterase-5 (PDE5) inhibitors are safe and effective medications used to treat many causes of ED. Common options include: 

• Sildenafil (Viagra) 

• Tadalafil (Cialis)

• Vardenafil 

• Avanafil (Stendra)

Good to know: While these medications are in the same medication class, they work slightly differently. So it may take some time to find the best option for you. Connect with your healthcare team to find the right approach for you. 

Other remedies to treat erectile dysfunction

There’s a big market for “male-enhancement” products that claim to improve your sex life and erections. Despite the eye-catching claims, the FDA doesn’t regulate nonprescription treatments. That’s why the FDA issued a warning about many of them.

Depending on what’s causing your ED, some options are available. These can be alternatives to medication, or used alongside it. These options include:

• A vacuum erection device

• A penile prosthetic implant

• Repair of damaged penile blood vessels (revascularization surgery)

• Therapy (sex therapy, counseling)

There are also some lifestyle habits that may prevent your ED from worsening and support your ED treatment. Here are some natural remedies for managing ED:

• Eat a balanced diet with plenty of fresh produce, lean protein, and minimally processed foods.

• Be physically active. Do your best to do moderate exercise, 3 to 5 days a week.

• Aim to get consistent and quality sleep.

• Practice relaxation and mindfulness techniques.

• Avoid or limit alcohol and tobacco.

Frequently asked questions

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Dr. Nahvi is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works clinically at Concord Hospital in Concord, New Hampshire, and is a clinical assistant professor of emergency medicine at the Geisel School of Medicine at Dartmouth. Prior to this, he worked as an ER physician and clinical assistant professor of emergency medicine at the Mount Sinai Health System, NYU Langone Health, NYC Health + Hospitals/Bellevue, and the Manhattan VA. He is a graduate of Cornell University and NYU School of Medicine.

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