The Top 11 Causes of Erectile Dysfunction (ED)

1. Diabetes

Diabetes is a common cause of ED. Men with diabetes are about three times as likely as men without diabetes to develop ED. That’s because diabetes can damage the blood vessels in the body, which may lead to decreased blood flow for erections. The longer you have diabetes, the more likely you are to experience ED.

When a person with diabetes develops ED, it may be a sign that other long-term complications of diabetes are developing. The changes in blood flow that lead to ED can also lead to problems with your: 

• Vision

• Foot health

• Heart

• Kidneys

So it’s important to share with your healthcare team if you’re having new symptoms of ED. 

2. High body fat

Carrying extra weight, especially around the waist, increases the chances of having ED. Men with a higher body mass index (BMI) are more likely to experience moderate-to-severe ED. Researchers believe excess body fat can disrupt hormone levels and blood flow, both of which are important for erections.

If high body fat may be causing your ED, you may be able to reverse your symptoms by focusing on weight-management strategies like exercise, diet changes, and medications. 

3. Heart disease

Experts are now understanding more about how ED and heart health are linked. 

The American Heart Association notes that ED may even be the first sign of heart disease. That’s because heart disease is often caused by a buildup of atherosclerosis in the arteries, which leads to poor blood flow. Atherosclerosis can also reduce blood flow in other areas, including the penis. Research has shown that people with ED are often diagnosed with heart disease within 5 years.

Conditions like high blood pressure and high cholesterol are also linked to ED because they increase the chances of developing atherosclerosis and heart disease. So evaluation of new ED often includes an evaluation of your heart health.

4. 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.

5. Prostate inflammation or 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, can also cause ED. The larger the prostate, the higher the chances are of developing ED. 

6. Low testosterone

About 40% of men over age 45 have lower-than-normal levels of testosterone, also known as “low T.” In addition to ED, low T can cause many different types of health conditions in men including: 

• Hair loss

• Insomnia

• Low libido (sex drive)

• Depressed mood

The lower the level of testosterone, the more symptoms you may experience. This can be diagnosed 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.

7. 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.

8. Stress

Your brain plays a big role in your ability to achieve and sustain an erection. Stress, anxiety, or relationship difficulties can interfere with the signals between your brain and body that make erections possible. In one small study, an 8 week stress-management program improved ED symptoms as much as medication did. 

There’s support available to help manage these issues. When it comes to managing ED symptoms, your options can include:

• Counseling

• Psychotherapy

• Stress-reduction techniques 

9. Mental health conditions

While stress can contribute to ED, ongoing mental health conditions can also play a significant role. Depression, anxiety, and other disorders can affect sexual desire, arousal, and performance. In some cases, the medications used to treat these conditions may also contribute to ED.

Examples include:

• Depression

• Anxiety

• Grief

• Traumatic past experiences

10. 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. 

11. Alcohol

Alcohol can also make it harder to get or maintain an erection. While a small amount may lower inhibitions, larger amounts can interfere with arousal and the brain-body signals needed for an erection.

Over time, heavy or frequent drinking can increase the risk of ED. In general, the more alcohol someone consumes, the higher their risk of developing ED.

In one study of people with alcohol use disorder and ED, a month of not drinking led to big improvements in symptoms. If you drink regularly and experience ED, cutting back may help.

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