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    Causes of erectile dysfunction

    On this page
    1. What are the main causes of erectile dysfunction?
    2. Physical causes of erectile dysfunction
    3. Narrowing blood vessels
    4. Hormonal imbalance
    5. Nerve problems
    6. Can a tight foreskin cause erectile dysfunction?
    7. Medicinal causes of erectile dysfunction
    8. Psychological causes of erectile dysfunction
    9. Lifestyle factors linked to erectile dysfunction
    10. Erectile dysfunction and COVID-19
    11. Erectile dysfunction treatments

    Erectile dysfunction (ED) also known as impotence, is the inability to get or maintain an erection  long enough to have successful sexual intercourse. This can inhibit sexual performance and impact confidence. It’s a very common condition, particularly in older men.

    Fortunately treatments for erectile dysfunction have improved significantly, so with the correct option, you will be able to have full intercourse again.

    What are the main causes of erectile dysfunction?

    To maintain an erection, you need a healthy blood supply, a healthy nervous system and sexual desire. Various physiological and psychological conditions can affect all aspects of your sex life, which can result in ED. For example, men over the age of 40 may have an underlying medical condition causing their ED.

    Physical causes of erectile dysfunction

    Narrowing blood vessels

    High blood pressure, cholesterol and diabetes can all result in narrowed blood vessels. ED can be the first sign of these conditions, so testing for them is important. Men who have atherosclerosis (a thickening and hardening of the blood vessel walls) often have difficulties with ED as well. This is because the same hardening that goes on in the heart’s blood vessels goes on in the blood vessels in the penis.

    Hormonal imbalance

    Sometimes an imbalance in hormones can cause ED. Signs of hormonal imbalance can include sudden weight gain, weight loss or reduced sex drive. In some cases, ED can be the only symptom of a hormonal problem.

    Nerve problems

    There are many conditions that affect the nerve supply, such as spinal trauma, Parkinson’s or Multiple Sclerosis. In these situations, the nerve problem occurs prior to ED. Some surgeries, such as radical prostatectomy, that involve nerves being cut as part of the operation can also lead to ED.

    Can a tight foreskin cause erectile dysfunction?

    Changes in the actual penis structure can make getting an erection difficult. Peyronie’s (a bending in the erect penis), phimosis (a tight foreskin) or a tight frenulum (the elastic piece of skin that joins the foreskin to the shaft of the penis) can all cause ED.

    Medicinal causes of erectile dysfunction

    Some commonly prescribed drugs can cause ED. Medication for depression, psychotic illness, heart conditions, blood pressure and prostate conditions are all potentially implicated. However, these drugs are given for significant conditions so you should talk to your GP for advice.

    Psychological causes of erectile dysfunction

    Psychological factors are responsible for a large amount of ED cases. The most common psychological causes include:

    • Stress – when the brain is dealing with stress it becomes harder to remain focused on intercourse, especially as your body produces more cortisol (the body’s stress hormone)
    • Trauma – in some cases, ED may stem from childhood abuse or sexual trauma
    • Depression – a chemical imbalance in the brain can affect both sexual desire and function. Speak to your GP if you are experience feelings of low mood
    • Relationship trouble – it may be that your sex life suffers if you are having concerns about your relationship in general
    • Performance anxiety – failure to sustain an erection can be stressful in itself, causing a negative spiral

    Lifestyle factors linked to erectile dysfunction

    Studies show that there is a marked correlation between an unhealthy lifestyle and ED. A number of physical conditions and habits that damage your health can also affect your ability to sustain an erection, such as:

    • High cholesterol – if your arteries are clogged up with cholesterol, they will limit your blood flow, which will affect your erection
    • Smoking – damages your blood vessels and ED is often the result of poor blood flow
    • Alcohol – people mistakenly believe alcohol is an aphrodisiac whereas, in fact, binge drinking can cause temporary ED and long-term alcohol use can decrease your sex drive
    • Recreational drug use – rather than enhancing sexual experience, many recreational drugs will actually have adverse effects on sexual function
    • Sedentary lifestyle – being inactive makes it harder to control weight and negatively affects your heart
    • Being overweight – carrying extra weight can increase your blood pressure and increase your risk of blood vessel disease which can cause ED

    Erectile dysfunction and COVID-19

    Since the COVID-19 pandemic, some men have been reporting experiencing ED for the first time. And studies have suggested that this is likely to be a consequence of catching COVID-19. Find out more about the link between COVID-19 and erectile dysfunction

    Erectile dysfunction treatments

    If you are experiencing ED, it is recommended that you have a consultation with your GP in case there is an underlying medical issue causing it. They will ask you questions about your symptoms and perform some simple tests to make sure you are advised on the best course of action for your needs.

    Alternatively, if you are considering treatment such as Viagra and Cialis without the need for a face-to-face appointment, you can have an online assessment with our NHS-experienced clinicians.


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