Causes of erectile dysfunction

Reviewed by Dr Bhavini Shah

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 - it's estimated that one in five men suffer from it.

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

But what causes erectile dysfunction? There are many factors that can lead to impotence, from confidence struggles to medical issues. In this article, we’ll cover:

• Physical causes of erectile dysfunction: blood vessels, nerves, hormonal imbalances
• Lifestyle factors linked to erectile dysfunction: weight, smoking and alcohol
• Psychological causes of erectile dysfunction: performance anxiety and depression
• How to treat your erectile dysfunction: looking for the cause of your ED and helping to find a suitable treatment

How common is erectile dysfunction in different age groups?

While the perception of ED is that it affects men more as they get older, it can be common regardless of your age.

“ED doesn’t discriminate by age, and you shouldn’t be ashamed if you’re suffering from it in your 20s and 30s. If you are, it’s important to understand the underlying causes – speak to your doctor who can help you further.” - Dr Bhavini Shah

What are the main causes of erectile dysfunction?

To maintain an erection, you need: 

• A healthy blood supply
• A healthy nervous system
• 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

According to the British Association of Urological Surgeons, 90% of men with ED can trace it to at least one underlying physical cause. The most common of these is cardiovascular disease. However, abnormalities that contribute to erectile dysfunction can include diabetes, hormone problems and neurological disorders, among others.

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.

Does an enlarged prostate cause erectile dysfunction?

While there isn’t a clear clinical link between prostate size and ED, treatments for benign prostate hyperplasia (BPH) can have erectile dysfunction as a side effect.

Please talk to a healthcare professional about your prostate if you have:

• Changes to urinating: difficulty, weaker stream, suddenly needing to go
• Difficulty sleeping
• Increased UTIs and bladder stones

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 – Cholesterol plaques build up in arteries throughout the body, including those that supply blood to the penis 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

“It’s important to assess your lifestyle and any psychological issues before presuming there is something physically wrong. Seeking medication for ED and performance issues but not addressing the initial cause will only prolong the issue.” - Dr Neel Patel

Medicinal causes of erectile dysfunction

Some commonly prescribed drugs can cause ED. Medication for depression such as Sertraline, as well as medication for heart conditions, blood pressure and prostate conditions are all potentially implicated or list erectile dysfunction as a possible side effect.

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

Treating erectile dysfunction

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, lifestyle and sexual history. They will also 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 without the need for a face-to-face appointment, you can have an online assessment with our NHS-experienced clinicians. They can help to suggest a suitable treatment plan for your erectile dysfunction going forwards if clinically appropriate.