- Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
- Causes are usually medical but can also be psychological.
- Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
- Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.
Normal erectile function can be affected by problems with any of the following systems:
- blood flow
- nerve supply
It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.
Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties.
The following list summarizes many of the most common physical or organic causes of ED:
Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.
Numerous prescription medications can also cause ED, including those below. Anyone taking prescription medications should consult their doctor before stopping or changing their medications:
- drugs to control high blood pressure
- heart medications such as digoxin
- some diuretics
- drugs that act on the central nervous system, including some sleeping pills and amphetamines
- anxiety treatments
- antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
- opioid painkillers
- some cancer drugs, including chemotherapeutic agents
- prostate treatment drugs
- hormone drugs
- the peptic ulcer medication cimetidine
Physical causes account for 90 percent of ED cases, with psychological causes much less common.
In rare cases, a man may always have had ED and may never have achieved an erection. This is called primary ED, and the cause is almost always psychological if there is no obvious anatomical deformity or physiological issue. Such psychological factors can include:
Most cases of ED are 'secondary.' This means that erectile function has been normal, but becomes problematic. Causes of a new and persistent problem are usually physical.
Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time.
It is important to note that there can be overlap between medical and psychosocial causes. For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection, which is a physical cause. However, he may also have low self-esteem, which can impact erectile function and is a psychosocial cause.