Erectile Dysfunction – Causes, Prevention and Treatments

In this article we’ll discuss the causes symptoms, and the ways to treat or prevent erectile dysfunction

A picture of an erectile dysfunction patient at the doctor office

Erectile Dysfunction Key Takeaways

  • Erectile dysfunction (ED) is very common
  • Its’ causes can be psychological or physiological
  • Lifestyle changes can help prevent ED
  • Medications, injections or surgery can treat ED
  • Many cases of ED can be resolved
  • Diagnosis should be made by a doctor

What is erectile dysfunction?

Erectile dysfunction (or ED) is the most common male sexual problem. ED means that a man has a recurrent and persistent problem getting or keeping an erection during sexual intimacy. ED can be quite distressing to both a man and his partner.

Here, we’ll discuss all about ED, its causes and steps you can take to prevent and treat it.

What are the symptoms of ED?

Erectile dysfunction can have a wide range of symptoms depending on the severity:

  • Complete loss of erections during intimacy suggest severe ED
  • Erections, but not as firm as in the past suggest milder ED
  • Erections that become limp during sexual activity.
  • Loss of early morning erections or erections with masturbation may signal a physiological cause.
  • Loss of erections during sex, but not during masturbation, may signal psychological erectile dysfunction.
  • Some men may become depressed or lose a sense of self-esteem issues, and both partners may become distressed.

On the other hand, most men will not notice any pain. Many will continue to have an interest in sexual activity that makes the symptoms of ED all the more distressing.

The Difference between low libido and ED

Men should also be aware that ED is not the same as low libido. Libido refers to a man’s interest in sexual activity.

While low libido can also increase with age, it is different form ED. Men with ED are still interested in sex, while men with low libido simply have lost interest.

A man may have both low libido and ED, but it is important to distinguish the two as the treatment (and goals) may be different.

You can learn more about low libido here.

Who is at risk for erectile dysfunction?

A chart that shows the risk factors for erectile dysfunction

Men with long term medical problems, such as Diabetes, heart disease and sleep apnea, are more likely to have ED. In fact, ED may an early sign of these illnesses, and shouldn’t be ignored. Also, men who are overweight, smoke or do not exercise regularly are more likely to have erection problems.

Is age a risk factor for ED?

Yes, it is estimated that  18.4% of men experience ED, but it is more common as a man ages. 5% of men under 30 have ED, while that number increases to 70% in men over than 70. Still, ED affects men of all ages. For younger men, often the cause for ED is stress or anxiety.

a chart that shows the prevalence of erectile dysfunction by age
The prevalence of erectile dysfunction increases with age

While men may feel like they are the only one dealing with ED, like we’ve seen, it is actually very common. Many men do not talk about their problems with ED since it is quite a personal topic. Unfortunately, this means that they will suffer in silence, not receiving the right treatment or knowing the necessary steps to prevent it.

How do erections work?

While it happens quickly, an erection is actually quite complex and needs the vascular, neurologic and hormone systems to work together.

There are three types of erections:

  • Psychogenic erections – erections from sexual stimuli. This occurs during intimacy, visual images or an active imagination. These erections begin in the brain, leading to a cascade of events that activate the nerves to the penis.
  • Reflexogenic erections – erections from touch. These do not require sexual thoughts, but still require active nerves to stimulate the penis.
  • Nocturnal erections – erections that happen at night. Most men have 3 or 4 erections at night that often occur while dreaming or upon waking. They are normal and continue throughout a man’s life.

A man’s nerves are important for erections to happen. In psychogenic erections, brain nerves activate, sending signals to the spinal cord, while the other two types begin in the spinal cord. From there, nerve impulses travel to the penis, releasing a chemical (nitric oxide) that:

  • increase blood flow to the penis, and
  • reduce blood flow leaving the penis.

Hormones, like testosterone, makes sure there is enough nitric oxide to maintain an erection. A problem in any of these steps can lead to ED.

What causes ED?

ED can be due to both physiological and psychological causes. Remember that some men can have both physiological and psychological reasons for ED.

Physical causes for erectile dysfunction

a chart that lists the physical causes for erectile dysfunction
  • Diabetes– over time high blood sugar can affect the small nerves and blood vessels that go to the penis. When these are damaged, signals from the spinal cord never make it to the penis. Therefore, the blood vessels can’t fill with blood to cause an erection.

    This problem affects other nerves and blood vessels in the body, so diabetic men may have kidney failure, heart attack and other problems as well.

    Also, many men with diabetes have low testosterone worsening the problem.

  • Low testosterone – while low testosterone levels are commonly associated with low libido, men with ED can have low testosterone levels as well.

    Testosterone is important in maintaining a firm erection. So, low testosterone can cause a man to have a soft erection.

    If ED is from low testosterone, you might notice other signs, like fatigue, low libido, weight gain and muscle loss.

  • Hormonal imbalance – low testosterone is only one type of hormone imbalance. Disorders of the thyroid, cortisol (the “stress” hormone) and others can all lead to ED.

    Often men will have other symptoms like change in appetite, body temperature, weight, or increased fatigue that may be clues to the hormone imbalance.

  • Cardiovascular diseasemen with heart disease such as heart attacks and stroke are very likely to have ED. Remember that erections require healthy blood vessels. If large blood vessels in the heart and brain are damaged, it is likely that the smaller ones in the penis will also be damaged, causing ED.

    Also, some men with severe heart disease may be told not to have sex because it can increase their risk of more heart damage.

  • Atherosclerosis – means “hardening of the arteries.” Hard arteries do not have good blood flow, and so men with atherosclerosis will have a had time getting an erection.

    Men with this problem are at risk of heart attacks and strokes, so it’s important to talk with your doctor and change your diet to decrease your risk.

  • Kidney disease – men with kidney disease have a lot of reasons to get ED. Kidney disease causes nerve damage, blood vessel disease hormonal imbalances (including low testosterone) and many men deal with depression.

    Also, some of the medicines used to treat kidney disease cause ED. In a man who has severe kidney disease, dialysis and renal transplant helps to improve ED.

  • Multiple sclerosis (MS) – neurological conditions like MS can lead to ED. Remember that ED is also a neurological disease. If there is any damage to nerve cells, ED can happen. In multiple sclerosis, nerve impulses travel very slowly, or not at all, leading to its multiple neurologic symptoms, such as ED.

  • Parkinson’s disease (PD) – neurodegenerative disorder (like PD and Alzheimer’s) can cause ED. That’s because penile nerves are damaged as well. In fact, ED can begin before the more common signs of Parkinson’s, like slowed movements. As the disease progresses ED can worsen, especially in men who are also depressed.

    Some Parkinson’s medicine also may cause ED. Almost half of men with Parkinson’s disease have ED, so talk with your doctor if you have concerns.

  • Peyronie’s disease – refers to a curve, bend or narrowing in the penis from scar tissue in the penis. If it becomes severe, the scar tissue can interfere with the blood flow in the penis. Some men may notice a change in the quality of the erection in different parts of the penis.

  • Certain medications – there are many medicines that can cause ED, either because they affect hormonal balance or nerve function. Common medicines that can cause (or worsen) ED include high blood pressure, antidepressant, and heartburn medicines.

    Also, men should be aware that long term use of alcohol, tobacco and drugs like heroin and marijuana can also affect ED.

  • Prostate cancer treatment – prostate cancer is a common cancer in older men and while there is good treatment, some can lead to ED.

    If you have prostate cancer and are getting treatment, make sure to have a full discussion with your doctor about the side effects of treatment.

Psychological causes for erectile dysfunction

a chart that lists the psychological causes of erectile dysfunction
  • Stress– when we are stressed, sex is often the farthest thing from our minds. Men (and women) who are stressed are less likely to be interested in sex, and are more likely to have ED when they do have sex. Reducing stress is key step to improve ED in this case.  

    Read Next: Stress and Erectile Dysfunction – Causes and Treatments

  • Performance anxiety – Sometimes, sex itself can be stressful. Men with performance anxiety may worry that they will not please their partner or they will be unable to perform in the bedroom. This anxiety can actually lead to ED, causing a self-fulfilling prophecy.

    Read Next: Performance Anxiety and Erectile Dysfunction

  • Relationship issues – if you are angry with your partner, you’re less likely to want to be intimate. Relationship issues are a common cause of ED.

    It is also more common for men in this situation to have ED during sex with their partners, but not when masturbating or watching erotic stimuli.

  • Depression– depression affects your whole body, including your ability to have an erection. Depressed men have hormonal imbalances, which can reduce testosterone levels and decrease sex drive.

    Also, depression alters adrenaline and cortisol (the stress hormones) which can block a man’s ability to achieve or maintain an erection.

  • Watching porn excessively– too much porn watching may cause erectile dysfunction by affecting the brain’s chemistry. This can make men dependent on porn to feel desire. Also, some men may develop performance anxiety after watching porn.

    Read Next: Porn Induced Erectile Dysfunction – Can Porn Cause Erectile Dysfunction?

For a more through overview of the psychological causes and treatments read this extensive article we wrote about psychological erectile dysfunction.

Important note: ED can an early sign of a major medical problem. If you notice regular erection loss, don’t delay and talk to your doctor

How to prevent erectile dysfunction

You should never feel hopeless about ED. Here, we’ll talk about some of the options for improving or preventing ED.

Prevent psychological ED

Men with psychological ED often have a number of symptoms in addition to ED. For example, depression and stress can lead ED. Also if you notice persistent low mood, significant anxiety or other emotional concerns, your ED may be related to psychological causes.

Reducing stress, seeking out psychotherapy and talking with your partner are some steps you can take to prevent psychological ED. If you notice sexual performance anxiety, read this article to learn about effective strategies to avoid the condition.

a picture of a treatment for stress induced erectile dysfunction
Advertisement: Try the Mental Impotence Healer Program – a guided imagery program created specifically for psychological erectile dysfunction.

Lifestyle changes you can take to improve ED

ED is often a result of bad lifestyle choices; that’s why so many men with ED are affected by heart disease and Diabetes.

If you take certain steps to reclaim your health, you can improve or even fix your erectile function. Here are a few ideas to jump start a healthier new you

A chart that lists lifestyle changes you can make to improve erectile dysfunction
  • Exercise several times a week – ED Studies suggest that aerobic exercising with moderate to high intensity can help prevent ED. Exercising 40 minutes, 4 times per week is recommend for men with physical ED which is caused by physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. 6 months of aerobic activity can contribute to decreasing erectile problems.
  • Eat a well-balanced diet – a diet low in saturated diet and refined carbohydrates. Any diet that decrease heart disease is good for erectile dysfunction. Recent studies suggest that the Mediterranean diet could help in preventing ED.
  • Stop smoking – smoking hurts blood circulation and increase the risk for erectile dysfunction
  • Don’t drink excess alcohol or binge drink – Excess drinking is defined by NIH as, 2 or less drinks per day (on average for men). Binge drinking is 5 or more drinks within 2 hrs for a man.
  • Stop using illicit drugs

How to treat erectile dysfunction

If eating right, exercising and reducing stress or working on any relationship problems aren’t enough to treat your ED, there are many effective options to help a man achieve regular erections.

Treatment for physiological ED

Oral medications

an image of pills for erectile dysfunction

Pills are an easy and effective treatment for ED, and are the first step if lifestyle changes don’t work.

The pills used for ED are called phosphodiesterase-5 (PDE5) inhibitors. They work by increasing the amount of nitric oxide in penile blood vessels, directly improving the blood flow in the penis. Common examples of PDE5 inhibitors are:

  • Viagra ®
  • Cialis® (it can be taken daily to improve erections)
  • Levitra®
  • Stendra®

It’s best to talk with your doctor if you want to start this medicine. While they are available online, the quality (and ingredients) may not be what you expect. Also, these medicines can have serious side effects— especially if you take certain medicines called nitrates— that a doctor should go over with you. 

If you do decide to use an online pharmacy, it is very important to choose one that has a license. If you use these services, make sure to speak with the doctor or pharmacist about the possible side effects of the medicine and what you should do if you have one.

Penile injections

an image of a syringe for an erectile dysfunction injection

Penile injections are for erectile dysfunction that are typically tried only if pills do not work. A man will eject his penis with medicine (often a combination) before sexual activity.

As you can imagine, men must go to their doctor to learn the correct technique and only proceed if they are able to do injections safely.

While most men are satisfied (almost 90%)  with the result after getting comfortable with injections, they may notice some initial pain as well as bruising. Also, men who perform penile injections or use pills should be aware that an erection lasting longer than 4 hours (called priapism) is an emergency that should be treated immediately by their doctor or in an emergency room.

Vacuum devices

an image of a penis pump for erectile dysfunction
Encore Deluxe Battery and Manual Vacuum Erection Penis Pump

These devices use vacuum pressure to draw blood into the penis, causing an erection. Often men will place a ring at the base of the penis to stop blood from leaving the penis. Some men will use PDE5 inhibitors at the same time to improve their results. 

Men who use this option are often in stable relationships, as it does take some spontaneity from sex.

The ring may make ejaculation difficult and the erection differs from a physiological erection (the tip of the penis may not become firm). Regardless, men who stick with vacuum devices have good results.

Many of these devices are available over the counter or in sex stores, however it is a good idea to talk with your doctor so you are aware of how to use it correctly.


an illustration of a penile prosthetic for erectile dysfunction

Surgery is another option for men with ED, but few men will need this option.

The most common surgery is the penile implant. In the surgery, a semi-rigid or inflatable device is placed in the penis allowing sexual intercourse when the man desires.

As this is a surgery, you will need to see a doctor (urologist) to discuss the risk of the surgery and make sure you are a good candidate. The success is very high, and most men who have this treatment are very happy with the results.

Remember to check your prescriptions!

an image of prescription medications
prescription medications could cause erectile dysfunction

As we mentioned before, some medicines prescribed by your doctor can cause ED. Always ask your doctor about side effects and read the instructions carefully. Remember, your ED may be completely reversible if you stop a medicine linked to ED.

  • Cimetidine (Tagamet)
  • SSRI antidepressants (i.e. Paxil, Prozac)
  • Blood pressure medicines (i.e. Aldactone, Catapres, Oretic, Apo-Hydro and many others)

Beware of dangerous “alternative treatments”

An image of a bottle of a dangerous supplement for erectile dysfunction

As ED is a common problem and many men are wary to talk to their doctors, a lot of “alternative treatments” are available online. Some of these may look like medicines you get from your doctor, but it is hard to know what is in the pill if you do not get it from a trusted pharmacy.

Also, there are many “natural supplements” that have not been proven to be effective. Some can even contain medicines that could be dangerous.


Take a deep breath and make an appointment with your doctor; it’s the best way to know if you are dealing with ED. When you go, your doctor will ask several questions and do a physical exam. The questions will try to figure out if you really have ED (or alternatively low libido or low testosterone) and figure out any risk factors for ED (like diabetes or heart disease).

He or she may ask how long you’ve had symptoms and how severe they are. Your doctor may also ask about psychological stressors or relationship concerns that are common in ED.

A physical exam is necessary to make sure that there are no signs of diseases that can cause ED, such as vascular disease or low testosterone.

Finally, your doctor can order some blood work such as tests for diabetes, heart and thyroid disease and low testosterone levels. to make sure these are not causing ED. It’s all quite painless and can give you (and your doctor) valuable information to know the next best steps to treat your ED.

What ED is not

up to 25% of erectile dysfunction cases are associated with stress, fatigue or illness and should not be a cause for concern.

It is important that men remember that ED is a persistent problem. All men may notice difficult with an erection or a lost erection from time to time. In fact this can happen up to 25% of the time and is often associated with stress, fatigue or illness and should not be a cause for concern.

Read Next: Temporary Erectile Dysfunction – What Causes a Sudden Loss of Erection?


Remember if you are dealing with problems in the bedroom, you are not alone. Many men deal with ED as they get older and there are many things you can do to take control of your sexual health. Changing your diet, exercising and reducing stress are key treatments. ED may be a sign of an underlying medical problem, so if none of these steps work, make an appointment with your doctor.  You’ll be able to figure out what’s causing your ED and find the right treatments to help you fix it.

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