What causes erectile dysfunction?
Happy man and woman couple in bed

The uphill struggle of keeping it up can become a problem no matter your age. So what can cause erectile dysfunction?

Erectile dysfunction (ED), or impotence, is the inability to get and maintain a proper erection sufficient for satisfactory sexual performance. Most men may have occasions where they cannot achieve an erection for example if they are tired, stressed or have drunk too much alcohol.

However, around half of men aged between 42 – 70 years old have a persisting or recurrent problem with ED, and it becomes more common with increasing age. In 80-90% of men there is an underlying physical reason for it, and in only 10-20% the cause is related to mental health or relationship problems. For this reason, it is important that all men with persisting erectile problems should see a doctor for a health check.

What causes ED?

When sexually aroused, nerve impulses travel from the brain to the penis. These impulses cause extra blood to flow into the penis resulting in an erection. Anything that affects the nerve supply, or the blood vessels will affect erectile function.

There are multiple causes of the erectile dysfunction:

  • Vascular – i.e. narrowed arteries. This is most common cause and obesity, smoking, raised cholesterol, high blood pressure and diabetes all contribute to this. ED may also be viewed as an early warning sign of risk of heart disease.
  • Hormonal – low testosterone levels. In less than 20% of cases, a lack of testosterone may be found. In these patients, ED will improve with testosterone replacement.
  • Neurological problems. For example, spinal injury, Parkinson’s disease and post prostate surgery.
  • Mechanical e.g. Peyronie’s disease which causes fibrosis within the penis.
  • Alcohol overuse
  • Certain Prescription Medication such as anti-depressants and blood pressure pills. Please do not stop medication suddenly without first checking if it is safe to do so.
  • Cycling for longer than three hours a week
  • Psychological Reasons. These play a part in 10 to 20% of cases. Relationship factors and mental health issues such as anxiety, stress and depression may affect erectile function.

Lifestyle factors such as regular exercise, weight reduction, stopping smoking, moderating alcohol intake, and eating a healthy diet are important in improving and maintaining a healthy erection.

As an aside, there is some evidence to suggest that a regular, 3 ejaculations per week may help prevent prostate cancer, leading to the mantra ‘use it or lose it’!

If you have persistent ED problems, speak to your GP. Your GP is used to discussing sensitive issues, and will take a detailed history, offer a relevant examination and arrange some blood tests. Tests will include checks for diabetes, abnormal cholesterol levels, and low testosterone. Depending on the outcome of the consultation and tests, treatment will be discussed.


For most men, a combination of changes to lifestyle and use of medication will improve erectile function. A happy sex life is important for mental well-being and maintaining relationships. Given that ED may be the first warning of an underlying medical problem, it is important to see a doctor for any persisting erectile problems.

Advice given by Dr Elizabeth Kershaw-Yates, GP and one of the medical team at TheOnlineClinic: https://www.theonlineclinic.co.uk/

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