Erectile dysfunction affects an estimated 300 million men worldwide and can be a powerful source of anxiety and stress. While you may think of ED as being either physical or psychological, it’s usually due to both physical and psychological causes. Here are some of the most common causes of erectile dysfunction, with how to treat them.
If you’d like to discuss your own risk factors for ED, especially if you’re experiencing symptoms, call us at eDrugstore.com to schedule a free video consultation with a licensed telehealth physician in our network, from the privacy of your home.
Physical Causes of Erectile Dysfunction
More than 80% of erectile dysfunction is the result of a physical problem. That’s because erections are mostly the product of a clever plumbing trick, except with arteries and veins instead of pipes and drains.
The most common physical cause of ED is inadequate blood supply to the penis. Just like attempting to fix the plumbing in your house, it sounds simple, but there are a lot of things that can go wrong! We’ll take a look at the main culprits, but we don’t want to look at your plumber’s crack, so please do us a favor and hike your chinos up first.
The biggest contributor to reduced blood flow is aging. As we age, our blood vessels become thicker and less elastic. This means they can’t change shape as quickly or as much in response to signals from the body. So when the signal arrives from the brain, the arteries supplying the penis don’t relax and let enough blood to flow in to cause a full erection. That’s one reason why ED is more common in men over 50.
Chronic Diseases and Conditions
Age isn’t the only factor. The second-place contribution comes from conditions like cardiovascular disease (CVD), type 2 diabetes, and high blood pressure. These conditions often go hand-in-hand with getting older, and men over 40 are likely to have more than one of these risk factors for ED.
CVD can cause erectile dysfunction because of a process called atherosclerosis—the gradual build-up of fats, cholesterol, and other substances on the inside of the arteries. These “plaques” take up space and reduce the amount of blood that can flow through. They also harden the artery wall so it loses elasticity. This can restrict the amount of blood that enters the penis even if the erection signal is normal. The arteries hear the message, they just can’t respond to it as well.
Type 2 diabetes (T2D) can lead to ED through a similar path as CVD, since most people with T2D have at least some degree of CVD. But uncontrolled high blood sugar in both Type 1 and Type 2 diabetes is also a frequent cause of neuropathy (nerve damage) that can affect nerves throughout the body.
You may be most familiar with diabetic neuropathy, which causes numbness and painful burning sensations in the hands and feet. But you may not realize that unchecked high blood sugar can also damage larger nerves, including the ones that control the penis. As a result, the erection signal coming from the brain can’t make it to the penile blood vessels to let them know to relax.
High blood pressure is another condition strongly associated with ED. It may seem counterintuitive at first glance. After all, wouldn’t higher blood pressure mean that more blood will get pushed into the penis when it’s erect? Sadly, that’s not the case.
Like type 2 diabetes, high blood pressure doesn’t usually cause obvious symptoms, so it can be there for years before being detected. By that time, the pressure has started to overstretch and stiffen the walls of your blood vessels just like in CVD. In fact, many people (especially if obese or overweight) have all three of these conditions, which doctors group under the umbrella term metabolic syndrome.
What You Can Do
To add insult to injury, some of the medications used to manage the above three conditions can cause ED or make existing ED worse. Diuretics and beta blockers for high blood pressure are the worst offenders.
If you’re experiencing ED with a new blood pressure medication, you have options to do something about it. You can talk to your doctor about alternatives that don’t commonly cause ED, including ACE inhibitors like lisinopril, ARBs like Diovan (valsartan), and calcium channel blockers like Norvasc (amlodipine).
You can also talk to a telehealth doctor to see if you’re a candidate for medications like Viagra or Cialis. Either way, if you’re concerned about erectile dysfunction or other sexual health problems, an honest conversation with a doctor is the best place to start.
The list of drugs that can cause erectile dysfunction is long, and includes prescription and over-the-counter medications like antidepressants, antihistamines, ibuprofen, antiseizure medications, and muscle relaxers. It also includes recreational drugs like methamphetamine, cocaine, oxycodone, and alcohol.
What You Can Do
Unfortunately, drug-induced ED often won’t go away until you stop taking the drug. If the issue is with an OTC medication, you can try switching to a different option (Claritin instead of Benadryl, for example), taking it less frequently, or just not taking it at all. But talk to your doctor before stopping or changing any prescription medications you’re on, as they’ll be in the best position to discuss an alternative that meets your medical needs.
ED drugs like Viagra and Cialis can help in most instances of drug-induced ED, but people who take nitrates or nitroglycerin for chest pain or who use recreational drugs called “poppers” (amyl nitrate, whippits) absolutely must not use Viagra or any ED drug. The combination can trigger a dangerous, possibly fatal drop in blood pressure.
Neurological Causes and Injury
An estimated 10-20% of erectile dysfunction cases stem from neurological causes. These include diseases like multiple sclerosis, Parkinson’s disease, stroke, and encephalitis. Traumatic spinal cord or brain injury may also result in erectile dysfunction, depending on the location and severity of the injury. Surgery for prostate cancer and other pelvic surgeries can cause ED because the penile nerves are intertwined in this area and can be physically damaged by the surgery.
What You Can Do
Depending on the cause, most men with neurologic ED can get some benefit from Viagra and similar drugs. For maximum effectiveness, these medications can be used with a vacuum erection device like the Freespace. This combination may be especially useful to preserve erectile function in men who have diabetes or undergone prostate surgery.
Psychological Causes of ED
Fifty years ago, erectile dysfunction was thought to be entirely psychogenic—meaning a psychological problem that’s “all in your head.” Medicine has come pretty far since then, and we now recognize that ED is mostly physical, even in younger men.
That said, the erectile signal starts in the brain, so your thoughts and emotions can play a significant role in your ability to get and maintain an erection. Obviously, physical attraction is important for sexual arousal, but your feelings or thoughts about your partner, yourself, your relationships, or outside stresses in your life can easily distract you and make it hard to…well, get hard.
That’s because stress and worry activate your sympathetic nervous system—your fight or flight response. And when your body is gearing up for either of those, it isn’t going to send a strong erectile signal, because let’s face it: running with an erection is kind of like riding a bike with the kickstand down.
Anxiety about performance and size is also pretty common, and can be self-reinforcing, meaning the more you think about getting erect, the more difficult it becomes to get there. Ultimately, the best solution for this is to address the source of your anxiety. This may mean improving communication with your partner, talking to a therapist or close friend, and practicing anti-anxiety mental exercises. If you find that you can’t help psyching yourself out before a sexual encounter, drugs like Viagra can definitely make it easier to get up and stay up, which a great confidence booster.
Whatever the Cause, We Can Help
eDrugstore.com wants to help you tackle ED and get back your confidence in the bedroom. As a trusted telehealth provider for over 20 years, we can connect you with a licensed physician for a confidential consultation about your symptoms. We also carry all the most popular medications for erectile dysfunction and offer free shipping right to your doorstep. So for all your men’s health needs, check out eDrugstore.com.
Randall is a medical writer with years of experience in the healthcare and pharmaceutical industries. After earning his Doctor of Pharmacy degree from the Albany College of Pharmacy and Health Sciences, he worked as an infusion and specialty pharmacist, where he discovered his passion for making trustworthy healthcare information accessible to everyone.