Basics of Erectile Dysfunction

Causes of Erectile Dysfunction

Chris Regal Aug 9, 2012 (updated Nov 13, 2014)
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Heart disease
Heart disease
Men who have experienced ED are at a greater risk for angina, heart attack or stroke.  In effect, ED can act as a warning sign for a more serious heart-related condition.  It is estimated that 40 percent of men with ED have hypertension, and the drugs used to treat these conditions can exacerbate the situation.
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Diabetes
Diabetes
Abnormal arteries and nerve damage are both common complications of diabetes. Damaged blood vessels or nerves can lead to erectile dysfunction.  Between 30 and 50 percent of men with diabetes report some form of sexual difficulty.  As with heart conditions, ED can serve as a warning about diabetes.
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Obesity
Obesity
Obesity causes a myriad of problems and can increase the risk of countless conditions.  Among those are heart disease, diabetes, and, yes, erectile dysfunction.
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Metabolic syndrome
Metabolic syndrome
Metabolic syndrome -- a cluster of conditions that includes obesity and abdominal fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance -- is also a risk factor for erectile dysfunction in men older than 50 years.
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Enlarged prostate (BPH)
Enlarged prostate (BPH)
BPH occurs in nearly 60 percent of men over the age of 60 and 80 percent of men over the age of 80.  Many men take medication or undergo surgery to treat the enlarged prostate, which can cause erectile dysfunction.  BPH is caused by hormonal imbalances in the prostate, which could influence sexual functionality.
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Neurological conditions
Neurological conditions
Conditions that affect the central nervous system, including Parkinson's disease, multiple sclerosis or stroke, can also cause erectile dysfunction.  These diseases interfere with nerve functionality, which could affect sexual performance.
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Hormonal conditions
Hormonal conditions
Low levels of testosterone can be a contributing factor to ED, but this is in about 5 percent of men. More often, it is a combination of risk factors, of which low testosterone plays a role.  Abnormalities in the pituitary gland can also cause excessive production of the hormone prolactin, which is likewise associated with ED.  Thyroid and adrenal gland problems can also contribute to ED.
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Physical injury
Physical injury
As with diabetes and neurological conditions that can affect the nerves, physical trauma to the spinal cord or pelvis can also cause nerve damage that can lead to ED.  Pelvic fractures, spinal cord tumors, spina bifida and polio have also been linked to ED.
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Surgery
Surgery
Prostate cancer surgery, including radical prostatectomy, can contribute to ED.  Surgery for colon and rectal cancers can also contribute to ED in some cases.  Orthopedic surgery can sometimes do damage to the nerves in the pelvis, leading to ED in some cases.  Both short and long-term dysfunction can arise from these surgeries.
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Prescription medications
Prescription medications
Some prescription medications can increase the risk of erectile dysfunction.  High blood pressure medications, heart and cholesterol medications, depression and bipolar medications, medications for GERD, chemotherapy and hormone drugs can all have an influence on sexual performance.  If you have concerns about the side effects of a medication, consult with your doctor.
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Psychological causes
Psychological causes
Anxiety, stress and depression are conditions that need consideration when addressing the causes of ED. Due to the very nature of ED, undiagnosed psychological underpinnings can lead to a vicious cycle, where ED becomes a greater issue as a man becomes anxious or depressed about his inability to perform.
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Lack of vitamin D
Lack of vitamin D
While vitamin D deficiency may not play a direct role in erectile dysfunction, it is a risk factor for a number of other conditions, like heart disease, which has been linked to impotence. To get more vitamin D, simply expose yourself to a few more minutes of sunshine each day. If your levels are extremely low, speak to your doctor about supplements. 
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Sleep apnea
Sleep apnea
A recent study found that 40 percent of patients with obstructive sleep apnea (OSA) also suffered from erectile dysfunction (ED), while another study showed that 91 percent of men with ED also had OSA. Because both conditions share overlapping risk factors, it's difficult to say whether OSA is a cause of ED, or if they are simply comorbid conditions that share similar risk factors. 
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If you have a large neck...
If you have a large neck...
A new study out of Turkey says that men whose necks are more than 16.3 inches around are more likely to suffer from erectile dysfunction (ED). Researchers from the University School of Medicine in Ankara, Turkey, said that those with wide necks were more likely to suffer from metabolic syndrome - a combination of high blood pressure, diabetes and obesity - all of which can affect sexual performance.

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Too much bike riding
Too much bike riding
Your narrow bike seat may be damaging your nerves and blood vessels in your pelvic floor. Men who are avid bike riders, horse back riders or spin class fans may want to scale back their hours doing these activities if symptoms persist.
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Alcohol
Alcohol
Alcohol is associated with other conditions, like obesity and high blood pressure, which can directly cause erectile dysfunction. On its own, alcohol acts like a depressant in your body, which can cause problems with erections. Be sure to limit yourself to one or two drinks if you want to stay sexually stimulated.
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Nicotine
Nicotine
Nicotine is known to constrict blood vessels and may cut off blood flow to the penis, causing erectile dysfunction. Some studies also show that smoking is associated with low sex drive.