Over the past decades, the medical perspective on the causes of erectile dysfunction has shifted. Common belief used to attribute almost all cases of ED to psychological factors. Now doctors believe that up to 85% of ED cases are caused by medical or physical problems. Only 15% are completely psychologically based. Sometimes, erectile dysfunction is due to a combination of physical and psychological causes.
A number of medical conditions share a common problem with erectile dysfunction -- the impaired ability of blood vessels to open and allow normal blood flow.
Heart Disease, Atherosclerosis, and High Blood Pressure
Heart disease, atherosclerosis, high blood pressure and high cholesterol levels are major risk factors for erectile dysfunction. In fact, erectile problems may be a warning sign of these conditions in men at risk for atherosclerosis. Men who experience ED have a greater risk for angina, heart attack, or stroke. [For more information, see In-Depth Report #3: Coronary artery disease.]
Erectile dysfunction is a very common problem in men with high blood pressure. More than 40% of men with erectile dysfunction have hypertension. Many of the drugs used to treat hypertension (such as calcium channel blockers and beta-blockers) may also cause ED. [For more information, see In-Depth Report #14: High blood pressure.]
Diabetes is a major risk factor for erectile dysfunction. Between 30 - 50% of men with diabetes report some form of sexual difficulty. Abnormal arteries and nerve damage are both common complications of diabetes. When the blood vessels or nerves of the penis are involved, erectile dysfunction can result. Diabetes is also associated with heart disease and chronic kidney disease, other risk factors for ED. [For more information, see In-Depth Report #60: Diabetes type 2.]
Obesity increases the risk for diabetes, heart disease, and erectile dysfunction.
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.
Benign Prostatic Hyperplasia
Surgery and drug treatments for benign prostatic hyperplasia, such as finasteride (Proscar), can also increase the risk for erectile dysfunction. [For more information, see In-Depth Report #71: Benign prostatic hyperplasia.]
Diseases that affect the central nervous system can cause erectile dysfunction. These conditions include Parkinson's disease, multiple sclerosis, and stroke. [For more information, see In-Depth Reports #51: Parkinson's disease; #17: Multiple sclerosis; #45: Stroke.]
Endocrinologic and Hormonal Conditions
Review Date: 07/20/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.