Causes of Erectile Dysfunction

by Chris Regal Editor

Heart disease

Men who have experienced erectile dysfunction (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.

Blood sugar level test


Abnormal arteries and nerve damage are both common complications of diabetes. Damaged blood vessels or nerves can lead to ED. Between 30 and 75 percent of men with diabetes report some form of sexual difficulty. As with heart conditions, ED can serve as a warning about diabetes.

Obesity is a major cause of diabetes


Obesity causes myriad of problems and can increase the risk of countless conditions. Among those are heart disease, diabetes, and, yes, erectile dysfunction.

Measuring blood pressure

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 ED in men older than 50 years.

Bathroom Sign

Enlarged prostate (BPH)

Benign prostatic hyperplasia (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 ED.

Neuron cells

Neurological conditions

Conditions that affect the central nervous system, including Parkinson's disease, multiple sclerosis, or stroke, can also cause ED. These diseases interfere with nerve functionality, which could affect sexual performance.

Bowler hat and suit

Hormonal conditions

Low levels of testosterone can be a contributing factor to ED, but this is in about five 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.

Body skeleton diagram

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.



Most obvious is surgery on the prostate for prostate cancer, but 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.

Opening pill bottle

Prescription medications

Some prescription medications can increase the risk of ED. 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.

Friends conversing

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.

Beach umbrella

Lack of vitamin D

While vitamin D deficiency may not play a direct role in ED, 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 low, speak to your doctor about supplements.

Person with sleep apnea

Sleep apnea

A study found that 40 percent of patients with obstructive sleep apnea (OSA) also experienced 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 comorbid conditions that share similar risk factors.

Man holding neck

If you have a large neck...

A 2013 study out of Turkey says that men whose necks are more than 16.3 inches around are more likely to experience ED. Researchers found that those with wide necks were more likely to have metabolic syndrome — a combination of high blood pressure, diabetes and obesity — all of which can affect sexual performance.

Older man 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, horseback riders, or spin class fans may want to scale back their hours doing these activities if symptoms persist.

Toasting mugs of beer


Alcohol is associated with other conditions, like obesity and high blood pressure, which can directly cause ED. 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.

Used cigarette


Nicotine is known to constrict blood vessels and may cut off blood flow to the penis, causing ED. Some studies also show that smoking is associated with low sex drive.

Chris Regal
Meet Our Writer
Chris Regal

Christopher Regal is a former Web Producer for a variety of conditions on, including osteoarthritis, chronic pain, multiple sclerosis, ADHD, Migraine, and prostate health. He edited, wrote, and managed writers for the website. He joined HealthCentral in November 2009 after time spent working for a political news organization. Chris is a graduate of the Catholic University of America and is a native of Albany, New York.