What causes erectile dysfunction?

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Sexual performance is a sensitive and private subject but educating yourself about issues such as erectile dysfunction is important. Knowing more about the causes of erectile dysfunction and the possible treatments can help you to improve the condition and get your confidence back.

First of all, it’s more common than you might think. Erectile dysfunction affects 1 in 5 men in the UK (4.3 million), and is expected to affect 322 million men worldwide by 2025. So, if you struggle with erectile dysfunction and don’t know what to do about it, you’re not alone.

You don’t have to suffer in silence, and there’s no need to feel embarrassed or hopeless when there are many treatments available. This article will explain erectile dysfunction in depth to help you understand why it happens and what you can do to prevent it.

What is erectile dysfunction?

Also known as impotence, erectile dysfunction occurs when a person with a penis is unable to achieve or sustain an erection. It can develop at any age, though it does tend to be more common the older you become. Symptoms of erectile dysfunction include:

  • Inability or difficulty getting an erection
  • Difficulty maintaining an erection
  • Shame and anxiety about perceived sexual failures
  • Reduced libido (desire for sex)

Erectile dysfunction interferes with the ability to complete sexual intercourse, and can co-occur with issues like premature ejaculation or delayed ejaculation. Failing to get or keep an erection can happen to anyone at any time, so it’s not always an indication of a medical problem.

However, if you’re persistently unable to achieve or maintain an erection, it’s likely that you have erectile dysfunction. If these symptoms have lasted for 3-6 months or more, then you should visit your doctor to discuss the issue, so they can try to determine what’s causing it.

How erectile dysfunction works

Sexual arousal is a complicated process, so a problem at any stage can affect erections. When triggered by sexual thoughts or contact with the penis, the brain signals the nerves to release chemicals that will increase the flow of blood into the penis.

There are two cylindrical chambers of spongy tissue in the penis (corpus cavernosa), which relax and trap the increased blood. The resulting blood pressure causes the penis to become rigid. Upon orgasm, these muscular tissues contract, releasing the accumulated blood.

An insufficient flow of blood to the penis, or blood failing to stay inside the penis, can prevent an erection or cause an erection to fail prematurely. This could happen due to a physiological issue with blood flow or the nervous system, or problems with your mental or emotional state.

Why erectile dysfunction occurs

Though there are many possible causes for erectile dysfunction (ED), the two main categories are physical and psychological. Erectile dysfunction is often a sign of cardiovascular problems, meaning that people with this condition are commonly at higher risk of heart attacks or strokes.

A common cause of ED is atherosclerosis, a hardening of the arteries resulting from lifestyle behaviours. Risk factors for developing ED include:

  • Lack of exercise and obesity
  • Hypertension, high cholesterol, diabetes
  • Smoking, taking drugs, drinking alcohol
  • Trauma to the pelvic area (injury or surgery)
  • Tissue scarring (e.g. Peyronie’s Disease), atrophy, or fibrosis
  • Prescription drugs for chronic illness or chemotherapy treatments
  • Hormone abnormalities (thyroid issues, low testosterone, steroid abuse, etc)
  • Depression, anxiety, stress, performance anxiety

While a physical cause is often at the root of erectile dysfunction, it’s possible for the causes to be entirely psychological. However, there is usually a mix of physical and psychological elements in most cases of ED. Let’s take a look at the potential causes in more detail.

What are the physical causes of erectile dysfunction?

According to the British Association of Urological Surgeons (BAUS) , 90% of men with erectile dysfunction have a physical cause for it. Most physical causes involve reduced blood flow, or impaired nerve signals due to nerve and/or tissue damage.

There are many lifestyle choices, substances, and medications that can affect these things and result in erectile dysfunction. To give you an idea of the frequency of specific categories of physical causes of ED, here are some more statistics from the BAUS:

Physical causes of ED Percentage of ED cases
Cardiovascular disease 40%
Diabetes 33%
Hormone problems (e.g. high prolactin, low testosterone) and drugs   11%
Neurological disorders 10%
Pelvic surgery or trauma 3-5%
Anatomical abnormalities (e.g. tight foreskin, short frenulum, Peyronie’s Disease) 1-3%

Age is often related to the onset of erectile dysfunction because of the natural decline of physical and mental capacities as we get older, but it happens to people under 50, too. Many people may not realise that their substance use or medications can be linked to ED, but here are some that can lead to ED as a potential side effect:

  • Alcohol
  • Amphetamines
  • Antiarrhythmics
  • Anticholinergics
  • Antidepressants
  • Antihistamines
  • Antihypertensives
  • Anti-inflammatory drugs
  • Antipsychotics
  • Anti-seizure medications
  • Barbiturates
  • Cancer treatments
  • Cocaine
  • Diuretics
  • H2-receptor antagonists
  • Marijuana
  • Methadone
  • Muscle relaxants
  • Nicotine
  • Opiates (including opioid painkillers)
  • Parkinson’s Disease drugs
  • Steroids
  • Tranquilisers

As you can see, there are many possible reasons for ED, which can arise if you take prescription medications or other substances for physical or mental health conditions. This is why it’s so important to speak to your doctor, as they can determine whether your ED is related to your medications, and discuss which alternative options are available to you to avoid this side effect.

Never stop taking prescribed medications or change medications without consulting your doctor first, as this could have serious consequences for your wellbeing. It’s possible that your ED is caused by other factors, like your diet and exercise habits, which require further investigation before diagnosis and treatment can be decided upon.

What are the mental causes of erectile dysfunction?

As per the British Association of Urological Surgeons, a psychological problem is purely responsible for erectile dysfunction only 10% of the time. Since this is less common, there is less research into purely psychological causes of erectile dysfunction.

Part of the complication comes from the fact that psychological distress is often a secondary factor of ED. So, your ED may be caused by a physical or medical issue, but the negative mental and emotional state resulting from ED can then worsen the condition and create a cycle.

Additionally, ED can be caused by medications taken for mental issues as explained above, making ED a secondary condition resulting from treatment for a mental illness. In such cases, there is a mix of physical and psychological factors at play, rather than psychological factors alone.

Some of the mental causes of erectile dysfunction, or emotional issues that can contribute to ED, are the following:

  • Depression or low self-esteem
  • General or social anxiety
  • Stress at work, home, or school
  • Relationship problems or cultural conflicts
  • Lack of attraction or interest in sex
  • Pornography addiction
  • Sexual abuse or trauma

When these issues contribute to ED, this can result in a worsening of anxiety, stress, and self-esteem, causing feelings of guilt and inadequacy. It can also lead to physical problems such as premature ejaculation or an inability to have an orgasm.

In these cases, the cause is likely to be psychosocial, meaning that it’s a mix of psychological and social factors. Perceptions of body image, gender roles, and sexual relationships from social influences can negatively impact your emotional state and contribute to ED.

A common mental issue related to ED is performance anxiety. When you aren’t fully comfortable in a sexual situation and worry that you won’t be able to satisfy your partner, this can become a self-fulfilling prophecy. The more you worry about not being able to get or maintain an erection, the more difficult it will be do so.

The cause of your ED is likely to be at least partially psychological if you’re able to get an erection sometimes, but only experience ED in certain situations. For example, if you wake up in the morning with an erection or can become erect during masturbation, but can’t get an erection during sexual activity with a partner, this points to a psychological issue.

On the other hand, if you’re persistently unable to get an erection at all, or can’t maintain an erection under any circumstances, then the cause is likely to be physical. In either case, you should consult your doctor for more information and advice.

Who to go to for erectile dysfunction?

Sometimes ED can be a brief phase that passes without further incident. However, if you experience the symptoms of ED for 3 months or more, you need to seek medical intervention. Your doctor will be able to refer you to specialists who can investigate and create an appropriate treatment plan.

Before you can be formally diagnosed with erectile dysfunction, you’ll have to go through some testing. This includes providing information about your health history and lifestyle and undergoing a physical examination. You may be referred to a urologist for further lab tests.

Though you may feel embarrassed about talking to doctors about erectile dysfunction, they’re health professionals who regularly deal with medical issues such as ED on an impartial basis. They’re there to help you, so don’t be afraid to rely on this resource to find the cause of your ED.

How erectile dysfunction can be treated

There are many effective treatments for erectile dysfunction; the most appropriate course of action for you can be decided after determining the cause of your ED. Non-invasive treatments are preferred to start with, especially when there is a psychological element.

Most professionals recommend a combination of treatments, such as medication and lifestyle improvements, to achieve the best results. Common erectile dysfunction treatments include:

  • Lifestyle changes – improving diet, exercising regularly, losing weight, quitting smoking and cutting back on alcohol and recreational drugs
  • Emotional therapy – CBT (Cognitive Behavioural Therapy), psychotherapy, relationship counselling (being open with your partner about sexual anxieties)
  • Oral medications – e.g. Viagra, Cialis, Levitra, or Spedra (Viagra is widely available without a prescription, though others aren’t)
  • Intraurethral medication – e.g. cream absorbed through the urethra

If oral medication or topical cream don’t work, you may want to try vacuum pumping to encourage blood flow to the penis. Contact us to enquire about both a penis pump, which we can supply, or penile injections. These come in different forms and can be self-administered at home, causing an erection within 20 minutes that can last for up to 1 hour.

Finally, if these non-surgical options aren’t resolving your ED, you might want to consider surgery. A penile implant, or penile prosthesis, can help you to get and maintain an erection when other treatments have failed. Implants can also enlarge the penis, which helps with issues where ED is caused by anxiety about penis size and related sexual performance.

Moorgate Andrology can help you with a variety of treatments. Call one of our dedicated helplines, or contact us online to book a discreet consultation. We guarantee professional guidance and confidentiality every step of the way, so why not start your journey to treating erectile dysfunction with Moorgate today?

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