Because it is a fairly complex condition, there are several possible causes of erectile dysfunction

It needn’t be too concerning if it happens quite infrequently. However, if it begins to interfere with the quality of sexual activity and more broadly your quality of life, then it may be worth considering visiting your doctor or a sexual health expert. 

Though it can be caused by psychological problems, in the majority of instances ED is caused by a physical health condition. 

But even if your ED is caused by a physical factor, it may impact mental wellbeing, which can, in turn, make the symptoms of ED more severe. 

On this page we will consider the main physical causes of ED and talk in depth about each. 

Physical causes of erectile dysfunction (ED) 

  • Cardiovascular disease - 40.82%
  • Diabetes - 33.67%
  • Hormone problems and medications - 11.23%
  • Neurological disorders - 10.20%
  • Pelvis surgery or trauma - 3.06%
  • Anatomical abnormalities - 1.02%

Cardiovascular disease

Cardiovascular disease (CVD) is an overarching term used to describe any condition which relates to or affects the heart or blood vessels. 

It’s typically associated with blockages in the arteries, also known as blood clots, but can also surround damage, or even collapse, of the vessels too. 

Types of CVD include coronary heart diseases (like angina, heart attacks or heart failure), stroke, peripheral arterial disease and aortic disease.  

CVD is incredibly commonplace and is one of the biggest causes of death and disability in the UK. It can be the result of the following: smoking, high cholesterol, diabetes, lack of exercise or activity, being overweight or family history. 

Most people know that uncontrolled hypertension can be a precursor to heart problems in later life. But high blood pressure and erectile dysfunction are also closely linked. 

Because erectile dysfunction often relates physically to the blood vessels, it can actually serve as an early warning sign of CVD. 

This is why it’s important to see a doctor if you have persistent ED and you’re of a certain age. 

Diabetes

Erectile dysfunction is common in men who suffer with diabetes, particularly Type 2 diabetes. Type 2 diabetes is when the pancreas doesn’t produce enough insulin or the body’s cells do not react to insulin. 

Recent data shows that roughly 4 million people in the UK are living with diabetes. Of those people 90% will have Type 2 diabetes (around 4.2 million people).

Diabetes and erectile dysfunction are linked because diabetes can bring about damage to the blood vessels and nerves, which can make getting or maintaining an erection much more difficult. 

Certain lifestyle factors are also said to play a role in ED, including how much regular exercise a man gets, how often they drink alcohol and whether they maintain a balanced and nutritional diet

Hormone problems and medication

Hormonal levels can interfere with the ability to get or maintain an erection. Two particular hormones are thought to be of the most concern in relation to erectile dysfunction. 

One is prolactin, which is typically associated with the production of breast milk in women. What some people aren’t aware of is that it is present in men, though it’s not medically clear why. However, evidence has emerged that high levels of prolactin in men can be a cause of erectile dysfunction. 

A more well-known male hormone is testosterone. It’s primary function lies in the development of the testes and prostate, but it also has secondary characteristics such as increased muscle and bone mass, and the production of follicular matter. Low levels of testosterone can have a significant impact on the male body in several ways, but is also thought to cause ED. 

If your doctor believes your hormone levels may be impacting on your ability to get or maintain an erection, they may recommend a series of tests which measure the levels of such hormones. Supplementary hormonal replacement is something they may consider prescribing if they believe it will help. 

Separately, certain medications can also interfere with the ability to get an erection. Among the most prolific are medications used to treat high blood pressure, psychosis treatments, antidepressants, allergy treatments and certain recreational drugs like cocaine and heroin. If you take any prescription medication and have also started to experience erectile dysfunction, seeking an appointment with your doctor is advisable. 

Neurological disorders

A neurological disorder or condition is any which impacts the nervous system. This can include the brain, spinal cord or any bodily nerves. Neurological disorders can manifest as migraines or various types of headache, or be more serious conditions such as Parkinson’s disease, multiple sclerosis or Alzheimer's. 

Sometimes, erectile dysfunction can be a symptom of a neurological disorder. In fact, ED can actually be an early warning sign of such a condition. 

Specifically, neurological conditions can impact arousal, the erection itself and can bring about ejaculation problems. 

Pelvic surgery or trauma

The pelvis is a group of bones which sit above the legs and below the spinal cord. The majority of its surface area consists of the hip bones, but also incorporates the sacrum and coccyx.

There are a number of surgical procedures which require access through the pelvic area. Examples include surgery of the prostate or bladder. These procedures are often highly technical and meticulous, and damage to the nerves affecting erectile function is a possibility. This can have repercussions for blood flow in and out of the penis, which in turn can impede the ability to get or maintain an erection. 

A trauma or injury in these areas can also damage the nerves and blood vessels and may also impact erections. 

Anatomical abnormalities 

Every penis is different. Some people are born with, or can develop, anatomical abnormalities which can impede the ability to become erect. 

While it makes up for a very small minority of ED, it can still be a cause. One example of this is a tight foreskin, which can become extremely painful in moments of arousal when an erection is present, making it difficult to maintain. 

Vasectomy

A vasectomy, also known as ‘male sterilisation’ is a minimally invasive procedure which is usually carried out under local anaesthetic. Essentially, the small operation cuts or ties the tubes which carry sperm to the head of the penis. This leads to a state of permanent male contraception, though additional contraceptive methods (such as a condom) must be employed roughly 8 - 12 weeks following on from the operation. 

In the vast majority of successful procedures, a vasectomy will not cause any erection problems. However, even though erectile dysfunction and vasectomy are rarely physically linked, there are certain psychological side effects that can come about as a consequence of the procedure and have been known to impact erections. 

How can I combat the physical causes of erectile dysfunction? 

The simple answer is to do your best to lead a consistently healthy life. Both cardiovascular disease (which includes a plethora of conditions) and diabetes make up for roughly 73% of all physical ED causes - a vast majority. 

While some conditions cannot be helped, like Type 1 diabetes or a heart condition that was thought to be inherited, many other conditions can be prevented, or at least delayed, through healthy living. 

This can include things like eating well, exercising often, being watchful of blood pressure, limiting alcohol intake, not smoking, managing stress and keeping cholesterol levels under control. If someone does these things from a relatively early age, they will greatly reduce the risk of erectile dysfunction (as well as a spectrum of other, arguably more serious medical conditions). 

What happens if I’m young? 

Many of the physical causes of erectile dysfunction are arguably those we associate with ageing, particularly cardiovascular disease. Indeed, cardiovascular disease is one of the biggest contributors of death in the UK. It’s true to say that the older we become, the more likely we are to develop these conditions. 

However, this isn’t to say that these conditions cannot affect any man of any age. It is more unlikely, but not unheard of. If you’re under the age of 40 and are suffering with ED, you should seek an appointment with your GP. 

The prevalence of ED in young men is on the rise, but clearly young men are less likely to suffer with the physical conditions listed above. This has led certain medical professionals to argue that psychological causes may be more of a factor in younger men.

Page last reviewed:  29/07/2020