What are the real causes of erectile dysfunction?

Erectile dysfunction (ED)—two words penis-owners want to avoid. But if this is something you're struggling with, know that it’s a lot more common than you might think. In the UK, it is estimated that around 4.3 million penis-owners are affected by ED, and while it is most common in those over the age of 40, it is not a typical part of aging.

Surprisingly, getting an erection is a pretty complicated job. It’s not just a simple on-off switch—it involves your brain, hormones, emotions, nerves, muscles and blood vessels. Everyone has to show up and do their part.

So, if things aren’t rising to the occasion right now, it’s rarely down to just one thing—and it’s never a personal failure.

In 90% of cases, men will have at least one underlying physical cause, while purely psychological/anxiety-related ED is observed in just 10%. It can also be an early sign of an underlying health condition that may need attention.

This article will look at the causes of ED and point you in the right direction, so that if you’re worried about your symptoms you know what to do next.

What physical factors can cause erectile dysfunction?

The physical causes of ED can seem overwhelming, but they are common and often closely linked to your overall health.

Erections need blood to flow freely to the penis. Some heath conditions can prevent this from happening, making it more difficult to achieve or maintain an erection. For example:

• Atherosclerosis (narrowing of arteries)
• Cardiovascular (heart) disease
• Diabetes
• High blood pressure

Hormones also play an important role—in particular testosterone. Low testosterone levels, whether caused by medical treatments, health conditions, or illness, can reduce sex drive and negatively affect the processes involved in achieving an erection.

Although less common, nerve damage can also contribute to ED. Erections rely on signals traveling from the brain to the penis, and when these signals are disrupted due to trauma, pelvic surgery, or certain neurological conditions, erectile function may be affected. Think of it as WIFI with a bad connection.

Some prescription medications can also contribute to ED. Blood pressure medications such as beta-blockers and certain diuretics are known to cause erectile difficulties in some men. If this happens, it doesn't mean you should stop the medication, it means you should speak to your healthcare professional.

Remember physical causes are common. But it’s important to get to the root cause so you can manage and treat it effectively.

What are the psychological causes of impotence or erectile dysfunction?

Arousal starts upstairs. No, not in the bedroom, in the brain. And it plays a crucial role in getting you in the mood because the mind and body are in constant conversation.

Common psychological causes of ED include stress and anxiety. Stress and anxiety are major mood killers as they interfere with the brain's ability to get and stay aroused. When the body is in a state of stress, it remains in a 'fight or flight' state, which could lower sexual function.

Stress and mental health conditions also send the body’s main stress hormone, cortisol, soaring.

Ironically, the more you try to “make it happen,” the more your brain starts overthinking and erections don’t tend to thrive under pressure. This worry is known as sexual performance anxiety and is a very common psychological factor in ED.

Sound familiar?, Don’t worry, you're not alone. A survey conducted between 1999 and 2001 in Britain found that 9% of men experienced anxiety about sexual performance lasting at least one month in the previous year. And sexual performance anxiety can potentially lead to ED*. It's a concern, but it's common and can be treatable. And it doesn't mean your sex life will be affected forever.

_{*Sexual function problems and help seeking behaviour in Britain: national probability sample survey. A survey of 11,161 men and women aged 16-44.}

Lifestyle factors that affect erections

As with almost every function in the body, lifestyle choices play an essential role. Known contributors to ED include:

• Smoking
• Alcohol consumption
• Being physically inactive
• Stress

Achieving an erection can be difficult without good blood flow. If blood vessels in the penis struggle to relax properly, this can reduce blood flow to the penis, which can make it harder to get and maintain an erection.

And when you're feeling stressed and anxious, it can be hard to make good lifestyle choices for yourself. Sleep can go out the window, the nervous system stays in a constant state of alert and it's easy to forget about exercise or nutrition.

The good news here is that small, realistic lifestyle adjustments can sometimes help with ED. The following changes may improve your symptoms:

• Healthy eating
• Quitting smoking
• Limiting alcohol use
• Regular exercise

How to identify your personal risk factors

Now that you know what causes ED, start paying attention to any patterns or factors that could be affecting your erection quality. A GP can also help you identify these. Any of the following could play a role:

• Health conditions
• Stress and anxiety
• Not enough sleep
• Limited exercise

Often, ED isn’t caused by just one thing. Instead, it’s usually a combination of physical and mental factors. A combination of depression, anxiety, stress, or medication, such as antidepressants or those that lower blood pressure, can lead you to experiencing ED.

But the more you know, the more in control you’ll feel—and the closer you’ll be to finding the right fix. To help you jump back in the saddle, or under the sheets.

What to do next

There's no two ways of looking at it. ED can be stressful and upsetting for any penis-owner. But identifying the underlying causes is the first step in improving your sex life.

So, what now? If you're worried, consider speaking to a pharmacist. They can discuss helpful products or advise if you need to consult a GP. You can also visit the NHS website for further guidance and support. Remember, there are lots of treatments available that can usually help. You might feel vulnerable talking to a healthcare professional, but they can help you get the most out of your sex life so you can get back on track.

But you don’t need to put your sex life on hold. You can still experiment and have fun while you get to the root of what’s going on.

Don’t be ashamed of ED

ED is usually caused by a variety of factors, frequently in combination, which is why it's helpful to seek professional medical advice so your doctor or nurse can help you consider everything. It's also important to remember that ED is common, and many penis-owners experience it at some point. You're not alone, and there are treatments available.

Discussing your symptoms can feel daunting, but it's often the first step towards making positive and empowering changes to your sex life.

Durex Sildenafil 50mg film-coated tablets. For erectile dysfunction problems in adult men. Always read the label. Ask your pharmacist if this medicine is suitable for you.

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