Health Conditions
What is the main cause for erectile dysfunction?

What is the main cause for erectile dysfunction?

30 Nov 2022
Stefano Mirabello
Stefano Mirabello
Medical Writer

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for sexual intercourse. While it is often thought of as a problem that only affects older men, ED can occur at any age. It can be a sign of underlying causes and health problems, such as heart disease or diabetes. ED can also be caused by psychological problems, such as anxiety or depression. In some cases, ED can be a side effect of certain medications. Let’s take a look at some of the causes of erectile dysfunction and the treatment options available.

How does the erection process work?

The brain activates nerves in the parasympathetic nervous system as a result of some form of stimulation such as touch, sight, sound or something else. These nerves cause the muscles to relax so that blood flows into the penis greatly increases. The increased blood flow causes the penis to expand and harden, resulting in an erection. When the penis is erect it contains about eleven times more blood than when it is not erect. Once an erection has been achieved, the veins in the penis constrict, preventing blood from flowing out of the penis and maintaining the erection. With sufficient stimulation muscles contract ejecting semen through the urethra. This is called ejaculation or orgasm.

What are the symptoms of erectile dysfunction?

There are a variety of symptoms that can be associated with ED. In some men, the only symptom is difficulty getting or maintaining an erection. In other men, there may also be difficulties with ejaculation or orgasm. Some men may experience a decrease in libido (sex drive), and others may have problems with pain during intercourse. If you are experiencing any of these symptoms, it is important to see your doctor for a diagnosis. ED can often be treated successfully, even if the underlying cause cannot be identified or cured.

How is erectile dysfunction diagnosed?

The diagnosis of erectile dysfunction (ED) can be a difficult and sensitive process. Many men feel embarrassed or ashamed to talk about their sexual health, and as a result, ED can be a hidden problem. However, it is important to remember that ED is a medical condition, and like other medical conditions, it can be diagnosed by a healthcare provider. The first step in the diagnosis of ED is to take a detailed medical history. This will help to rule out any potential underlying causes of ED, such as diabetes or heart disease. Once potential underlying causes have been ruled out, a physical examination will be conducted. During the physical examination, the healthcare provider will look for signs of penile damage or other problems that could contribute to ED. Finally, a series of tests may be conducted to assess blood flow and nerve function. They may also order blood tests to check for underlying health conditions. With these steps, the healthcare provider can arrive at an accurate diagnosis of ED.

What causes erectile dysfunction?

Erectile dysfunction can have a range of causes, both physical and psychological.



There are a variety of physical causes of ED, including:

  • Heart disease/Cardiovascular disease/ atherosclerosis: Atherosclerosis is a buildup of plaque in the arteries that can cause erectile dysfunction. Plaque is made up of fat, cholesterol, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your heart and other organs making it difficult for blood to flow through them. This can lead to erectile dysfunction because the penis needs adequate blood flow to become erect
  • High cholesterol: High cholesterol levels can damage the blood vessels, including those that carry blood to the penis. This can lead to erectile dysfunction. In addition, high cholesterol can also cause problems with ejaculation. Seminal fluid may not be able to travel as freely, leading to reduced semen volume. High cholesterol can also cause testosterone levels to decline, which can contribute to erectile dysfunction and other sexual problems
  • Multiple Sclerosis: MS can also lead to erectile dysfunction. The exact link between MS and ED is not fully understood, but it is thought that the disease may disrupt the communication between the brain and the genitals. This can result in a loss of sensation in the penis, making it difficult to get or maintain an erection. In addition, MS can lead to fatigue and other physical issues that can reduce sexual desire
  • Diabetes: Diabetes can cause ED by damaging the nerves and blood vessels that are responsible for achieving and maintaining an erection
  • Hormonal abnormalities: Low testosterone production of the male hormone or overproduction of a hormone from the brain called prolactin
  • Parkinson’s disease: Though Parkinson’s disease is most commonly associated with tremors and difficulty with mobility, it can also cause several other problems, including sexual dysfunction. The disease can cause changes in hormone levels, which can lead to sexual problems. In addition, Parkinson’s can damage the nerves that control erections.
  • Peyronie’s Disease: Peyronie’s Disease is a condition in which the tissue of the penis becomes rigid and inflexible. This can cause the penis to bend or curve during erection, and can also lead to pain and discomfort. In some cases, Peyronie’s Disease can also cause erectile dysfunction. The exact cause of Peyronie’s Disease is unknown, but it is thought to be the result of trauma to the penis
  • Obesity: Excess weight can lead to inflammation and damage to the blood vessels, making it difficult to achieve an erection.
  • Pelvic surgery: Surgery in the pelvic area, such as for prostate cancer, can damage nerves and blood vessels, leading to ED.
  • Injuries: Spinal cord injuries or other damage to the nervous system can interfere with erections
  • Side effects of certain medications: Some prescription medications can cause or contribute to ED. These include antidepressants for mental health, antihistamines, and antihypertensives for high blood pressure


Psychological causes of ED include:

  • Sexual Performance anxiety: When it comes to sexual performance, men often feel a great deal of pressure to succeed. This pressure can lead to sexual performance anxiety, which in turn can cause erectile dysfunction. Sexual performance anxiety occurs when a man is worried about his ability to perform sexually, which can lead to stress and muscle tension. This muscle tension can prevent the penis from becoming erect or can cause the erection to be lost prematurely. In addition, sexual performance anxiety can cause low self-esteem and avoid sexual activity altogether
  • Stress: One of the most common psychological causes of erectile dysfunction is stress. Stress can come from a variety of sources, including work, financial worries, and relationship problems. When a man is feeling stressed, his body goes into fight-or-flight mode, which triggers a release of adrenaline. This hormone narrows the blood vessels and decreases blood flow to the penis, making it difficult to achieve and maintain an erection. In addition, stress can lead to anxiety and depression, which can also contribute to erectile dysfunction
  • Relationship issues: Relationship issues are often a psychological cause of ED. If you’re in a relationship where you’re constantly arguing with your partner or you don’t feel emotionally close to them, it can affect your ability to get or keep an erection. feeling anxious, stressed, or depressed about your relationship can also lead to ED. ED can be a vicious cycle, as the anxiety and stress caused by the disorder can further contribute to relationship problems

Treatment options

The good news is that there are treatments available that can help most men overcome ED. In some cases, simple lifestyle changes like exercising more and quitting smoking may be enough. For other men, oral medications, injections or implants may be necessary.

Erectile dysfunction treatment includes:

  • Viagra (Sildenafil). Viagra also called sildenafil Viagra is a prescription medication used to treat erectile dysfunction. It works by relaxing the blood vessels in the penis, allowing more blood to flow into the area and causing an erection. Viagra can be taken with or without food, and it typically begins to work within 30 minutes. The effects of Viagra usually last for four hours, although they may last longer if taken with a high-fat meal. Viagra is available in 25mg, 50mg, and 100mg tablets, and it should be taken as needed before sexual activity. For most men, the recommended dose is 50mg. Viagra should not be taken more than once per day. Some men may experience side effects such as headache, flushing, dyspepsia, or visual changes. Rarely, more serious side effects can occur, such as dizziness, fainting, or prolonged erection. If you experience any of these side effects, you should seek medical help immediately. Viagra is a safe and effective treatment for erectile dysfunction, but it is not suitable for everyone. You should speak to your doctor before taking Viagra if you have any other medical conditions or are taking any other medications
  • Vardenafil (Levitra). The drug has very similar characteristics and works the same as Viagra but the dosage differs
  • Tadalafil (Cialis). This drug works like the two drugs above but it stays active for 36 hours and its onset of action is 20mins half the time of Viagra and Levitra

Viagra, Cialis, and Levitra are all PDE-5 inhibitors. They work by inhibiting the enzyme PDE-5, which is responsible for the breakdown of cGMP (cyclic guanosine monophosphate). cGMP is a messenger molecule that is involved in the relaxation of smooth muscle cells. By inhibiting PDE-5, these drugs allow cGMP to build up, leading to the relaxation of smooth muscle cells and increased blood flow.

Do not take Viagra, Levitra or Cialis if you are also taking a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates widen the blood vessels and can cause dangerous drops in blood pressure.

  • Alprostadil (Caverject or Viridal Duo). Alprostadil is a synthetic hormone that is similar to the naturally occurring hormone prostaglandin E1. It works by relaxing the muscles in the walls of blood vessels, which increases blood flow and makes it easier for men to get and maintain erections.It can be used either as a self-injectable solution or as a suppository that is inserted into the urethra (the tube through which urine and semen are discharged). Although alprostadil is generally well tolerated, it can cause side effects such as pain at the injection site, swelling, and redness. In rare cases, it can also lead to priapism (a prolonged erection that can cause permanent damage to the penis). As a result, it is important to follow the instructions of a healthcare provider when using alprostadil
  • A vacuum device. Vacuum constriction devices are commonly used to treat erectile dysfunction. They work by creating a vacuum around the penis, which helps to draw blood into the penis and produce an erection. An elastic ring is then slipped onto the base of the penis to keep the blood inside it. The devices can be used with or without a pump, and are typically worn for 30-60 minutes before sexual activity. Vacuum constriction devices are safe and effective but may cause bruising or numbness in the penis. They should not be used by men with bleeding disorders or active urinary tract infections
  • Penile implant. A penile implant is a device that is placed surgically in the penis. The implants help to straighten and stiffen the penis, which can be helpful for men who suffer from erectile dysfunction. There are two types of penile implants: inflatable and malleable. Inflatable implants are filled with saline solution, while malleable implants are made of silicone rods. Both types of implants have their advantages and disadvantages, so it is important to discuss all options with a urologist before making a decision. In general, however, inflatable implants tend to provide a more natural erection than malleable implants. With proper care and maintenance, a penile implant can provide many years of satisfaction for both the patient and his partner
  • Vascular surgery. This is a rare ED treatment that aims to improve blood flow in the penis and is another surgical option
  • Testosterone replacement if your testosterone level is low. This comes in skin patches, gel, or injections into the muscle

Lifestyle changes

Erectile dysfunction is a common problem that can hurt both a man’s quality of life and his self-esteem. While there are many potential causes of erectile dysfunction, lifestyle choices are often to blame. Making simple changes to your diet, exercise routine, and sleep habits can often improve erectile function.

For example, obesity is a major risk factor for erectile dysfunction. Losing weight can help to improve blood flow and reduce inflammation throughout the body, both of which are important for maintaining normal erectile function.

Exercise is also important for improving blood flow and reducing inflammation. In addition, regular exercise can help to improve mental health and reduce stress levels, both of which can also contribute to erectile dysfunction.

Excessive drinking can also lead to erectile dysfunction by interfering with hormones and neurotransmitters that are responsible for sexual arousal. Reducing alcohol use can help.

Smoking cigarettes is another risk factor which can damage blood vessels and reduce blood flow to the penis. Reducing or stopping smoking is recommended.

Getting enough sleep is also important for maintaining normal erectile function. Sleep helps to reduce stress levels and promote healthy hormone levels, both of which are necessary for normal sexual function.

Making these lifestyle changes can be difficult, but they are often essential for improving erectile function.


In many cases, erectile dysfunction is a result of a combination of physical and psychological factors. Treatments for erectile dysfunction may include oral medications, hormone therapy, injections, and surgery. The most effective treatment depends on the underlying cause of the condition. With proper treatment, medical advice from sexual health professionals and openly talking to your partner about sex and your relationship, you can still enjoy a healthy and fulfilling sex life. Always inform your healthcare provider about your medical history, health conditions and any medications you take.

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