Causes of Erectile Dysfunction

One of the most common psychological causes of ED, anxiety stimulates the body to release the stress hormone cortisol, which constricts blood flow and, more specific to sexual arousal, limits the blood supply to the penis, thus decreasing the chance of developing an erection. If the problem persists, the idea of sex can create a confluence of fear, trauma and embarrassment that can become performance-related anxiety that exacerbates the issue. Performance anxiety contributes to erectile dysfunction by disrupting the matrix of hormones, neurotransmitters and blood vessels that lead to a thriving sex life. If performance anxiety festers, it can cause a great deal of suffering. While it's true that mental illness and sexual performance are closely knit, they are not inseparable, and there is hope.

Cycling is a healthy and fun activity. However, riding a bicycle for extended periods on a poorly fitted seat, combined with a lack of stretching, can make preexisting erectile dysfunction (ED) worse and might even cause ED by restricting blood flow and the nerves in and around the groin area.

A Harvard Health report made the case that seat shape is the primary culprit behind erectile dysfunction-related complications from cycling. The report stated that improperly fitted seats can put pressure on the perineum, the area between the anus and the base of the penis shaft. This pressure can pinch and dull nerves in the area, putting a damper on the stimulus that typically occurs during sexual arousal. Complications were most apparent in men who rode for three hours a week or more.

Much like smoking, you already know that consistent alcohol use is not great for your overall health. While some guys may enjoy the disinhibiting effects of alcohol that may temporarily make them feel horny, a lot can go wrong when you mix sex and alcohol. You've likely heard of "whiskey dick," when a night of drinking gets in the way of your erection. But heavy alcohol use, which is defined as 15 or more drinks per week for a man, can lead to a number of health problems, including high blood pressure, cancer and mental health issues.

Studies confirm that heavy alcohol use is among the top reasons that men experience long-term sexual problems, including ED. Men who are dependent on alcohol have up to a 70 percent chance of suffering from sexual problems, including ED.

You already know smoking is bad for your vascular and sexual health. Since smoking damages the blood vessels, it can lead to a poor blood supply to the penis, resulting in ED. A study in the American Journal of Epidemiology found that ED is more likely in men who smoked at some time compared with men who never smoked. The study also indicated that cigarette smoking is a more significant factor for erectile dysfunction in younger men than previously thought.

A similar study in BJU International found that men who quit smoking were more likely to have improved ED symptoms than those who kept smoking.

One of the main contributors to ED is poor vascular health due to a sedentary lifestyle. Your vascular health can be significantly improved through regular exercise, with as little as half an hour of walking each day associated with a 41 percent drop in the risk for ED.

Some studies have shown that moderate exercise might help restore sexual performance in obese, middle-aged men suffering from ED.

Try to start and stick with a regular exercise plan. The key to consistency is to find an activity that you enjoy, such as riding a bike, so you don't think of workouts as a punishment. For many men, moderate to vigorous exercise for 30 minutes each day helps them maintain a healthy weight.

Also, Kegel exercises aren't just for women. These exercises can benefit men with ED because they specifically strengthen the pelvic floor muscles, which support erections and encourage more blood flow to the penis.

Your ability to get and stay hard is based on the quality of the blood flow to and within the penis. The same poor diet that contributes to heart attacks—one high in saturated fat and cholesterol—can also affect erections.

Eating a well-balanced and nutritious diet can help you manage ED. Cut back on fats and sugars and add more fruits and vegetables to your diet. Research has indicated that ED is less common among people who eat a Mediterranean diet, which includes fresh fruits and vegetables, fish, olive oil, legumes, and little or no red meat.

A study of more than 25,000 middle-aged males published in the American Journal of Clinical Nutrition suggested that the men who ate the most flavonoids had an approximately 10 percent reduced incidence of ED compared with the men who ate the least. The risk of ED decreased by up to 19 percent in men who consumed flavonoid-rich foods such as blueberries, strawberries, apples and pears.

While a number of physical and psychological factors contribute to ED, lifestyle factors such as diet, exercise, smoking and alcohol consumption can also add to erection woes. Additionally, physical stressors on the genital area, including from bicycle riding, can lead to the development of erectile dysfunction.

If you're stressed out from work, your home life or any other area of your life, your ability to get an erection can be impaired. It's important to differentiate between good stress and bad stress. When your brain is under good stress (eustress), your body releases testosterone, which can help cause an erection. However, when the brain is under unhealthy stress (distress), your body tends to release the hormone cortisol instead. Cortisol constricts the blood vessels in the penis, and when blood cannot flow properly to the penis, ED can be the result.

Depression is a mental illness marked by sadness and feelings of hopelessness and pessimism. The sexual urge that starts an erection begins in the brain. When there is a lack of brain chemicals to stimulate the blood flow needed for an erection, it can result in erectile dysfunction. Depression causes a chemical imbalance in the brain, which can lead to a reduced sexual drive and difficulty in getting an erection.

Symptoms of depression include:

• Low self-esteem
• Feelings of guilt
• Irritability
• Fatigue
• Decreased appetite
• Loss of interest in activities you used to enjoy
• Sleep disturbances
• Apathy

Mental health issues that contribute to erectile dysfunction can be more difficult to detect and diagnose than physical health conditions. Psychological factors are often a secondary reaction to underlying physical conditions. Some studies have indicated that nearly 80 percent of men with ED also suffer from anxiety, depression or both.

While erectile dysfunction can have psychological causes, it is often the byproduct of chronic physical conditions that, on the surface, may appear to have little or nothing to do with sexual function. That they often do impair sexual activity is a reminder that male genitals are as vulnerable to chronic health problems as any other organ. Some serious health conditions that can contribute to ED are chronic kidney disease, prostate problems, Peyronie's disease, obesity and low testosterone. 

Low testosterone is a condition in which the testes do not make enough testosterone to maintain sex drive, energy levels, muscle mass, red blood cell levels, bone density and sexual function, among other things. This decrease in testosterone can be natural, the result of aging, but it can also be due to certain risk factors, including illness, cancer treatment (e.g., radiation or chemotherapy), stress, obesity and alcoholism.

Erectile dysfunction (ED) is a common side effect of many different types of medications, including those that treat hypertension, high cholesterol, epilepsy and depression.

Diuretics and beta blockers, common treatments for hypertension (high blood pressure), decrease blood flow to the penis, which is one of the main causes of ED. Diuretics also lead to zinc deficiency and that can escalate problems with testosterone production. 

High cholesterol is often treated with a class of drugs called statins (e.g., lovastatin, atorvastatin, simvastatin). These drugs can interfere with testosterone production, ultimately reducing libido, lowering sperm count and contributing to ED.

Epilepsy is commonly treated with anti-seizure medications, such as carbamazepine, phenobarbital and valproic acid. These medications may be highly effective at preventing seizures, but they also affect nerve impulses related to sexual pleasure. Anti-seizure medications can also interfere with testosterone production, contributing directly to erectile dysfunction.

Additionally, opioids, antihistamines, hair-loss medications, and medications used to treat benign prostatic hyperplasia (BPH), or an enlarged prostate, can also cause erectile dysfunction.

There is a known link between diabetes and ED. When a man's blood sugar levels stay elevated for a long time, they can experience nerve and blood vessel damage throughout the body, including in the penis. They may experience inadequate blood flow to the penis, which results in an inability to get and keep an erection.

Diabetes can also affect levels of testosterone, the hormone that fuels sexual desire, or libido. If testosterone levels are low, libido may suffer, which can also cause ED. Men with type 2 diabetes have approximately double the risk of lowered testosterone levels than men who do not have diabetes.

An erection results from a complex dance of hormones, blood flow, psychological and physical sensory input, and nerve impulses from the brain that are sent via the nervous system to the genitals. Peripheral neuropathy, or nerve damage in the extremities, injures nerves in the penis that are crucial to feeling the sensations that cause and maintain erections. This condition can be caused by a variety of physical conditions, including:

• Spinal cord injuries
• Nerve damage from pelvic operations
• Parkinson's disease
• Multiple sclerosis

Erectile dysfunction occurs when you do not get an adequate supply of blood to your penis to get and maintain an erection. Thus, vascular diseases are a common physical cause of ED. High blood pressure, high cholesterol and atherosclerosis—a thickening and hardening of blood vessels that restricts blood flow to the rest of your body—are responsible for 70 percent of ED cases that have a physical cause. For men older than 60, atherosclerosis is the culprit in half or more of ED cases. 

Atherosclerosis is the buildup of plaque in your arteries. When plaque builds up over time, your arteries get harder and narrower, reducing the amount of blood that can flow through them. Atherosclerosis can be managed through lifestyle changes (diet, exercise, weight loss), medication, medical procedures (stents) or surgery (bypass).

High blood pressure (hypertension) occurs when the force of blood against the artery walls is consistently too high. High blood pressure damages your arteries by reducing their elasticity, which can reduce oxygenated blood flow to your heart and cause heart disease. 

Erectile dysfunction can be a sign of a number of physical conditions, including cardiovascular problems, nerve damage, diabetes, chronic kidney disease, prostate problems, Peyronie’s disease, obesity and low testosterone. It can also be the result of certain medications, including those taken for the aforementioned conditions, in addition to depression, epilepsy and high cholesterol.