There are many factors that contribute to erection and ejaculation. Physical and mental stimulants, hormones, neural transmissions and feedback, muscle contractions and relaxations, and cardiovascular blood flow all work together to create and maintain an erection leading to ejaculation. When any of these processes are disrupted, it can cause erectile dysfunction (ED).
The causes of ED are generally divided into two major categories: Those that are psychological in nature and those that are physical (or organic) in nature.
Psychological causes are based on cultural expectations, mental distractions, personal desires and sometimes mental illness. · Psychological causes of ED include:
- Anxiety
- Depression
- Fatigue
- Guilt
- Stress
- Marital discord
- Performance anxiety
- Excessive alcohol consumption
Physical causes of ED generally affect a particular step in the erection sequence. The most common physical causes for ED are:
Diabetes
Diabetes is one of the most common causes of ED. Nerves or blood vessels that control the flow of blood to the penis may become permanently damaged as a result of diabetes. Damage to either can lead to ED.
Cardiovascular Disease
Vascular problems, such as hardening of the arteries, can slow the blood flowing into the penis, making it difficult to get or keep an erection. (Since this affects the small vessels before it affects the bigger vessels, finding an ED problem could signal the presence of a cardiovascular disease.)
Sometimes, the veins that keep blood in the penis during an erection are damaged and don't keep the erection long enough for sexual intercourse.
Drug Therapies
Drugs, including some prescriptions for high blood pressure, depression, and a number of other conditions, may cause ED by interfering with the nerve impulses or blood flow to the penis. The following drugs can cause ED.¹
- Anti-psychotics
- Anti-depressants
- Anti-hypertensives
- Anti-convulsants
- Drugs for cardiovascular disease
- Drugs for Parkinson's disease
- Psychotropic drugs
- Amphetamines
- Histamine antagonists
- Hormones
- Opiates
Important: Medications should never be changed without your doctor's permission. Talk to your doctor about any concerns you have regarding the potential effects of medication on ED.
1. Nelson RP. Nonoperative management of impotence.J Urol. Jan 1988 v.139(1) p.2-5.
Alcoholism and Smoking
Alcoholism disrupts hormone levels and can lead to permanent nerve damage, causing impotence. Smoking may lead to vascular disease or other health problems, which may cause ED.
Hormone Problems
Certain diseases, such as kidney failure and liver disease can disrupt the balance of hormones, which control erections. Low levels of testosterone can also be a factor.
Body Trauma
Traumas to the body can result in ED. Some of these traumas include:
- Pelvic fractures
- Spinal cord injuries
- Perineal injuries
- Brain injuries
Neurological Trauma
Neurological traumas can cause ED. These types of traumas include:
- Back surgery
- Spinal cord injuries
- Some birth defects such as spina bifida and myelomeningocele
- Stroke
- Brain tumors and/or increased intracranial pressure
- Muscular disease such as multiple sclerosis (MS)
Priapism
Priapism is an erection that lasts longer than normal and is caused by reasons other than sexual desire. If an erection lasts longer than four hours, it can cause tissue injury, which will result in ED. Causes of priapism include:
- Sickle cell anemia
- Injection therapy for ED that is improperly prescribed or used
- Misuse of medications such as Viagra®
- Illegal drug use
Surgery
Surgery that interrupts blood flow or inhibits nerve innervations may result in ED. Some of these surgeries include:
- Radical prostatectomy
- Transurethral resection of the prostate (TURP)
- Bowel surgeries that involve the rectum and perineum
- Bladder or urethral surgeries
- Surgeries on or near the neurovascular bundle, such as surgery for Peyronie's disease
- Spinal surgeries
Effects of Aging
It is estimated that 65 percent of men over age 65 have some type of ED. Statistically, the number of men experiencing ED rises as their age increases. However, age alone does not cause ED. It is simply that older men are more likely to have the illnesses and treatments (such as prostate surgery) that can cause ED.
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