What Causes Erectile Dysfunction?

Erections are the result of a complex interplay of the brain, nerves, and blood vessels. Erectile dysfunction causes can range from injury to hormonal disturbances.

Prostate—male symbol—erectile_dysfunction

Erectile dysfunction is often the troubling consequence of all diseases of the prostate, not just prostate cancer. Fortunately there are plenty of drugs and therapies that relieve the condition.

When a man is aroused, the brain sends a signal to the nerves in the penis, which then stimulate the arteries in the penis to open up, filling with blood. Simultaneously, the veins close up and the blood in the arteries becomes trapped, causing enlargement and hardening of the penis. There’s a wide range of erectile dysfunction causes that can result in the disruption of this process. The sources of this disruption can be divided into the broader categories of physical, drug-induced, and psychological erectile dysfunction causes.

What Causes Erectile Dysfunction: Disruption of Blood Flow

  • Cardiovascular Disease: Diseases of the heart and blood vessels including hardening of the arteries (atherosclerosis) that occurs with high cholesterol levels and heart failure in which the heart pumps blood inefficiently can result in erectile dysfunction (ED).
  • High Blood Pressure: High blood pressure or hypertension damages arteries throughout the body and can lead to ED.
  • Diabetes: The high blood sugar levels characteristic of diabetes can damage the body’s blood vessels, including those in the pelvic region, and can cause ED.
  • Metabolic Syndrome: This is a syndrome characterized by high cholesterol, high blood pressure, high blood sugar, and increased abdominal fat that is associated with an increased risk for cardiovascular disease and diabetes. Damage to blood vessels similar to that in cardiovascular disease or diabetes, both of which may develop in people with metabolic syndrome, can cause ED.
  • Injury: An injury to the blood vessels of the penis or pelvic region can cause ED. This can be the result of a trauma accident or from activities such as prolonged cycling, which puts pressure on the vessels.
  • Surgery: Surgery in the pelvic region, such as for prostate cancer, may inadvertently result in damage to pelvic blood vessels resulting in ED.

What Causes Erectile Dysfunction: Nerve Disruption

  • Stroke: Damage to the brain from a stroke may impact the transmission of signals to the nerves involved in an erection resulting in ED.
  • Head Injury: Statistics show that 15 to 25 percent of men who have suffered a severe head injury causing damage to their brain experience ED.
  • Spinal Cord Injury: Injury to the spinal cord may affect the nerves involved in an erection causing ED.
  • Pelvic Injury: Traumatic injury to the nerves in the penis or pelvis whether from an accident or prolonged compression during activities like cycling may result in ED.
  • Parkinson’s Disease: Parkinson’s Disease is a disorder of nerve transmission that affects the ability to coordinate movements and can be a cause of ED.
  • Multiple Sclerosis: MS is a disease in which the protective sheaths of nerves are damaged affecting nerve function including that of the pelvic nerves.
  • Surgery: Inadvertent surgical injury of nerves, particularly during surgery for prostate cancer, can cause ED.

What Causes Erectile Dysfunction: Hormonal Disturbances

  • Thyroid Dysfunction: For reasons not fully understood, people suffering from either an overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid gland have an increased risk of ED.
  • Hypogonadism: Hypogonadism or low testosterone can be a cause of ED.
  • Cushing’s Syndrome: The elevated cortisol levels seen in people with Cushing’s Syndrome, a condition characterized by overproduction of cortisol by the adrenal glands, can cause ED.

What Causes Erectile Dysfunction: Anatomical Problems

  • Peyronie’s Disease: Peyronie’s Disease, a condition characterized by the build-up of scar tissue in the penis, causing a significant bend to the penis, can cause ED. In some men, Peyronie’s Disease is thought to be the result of an injury but in others it appears to be a gradual process not associated with a traumatic event.

What Causes Erectile Dysfunction: Drugs

A variety of different types of medications and recreational drugs can cause ED including:

  • Antidepressants
  • Some Antihistamines (including some of the H-2 antagonists such as ranitidine used to treat gastroesophageal reflux)
  • Some Diuretics (particularly the thiazide diuretics such as hydrochlorothiazide or chlorothiazide)
  • Some Hypertension Medications (particularly beta blockers such as metoprolol or labetalol)
  • Medications for Parkinson’s Disease
  • Anti-androgens
  • Some Chemotherapy Drugs (such as busulfan and cytoxan)
  • Some Seizure Medications (such as phenytoin or lorazepam)
  • Some Anti-psychotic medications
  • Corticosteroids
  • Some Cholesterol-lowering Drugs (particularly fibrates such as clofibrate used to treat elevated triglycerides)
  • Opiates
  • Cannabis or Marijuana
  • Cocaine
  • Alcohol
  • What Causes Erectile Dysfunction: Psychological Issues

    Specific psychological conditions such as depression or anxiety disorders may cause ED. Emotions ranging from embarrassment to fear to grief can all be associated with ED. Additionally, men suffering from physical causes of ED that might not necessarily have resulted in permanent ED may have added anxiety related to their sexual performance that exacerbates their ED.

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Helen Boehm Johnson, MD

Helen Boehm Johnson, MD, is a medical writer who brings the experience of a residency-trained physician to her writing. She has written Massachusetts General Hospital’s Combating Memory Loss report (2019, 2020, … Read More

View all posts by Helen Boehm Johnson, MD

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