Last updated:

January 19, 2024


 min read

What are the causes for ED?

Delve into the complexities of Erectile Dysfunction (ED) causes. Uncover insights on health, stress, and lifestyle and how it impacts men's sexual wellness.

Reviewed by
Dr. Ritika Sinha
Written by
Shreya Shankar

Erectile dysfunction (ED) is a prevalent sexual health issue that affects millions of men worldwide. It is characterised by the persistent inability to achieve or maintain an erection sufficient for sexual intercourse. While it is a common problem, many men find it difficult to discuss openly, owing to the stigma. Understanding the causes and risk factors associated with ED is essential to help individuals seek appropriate treatment and improve their quality of life. 

The symptoms of ED include being unable to achieve an erection, or being able to get an erection but not having it last long enough for sexual intercourse to take place.

ED is diagnosed by a urologist or a general physician. The doctor will take a medical and sexual history to understand the frequency of the erection, ability to ejaculate, past medical treatments, and substance use. Doctors might perform a physical exam to examine blood pressure, pulse, hormones, and appearance and sensitivity of the penis. A mental health exam to understand any emotional or psychological issues will also be conducted. Lab and imaging tests such as blood tests and Doppler ultrasounds can be done to have a more holistic understanding of the causes of ED in the individual. Nocturnal erection tests and intracavernosal injection tests may also be conducted to find the cause for the erectile dysfunction.

Causes of ED

Physiological causes

  • Vascular problems: One of the most common physiological causes of ED is vascular issues. Poor blood flow to the penis can hinder the ability to achieve and maintain an erection. Conditions such as atherosclerosis (narrowing of blood vessels), high blood pressure, and high cholesterol levels can contribute to reduced blood flow. Over time, these conditions can lead to damage to the blood vessels in the penis, making it difficult for blood to flow in and stay there during an erection.

  • Neurological disorders: These disorders can also play a significant role in ED. The brain, spinal cord, and peripheral nerves all play a crucial role in the complex process of achieving an erection. Conditions like multiple sclerosis, Parkinson's disease, and spinal cord injuries can disrupt the normal functioning of these nerves and hinder the transmission of signals necessary for an erection.

  • Hormonal imbalances: Decrease in testosterone levels can contribute to erectile dysfunction. Testosterone is a key hormone that plays a vital role in maintaining sexual function, including libido and the ability to achieve and sustain an erection. Conditions such as hypogonadism, where the body produces insufficient testosterone, can lead to ED.

Psychological causes

  • Stress and anxiety: The mind and body are closely connected when it comes to sexual function. High levels of stress and anxiety can interfere with the brain's ability to send signals to the penis, hindering arousal and erection. Stressors such as work pressure, relationship problems, or financial concerns can contribute to ED.

  • Depression: Depression can have a profound impact on sexual function. The feelings of sadness and hopelessness associated with depression can reduce libido and make it difficult to engage in sexual activities. Additionally, some medications prescribed for depression can have side effects that contribute to ED.

  • Performance anxiety: Leads to individuals becoming anxious about their sexual performance. The fear of not being able to satisfy their partner or perform well in bed can create a self-fulfilling prophecy, leading to erectile difficulties.

  • History of sexual abuse: A history of child sexual abuse can also can sexual dysfunction in men. This can also be associated with the trauma of the event and subsequent reactions of fear to be in a sexual situation.

Lifestyle and behavioural factors

  • Smoking: The chemicals in tobacco can damage blood vessels and reduce blood flow, affecting the ability to achieve and maintain an erection. Smoking also contributes to atherosclerosis, further exacerbating the problem.

  • Excessive alcohol consumption: Heavy drinking can lead to temporary or chronic erectile dysfunction. Alcohol is a depressant that can affect the central nervous system and impair sexual function.

  • Obesity: Associated with numerous health problems, including ED, obesity can lead to hormonal imbalances, particularly decreased testosterone levels. Obesity is also linked to diabetes and cardiovascular issues, both of which are significant contributors to erectile dysfunction.

  • Sedentary lifestyle: A lack of physical activity can contribute to ED by promoting obesity, reducing cardiovascular health, and decreasing overall energy levels. Regular exercise can help improve blood flow, reduce stress, and boost self-confidence, all of which are beneficial for sexual health.

Medications and medical treatments

  • Medications: Certain medications can cause or exacerbate erectile dysfunction as a side effect. Common prescribed medications include some antidepressants, antihypertensive drugs, and medications for prostate conditions. 

  • Medical treatments: Surgeries or treatments for other health conditions can sometimes lead to ED. For example, prostate surgery, radiation therapy for cancer, or treatments for Peyronie's disease can affect the nerves or blood vessels involved in achieving an erection.

Age and Aging

Age is a natural factor that can contribute to erectile dysfunction. As men get older, they may experience a decline in sexual function due to changes in hormone levels, blood vessel elasticity, and nerve function.

Risk factors

There are various risk factors that can increase the likelihood of an individual developing erectile dysfunction. These include:

  • Diabetes: Uncontrolled high blood sugar levels can lead to nerve and blood vessel damage, contributing to ED.
  • Heart disease: Cardiovascular problems often coexist with ED, as they share risk factors such as high blood pressure and atherosclerosis.
  • High blood pressure: Hypertension can damage blood vessels and reduce blood flow, making ED more likely.
  • Psychological factors: Chronic stress, anxiety, and depression can increase the risk of developing ED.
  • Smoking and substance abuse: These habits can contribute to both physical and psychological causes of ED.
  • Obesity: Being overweight is associated with hormonal imbalances and increased risk of ED.
  • Sedentary lifestyle: Lack of physical activity can contribute to obesity and reduce overall cardiovascular health.
  • Poor diet: A diet high in processed foods and saturated fats can contribute to heart disease and obesity, which are linked to ED.
  • Sleep disorders: Conditions like sleep apnea can affect hormone levels and lead to ED.

Treatment Options

Despite the stigma attached the ED, it is a treatable condition, and there are several effective treatment options available:

Lifestyle modifications

  • Quitting smoking
  • Reducing alcohol consumption
  • Diet and exercise can help to maintain and achieve a healthy weight
  • Exercises such as Kegel exercises


  • Oral medication such as Viagra, Cialis, and Levitra can help improve the flow of blood to the penis and facilitate erections.
  • Hormone replacement therapy may be recommended if low testosterone levels are the cause of ED.
  • Supplements such as L-arginine, Vitamin D to maintain and improve overall health.

Vacuum erection devices

These mechanical devices create a vacuum around the penis, drawing blood into the organ and facilitating an erection.

Penile implants

Surgical options include inflatable or semi-rigid penile implants, which can provide a reliable and long-term solution for ED.

Psychological counselling

Therapy, such as cognitive-behavioural therapy (CBT), can help individuals address underlying psychological causes of ED, such as performance anxiety or relationship issues.


Erectile dysfunction is a common condition and can have vast impacts on an individual’s relationship, well-being, and self-esteem. Understanding the various causes of ED, whether physiological, psychological, or related to lifestyle factors, is essential for effective treatment. Fortunately, there are multiple treatment options available, ranging from lifestyle changes to medications and surgical interventions. Seeking help from a healthcare provider is the first step toward addressing ED and regaining sexual confidence and satisfaction.

Book a session with our team of experts at Rocket Health to work towards mental and sexual well-being. 


Diagnosis of erectile dysfunction. (2017). NIH.

Erectile dysfunction. (2023, August 8). Cleveland Clinic.

Hagerty, K. (2022, July 14). “Let’s talk about PTSD and erectile dysfunction.” HIMS.

Holland, K. (2017, January 23). “Is erectile dysfunction psychological?” Healthline.

Maiorino, M. I. et al. (2015). Lifestyle modifications and erectile dysfunction: What can be expected? Asian Journal of Andrology, 17(1), 5-10.

McMillen, M. (2021, August 27). “Low testosterone and ED.” WebMD.

Symptoms & Causes of erectile dysfunction. (2017). NIH.

Vasculogenic ED (Erectile Dysfunction) program at University Hospitals. (n.d). University Hospitals. program#:~:text=Representing%20the%20most%20common%20type,narrowing%


Weber, M. F. et al. (2013). Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. Medical Journal of Australia, 199(2), 107-111.