Causes of ED

Erectile disorder (ED) is a common problem and the potential causes of ED are many and varied. In this blog we look at the biological and physiological risk factors and causes, if you are looking for ‘Everything you need to know about ED’ click here .

Psychological Vs. Biological causes of ED

For most men the reality will be a bit of both. However, there is an easy way to tell which one is the main cause of ED. If morning erections or erections for masturbation happen, then it’s mostly psychological. If no erections occur, or they are always soft then it is probably biological.

Psychological –  The most common psychological factor in my experience is anxiety. Anxiety works in direct opposition to erection. Any fear response will minimise all unnecessary functions to move blood to the heart, legs and arms. This is so you can fight or flee, but it’s not great for sex. Why men experience anxiety varies. Some men get anxious because they have had ED before. Some men get anxious because they are worrying about what their partner is thinking. These are two of the most common, but there are dozens. Below is a list of potential psychological causes of ED.

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Psychological causes of ED.

  • Performance anxiety.
  • Strong emotions (Anger, Guilt, Shame).
  • Relationship problems (power struggles, lack of intimacy, guilt over affairs).
  • Mental health issues (depression, schizophrenia, panic disorder).
  • Addictions – including Smoking.
  • Generalized anxiety disorder, personality disorders or traits.
  • Poor self-esteem.
  • Negative or distracted thoughts.
  • Bereavement
  • Loss of status (such as the loss of a job)
  • Sexual-orientation conflicts.
  • Gender identity conflicts.

(List compiled from Balon 2006, Araujo et al 1998, Nobre 2010, Beck & Barlow 1986)

Biological factors – a number of medications, medical interventions and medical condition are associated with ED. Of course associated does not mean that you will get ED if you have any of these conditions. However, when consulting your doctor about ED it is a good idea to mention these.

Medical conditions which can be causes of ED

  • Diabetes.
  • Heart and circulation problem.
  • Liver and kidney problems (usually chronic or severe).
  • Penile anomalies or diseases (including Peyronie’s disease).
  • Spinal cord injuries.
  • Multiple sclerosis.
  • Parkinson’s disease.
  • Sickle cell anaemia.
  • Decreased androgen production.
  • High cholesterol (risk of ED rises with LDL Cholesterol and drops with increased HDL – Wei et al 1994).
  • Sleep apnoea.
Medical interventions that can be causes of ED.
  • Pelvic (i.e., prostatic) surgery.
  • Psychotropic drugs.
  • Antidepressants.
  • Antihypertensives.
  • Antiulcer drugs.
  • Beta-blockers.
  • Hypolipidemics.
  • Antiarrhythmics.

(List compiled from Shin et al 2013, Delgado et al 2005, Balon 2006, Wylie 2007)

Risk factors for ED

The risk of Ed rises dramatically with age (Braun 2000). One study found a 9% risk factor of occasional to severe ED in men aged 40-44. This rises steadily with age to 54% for men 65-70 (Nicolosi et al 2003). However, if this is an inevitable part of the aging process or a representation of the build-up of other factors which tend to accompany aging (reduction in activity, Cholesterol build up, increased body mass, underlying medical issues etc) is currently unclear.

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Risk factors – these are factors which are associated with an increased risk of ED but do not necessity cause it.

  • Low physical activity.
  • General high alcohol consumption.
  • Low level education.
  • High body mass.
  • Increased age.

(List compiled from Nicolosi et al 2003, Esposito et al 2004, Chew et al 2000, Derby et al 2000)