Erectile dysfunction

Erectile Dysfunction: Why It Happens & How To Treat It

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Medically approved by Dr Earim Chaudry
Chief Medical Officer
iconLast updated 14th October 2021
Erectile Dysfunction: why it happens and how to treat it


Erectile Dysfunction, also known as ED, is probably the most common sex problem in men. It affects as many as 30,000,000 men. We define erectile dysfunction as trouble in keeping a firm enough erection to perform sexual intercourse.

Although it is not uncommon for men to have some issues with maintaining or getting an erection from time to time, erectile dysfunction is defined as being progressive or happening routinely/ commonly. If this is the case then it needs to be treated, as common and reoccurring issues with sex is not normal. 

Erectile dysfunction has many root causes, and figuring out which can mean sitting down and assessing your life and biology a bit, however, there are plenty of ways to treat it as well.

Today we will talk with you about what exactly causes erectile dysfunction, how to treat it, and how you can prevent it from happening to you as well.

Table of contents

  1. Introduction
  2. What is Erectile Dysfunction?
  3. Causes of ED
  4. How to Treat ED
  5. Other ways to Treat ED
  6. How to prevent ED
  7. Summary

What is Erectile Dysfunction?

What is Erectile dysfunction?

Understanding what exactly classifies as erectile dysfunction is the first step to preventing and treating it. There are several symptoms that are worth noting.


Erectile dysfunction symptoms can include a few different things, and it is not always all of them, it can be classified as just one of these things, or many.

Trouble getting an erection

This is probably the most commonly known symptom of erectile dysfunction. This means that you are struggling to get an erection in the first place. Your erection may be soft, only partially erect, or somewhere in between. This also means that while you may feel aroused, your erection is not mirroring how you feel. This is when you want to consider speaking to a doctor, or, better yet, book a consultation with, if you are worried about an awkward conversation with your general practitioner, Manual are the best option as treating men’s health is the forte.

While concerning and disheartening, there are plenty of ways in which you can rectify this and regain your ability to get erections. Start by finding the cause, and you will soon find the solution.

Trouble keeping an erection

This is the second best known symptom of erectile dysfunction. If you have trouble keeping an erection, then you had best see your doctor. In this case you may be aroused and may be able to achieve an erection, however, it may then mean that this erection does not last, or goes within minutes, despite arousal.

This is something that can be combated. The first step in combating any issues with keeping an erection is to look at the source, it can be due to lifestyle, medication, age, and biology. All of these things can be combat, once it is discovered which factor is causing the problem, you can start to fight it and get your erections back.

Reduced sex drive

Erectile dysfunction can also mean a reduction in your sexual desire. This can be simply that your libido has taken a downward spiral. However, it can also be due to one of the aforementioned problems causing low self-esteem, depression, and distress for both you and your partner.

This is not uncommon, if you feel like erectile dysfunction is affecting your well-being, your mental health, or your relationships, you should seek out to get it treated.

A reduction in sex drive, is commonly a sign of erectile dysfunction, and it can either be a cause or a result of the problem. This is also a sign that it may be affecting your mental health too. Mental health, confidence, and depression should never be ignored, even if it is in relation to sexual areas such as this.

Causes of ED

Erectile dysfunction can have a multitude of causes, many things that we may not even think could cause problems in the bedroom often do. Sometimes it is as simple as our lifestyle, what we eat, how we spend our days, or even the state of our mental health that can cause problems in the bedroom. Narrowing down which of these it is will help you to understand how you can fight ED.


Stress is the root cause of so many ailments, it can do horrific things to our health, it can make us sick, mess up our immune system, make us tired and increase our blood pressure, and yes, it can also cause reproductive issues as well. Stress can actually be one of the main causes of erectile dysfunction because it can cause so many other issues such as increasing our blood pressure, making us depressed and anxious, and of course when we are stressed we often tend towards unhealthy diets like comfort eating, alcohol, smoking, or even drugs.

So if you suffer from erectile dysfunction, take a look at the stress levels in your life first and foremost.

Depression and Anxiety

It is not unheard of that depression and anxiety can lead to a loss in libido, although it can also send you into a state of heightened libido, it can also decrease it rather a lot, this is more common.

Feeling depressed and anxious can have a similar effect on the body as stress does, and therefore can cause similar problems. It is also not uncommon for erectile dysfunction to cause depression and anxiety, and therefore experiencing this disorder as well as depression and anxiety should always be considered as one thing affecting the other and vice versa.

Hormone Abnormalities

Hormone abnormalities can cause ED, things such as increase in prolactin, which is a hormone that is made by the pituitary gland. Similarly, steroids used by bodybuilders can cause erectile dysfunction as well. Too little or too much of thyroid hormone, and hormones also used to treat prostate cancer, can cause ED.

It is also possible for low testosterone levels to cause erectile dysfunction as well.

Heart Problems

The most common heart problem associated with erectile dysfunction is heart disease. There is a very strong link between the two, in fact, several studies actually show that if a man has erectile dysfunction then there is a greater risk that he may also have heart disease. ED presents a greater risk of heart disease, as much so as smoking or a family history of coronary artery disease.

Clogged Blood Vessels

One of the paths that leads to erectile dysfunction starts in the heart, which pumps blood throughout the arteries to all areas of the body. Erectile dysfunction can often occur when these arteries are blocked by plaque. Thus meaning that clogged arteries can cause erectile dysfunction.

Cholesterol builds up on vessel walls, which can then cause them to narrow and slow down the blood flow. If it is bad enough, the blood flow can come to a halt. This condition can also cause angina, heart attacks, stroke and claudication which is a pain in the legs while walking. If you have ED, it is a good idea to get it checked as soon as possible. If the cause is due to clogged blood vessels, then your lack of an erection could very well be the problem that prevents these life-threatening possibilities.

High Cholesterol

As noted above, cholesterol has played a role in erectile dysfunction. Too much bad cholesterol in the bloodstream creates a plaque in the arteries, which damages and blocks the flow of blood. These blockages result in an inadequate circulation of blood through the whole body, including the penis. As a result of this, you will see problems with getting or maintaining an erection. Thus, if you are having trouble getting it up in the bedroom, get yourself up to the doctors. 

High Blood Pressure

Similar to how high cholesterol can cause issues in your sex life, high blood pressure can, too. Having high blood pressure damages the artery walls, which causes them to harden and narrow. Similar to cholesterol, his high blood pressure will then reduce the blood flow to your penis. In fact, erectile dysfunction is actually an early warning sign that you have damaged blood vessels.


Erectile dysfunction is common in men who have diabetes, especially those who have type 2 diabetes. It is not uncommon for it to stem from damage that has been done to blood vessels and nerves, which is caused by poor long-term blood sugar control. Much like in the aforementioned cases, diabetes is linked to ED through the damages of the internal system that carries blood to the penis that enables an erection to occur. When these vessels, nerves, and arteries are damaged, blood cannot get to the penis to provide or sustain an erection. If you have ED and diabetes, it is time to see the doctor.


Obesity can also cause erectile dysfunction. As well as the many other health conditions that can be caused by this, erectile dysfunction is one. Being overweight or suffering from obesity can cause ED by damaging the blood vessels, decreasing the testosterone in the body and causing a general state of inflammation. Obesity can also cause damage to blood vessels due to hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia. And as we know, damage to blood vessels can prevent adequate blood supply to the genitals.

Parkinson’s Disease

Parkinson’s disease affects the central nervous system, thus men who suffer with Parkinson’s Disease may find themselves unable to get or maintain an erection, let alone be able to ejaculate. Issues that surround blood circulation to the penis and the pelvic muscles can also further lead to ED.

As we know any issues referring to or in relating to the nervous system can or will affect the ability to get or keep an erection, as nerves, as well as blood supply are part of what assist the body in becoming erect for sexual intercourse.

Multiple Sclerosis

Anywhere from 35% to 50% of men who have MS will also experience problems with ejaculation. These problems can include delayed ejaculation or not being able to ejaculate at all. 

MS can cause sexual dysfunction in men. Often in reference to the neurological nervous system lesions of MS that can contribute to issues such as the loss of sensation or erectile dysfunction. This can happen as the effects of MS can cause issues on the pathways in the brain and the spine. There are some medications used in the treatment of MS that can impair sexual function due to the effects on the spine or on the brain.

There are many medications that themselves can cause ED, however, most of the time, these medications are saving you from something much worse.

Certain Medications

Although not ideal, there are a fair amount of prescription medications that have erectile dysfunction as a side effect. Although these medications treat a disease or a condition, as they do this, they can affect men’s hormones, nerves, or the circulation of blood, thus possibly causing ED, or an increase in the risk of developing ED.


We have already spoken about how healthy blood vessels are a requirement to getting a good erection. Smoking damages this. Male smokers do have an increased risk of erectile dysfunction, as the damage caused by the chemicals in cigarettes can affect their blood vessels, thus narrowing the arteries and causing a bad blood supply to the penis.

While many would argue that this isn’t the case, as they have smoked for years and can still perform in the bedroom just fine, or they know someone who wasn’t affected, there is no guarantee that it will happen. This just means that there is an increased risk it will happen among smokers.

Peyronie’s Disease

There is no confirmation that Peyronie’s Disease causes erectile dysfunction, however, there have been some correlations that raise questions, and there are a few reasons scientists believe this may be. These are; the plaques may weaken the smooth muscle tissue in the penis, thus making it harder for an erection to occur. The plaques may also impair blood flow into the penis, and as a result there is not enough of a blood supply for a firm erection to form. Similarly, it could be that the plaques cause blood to leave the penis too quickly, making the man lose his erection faster than is usual. 

Alcohol and Substance Abuse

It is no surprise to anyone that alcohol thins the blood and affects our oxygen levels and sleep quality. Many drugs will do the same, drugs such as barbiturates, nicotine, and heroin all decrease sexual desire. Marijuana can prevent smooth muscle in the penis from relaxing enough to let blood flow in, and amphetamines can cause blood vessels to narrow, thus preventing enough blood from reaching the penis.

Alcohol can greatly affect all parts of the body that are necessary to create an erection, alcohol also lowers hormone levels, including testosterone, and damages cells in your testicles. Even very mild damage from alcohol consumption can prevent you from adequately getting or keeping an erection.

Sleep Disorders

Sleep disorders can impact the levels of testosterone and oxygen in your body, this can lead to a variety of different issues, including erectile dysfunction. Research has actually found that there is a connection between erectile dysfunction and men who suffer with obstructive sleep apnea, although doctors are still not 100% sure why this is exactly the case.

Low Testosterone

Having low testosterone levels can make it hard to get or maintain an erection. Testosterone is the hormone that stimulates the tissues in the penis to produce nitric oxide, which starts off several reactions that result in an erection. If the levels of testosterone are too low, a man may therefore be unable to get or maintain an erection.

Enlarged Prostate

Doctors believe that urinary tract problems in men that are caused by an enlarged prostate can be associated with erectile dysfunction. These two very common conditions may often share a common cause. Research shows that lower urinary tract symptoms are more common as men age and their prostates start to enlarge, thus restricting the flow of urine. Similarly, problems with erectile dysfunction are also more common in older men, thus affecting more than 100 million men worldwide who are over the age of 65. 

It has been noted that as men’s symptoms for urinary tract problems increase, the level of sexual function also decreases, pointing out that there are possible ties. It is very possible that as the prostate enlarges in men, it does not only restrict urine flow from the bladder but also affects the functionality of a man’s sexual organs.

Erectile dysfunction causes

How to Treat ED

Many men who suffer with Ed feel a bit helpless, and this is a condition that can really affect mental health as well as sexual health. Yet, it is treatable in multiple ways. Let’s take a look at these.

Oral medications

Oral medications are one of the most successful erectile dysfunction treatments for any man. There are several medications that can be taken, and all of these enhance the effects of nitric oxide, which is a natural chemical found inside your body that relaxes muscles in the penis, thus allowing adequate blood flow and allowing you to get an erection in response to sexual stimulation.

Taking any of these tablets will not automatically provide you with an erection, sexual stimulation is required to cause the release of this natural chemical. These medications simply amplify the signal, allowing normal penis function in people who otherwise struggle to achieve this.


This is probably the most well known treatment for ED, and is widely available. Viagra works by relaxing the muscles and arteries inside your penis, helping more blood to reach the penis. When you are aroused, the combination of relaxation and increased blood flow will help to fill the penis with blood and thus provide an erection.


Some would say that Tadalafil is better than Viagra. It does offer many advantages; its longer duration, and faster reaction with milder side effects. Although both tadalafil and Viagra rely on an empty stomach, tadalafil is not affected by food in the way that Viagra is. 


Vardenafil is another option. It works within 60 minutes of taking it and penal stimulation is required. It has a positive success rate, although not being as common or popular as the aforementioned options, it is still a valid option for men who need that help.


Clinical studies conclude that Avanafil has a similar efficiency to Viagra, however it is viewed as being more favorable in terms of interactions with other drugs, and side effects. However, it also has less of an effect on lowering blood pressure.

Other ways to Treat ED

Penis Pumps

An erectile dysfunction pump is a device that is used to help you to achieve and maintain an erection by drawing blood into your penis via air suction. It is not a cure for this disorder, however it can increase your ability to engage in sexual intercourse. It is not an option for everyone, but for those who choose to use it, it can be a useful tool to boost confidence despite suffering with ED.

Surgery and Implants

This is known as erectile dysfunction penile prosthesis. It includes two attached cylinders, a reservoir and pump, which are placed surgically into the body. They are inserted into the penis and connect via tubing to a saline reservoir. In order to inflate the prosthesis, the pump should be pressed and saline will be pumped to the cylinders in the penis, inflating them and then causing an erection.

Lose weight if you are overweight or obese

Losing weight can be one of the best ways to restore normal erectile function. A study found that 30% of men taking part in a weight loss study regained normal sexual function after losing 33 lbs over 2 years. In some cases being overweight can affect sexual function and when this is the case, weight loss can be a fantastic way to regain your sexual abilities without external medical assistance.

Include physical activity in your daily routine

Physical activity has also been identified as being an effective treatment for erectile dysfunction. A study was conducted which found that participants of whom were active had better erectile function than those who were inactive or sedentary.

Eat healthier

Some research would suggest that the consumption of foods which are high in flavonoids- which is a type of antioxidant, can help to reduce the risk of erectile dysfunction. When we think of how cholesterol and high blood pressure can cause it, it is no real surprise that healthy eating can help to rectify this. 

How to prevent ED

The best way to treat ED is to prevent it from occurring in the first place, prevention is always better than treatment, and so there are many steps in which you can take to try and catch it out and prevent it from taking hold in your life.

Sometimes it is possible that ED can affect you based on lifestyle choices. Here, we will look at several ways that you can combat ED before it takes control in your life, preventing it from becoming a problem for you.

Get yourself checked regularly with your doctor if you have concerns

One of the main steps to combating ED is to check with your doctor, or seek out a consultation with Manual- for discreet and continual support- as soon as you have concerns regarding your sexual health. If you start finding sexual intercourse more challenging, or if you struggle to get a full erection or maintain an erection, even just a little, it is worth speaking to a specialist. Even the slightest problem could be a sign that ED is on its way to you, and it is better to be safe than sorry.

Always speak to your doctor if you have any concerns in regard to your sexual health and do not be afraid to be upfront about how your habits, bodily functions, and general health are. Any of this information can help stop you from getting this problem.

Stop smoking

If you are a smoker, quit. While this is easier said than done, it will benefit your health overall, general and sexual. If you have trouble quitting, try nicotine replacements, such as patches, gum and so on. Your doctor could also prescribe you medication. If none of this works, you can try to use electronic cigarettes, as these give you the option to slowly lessen your nicotine intake. This is an option best for heavy or chain smokers, it will let you slowly lessen your nicotine intake rather than quitting cold turkey.

Limit alcohol consumption

Limit your alcohol intake, consider the alcohol limit considered okay. The safe limit for drinking is around 100grams per week for men and women. However, if you suffer with alcohol addiction or dependence seek out help, talk to your doctor and try to find a way that you can lessen your intake or quit altogether. Not only will it improve your sexual health, but your liver and kidneys will thank you for it.

Don’t use illegal drugs

Similarly, drugs will affect your body in multiple ways, your brain, stomach, liver, kidneys, and other organs will all suffer for it and of course, your sexual function as well. Try to get help if you find it hard to quit, speak to a doctor, or seek out a form of rehabilitation to combat this and regain your health. Doing illegal drugs can worsen erectile dysfunction directly, or indirectly by causing other long-term health problems. 

Do plenty of exercising

Exercise helps the blood flow better and will help in preventing weight gain, which can also cause erectile dysfunction. You do not need to be hitting the gym, but getting out of the house and getting some sun, going on a walk, hiking through nature, taking up cycling, or even horse riding can be beneficial, why not jog to the shop or if you have a dog take it for a run rather than a walk. There can be some negative connotations around exercise, however it doesn’t need to be painful, simply a little can boost your whole body and fend off erectile dysfunction.

Find a way to reduce stress

Stress is not just an erection eradicator, it can really be a killer. Stress can lead to a whole multitude of severe health conditions. So, for the sake of your erections and your overall health, getting rid of sources of stress is imperative. Sometimes we cannot get rid of the sources of stress, as sometimes it can be down to work, family, or financial distress, however, finding ways to cope and release the stress will prevent it from becoming a ruling factor in your life. Meditation, nature walks, music, a relaxing hobby, exercise, gardening, anything, find something that elevates your stresses when you cannot remove the source altogether. 

Get help for anxiety or depression

If anxiety or depression is a ruling factor in your life, getting help is necessary. Obviously it will make your life really hard anyway as it is tough to live with and will be painful for you. However, with the among of physical ail these problems can also cause, such as ED, it gives even more need to combat it. Speak to your doctor, a therapist, or if you have already found that these issues are trigger ED, you could seek out sexual health therapy, especially if your anxiety or depression are related to sexual activity in particular.

Change your diet

Finally, consider your diet. Eating a lot of foods that increase your blood pressure and cholesterol will do you no good at all. Remember that you need 5 fruits or veg a day, why not switch out a breakfast of bacon and egg for a fruit salad and some cereal.

Some foods can actually help erectile dysfunction, such as watermelon, oysters, coffee, dark chocolate, nuts, and garlic. If you are already showing signs, try to mix some of these into your daily meals.


Erectile dysfunction plagues many men across the world, and it has so many causes that it can be hard to narrow it down. It is a condition that not only affects a man’s sexual health but can be detrimental to their mental health and confidence, do not worry though, you are not alone and there are many cures and treatments. Speak to your doctor, or get that Manual consultation to find the root of your problem and with this specialist help and with dedication and treatment you will be back to the bedroom living your best life in no time at all.

While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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