What causes erectile dysfunction?

Written by the Manual Team · Medically approved by Dr Earim Chaudry - MD

What is erectile dysfunction? Erectile dysfunction is defined as the inability to achieve and maintain a penile erection adequate for satisfactory sexual intercourse.

Physical and psychological health problems, smoking, hypertension and certain medications can all cause erection problems, leading to performance anxiety and depression. The good news is that most of the time the underlying causes can be addressed and ED can be successfully managed.

Is erectile dysfunction physical? Erectile dysfunction may have a disease related cause e.g. heart disease, high cholesterol, diabetes, thyroid problems, Multiple Sclerosis, Parkinson’s disease, a physiological cause e.g. hormonal imbalance or a structural cause e.g. peyronie’s disease.

Is erectile dysfunction psychological? Psychological factors are suggested when erectile dysfunction happens intermittently or in certain situations. External stress, anxiety and in some cases medication used to manage these conditions can induce ED. Psychological causes for erectile dysfunction are also more common in younger men. 

What are the main erectile dysfunction risk factors? Aging, high blood pressure and diabetes are factors which increase cardiovascular risk and can lead to the development of ED. Depression and anxiety, taking certain medications, smoking and alcohol act as modifiable risk factors that can fuel ED. 

What are the myths around erectile dysfunction? Some believe impotence to be part and parcel of getting older. It is more common among older men, but you don’t just have to learn to live with it. Likewise, young men can be affected by low testosterone, stress and other health conditions which can lead to impotence.

What are the physical causes of erectile dysfunction?

Heart disease, blocked arteries (atherosclerosis), high cholesterol, thyroid disease, high blood pressure, diabetes and obesity are some of the more common physiological causes of ED. Metabolic syndrome (high blood pressure, high insulin, abdominal fat and high cholesterol) can also cause problems getting an erection. Parkinson’s, Multiple Sclerosis and surgeries that affect the spinal cord and nerves, are another cause of impotence. 

The link between erectile dysfunction and diabetes, and erectile dysfunction and high blood pressure is well known. Medications used to treat these illnesses can also contribute to the issue. This is why drugs like Sildenafil can be introduced to support those with underlying medical conditions achieve an erection. Imbalance of essential hormones within the body, e.g. thyroid, and testosterone levels can be treated and may help to alleviate symptoms of ED.

Vasculogenic conditions 

High blood pressure can cause your arteries to become damaged. When this happens, they become thicker. This damage means the blood flow to the nervous tissue is compromised and less engorgement within the penis can occur to allow for a successful erection. Medications for high blood pressure can also be a cause of ED..

Neurogenic conditions

Diabetes can cause problems in two ways. Raised blood sugar levels sustained over a period of time can lead to the development of changes to the inner blood vessel walls, lowering blood flow to the penis. It can also damage nerves directly supplying the erectile tissue within the penis and therefore impact on the development of an erection.

Hormonal conditions 

Both hypothyroidism (underactive thyroid) and hyperthyroidism (excess thyroid hormone) can cause erectile problems. Men who have Hashimoto’s disease -the autoimmune form of hypothyroidism- may have more severe erectile dysfunction and a lower sex drive. The lack or overproduction of hormones disrupts chemical messages which control sexual desire and function. Low testosterone can also cause erectile dysfunction. The hormonal levels can be picked up on blood tests which can be arranged with your GP.

Injury or disease

Diseases which damage the nerves, like Parkinson’s, Multiples Sclerosis and Peyronie’s disease can cause erectile problems by disrupting the flow of nerve activity that triggers an erection and keeps it firm during sexual activity. 


Medications that treat high blood pressure, and anti-depressants, can impact the blood flow to the penis, making it harder to achieve an erection.

Is Erectile Dysfunction Psychological?

Depression, anxiety, mental illness and chronic stress can impact on your ability to achieve and maintain an erection. Relationship problems like poor communication and stress over financial and other matters can also affect sexual performance. 

E.D. psychological causes can be either acute or chronic. If you are stressed by a death or accident, your body inhibits testosterone, dopamine and serotonin. Erectile dysfunction psychological causes can also be the result of chronic long-term stress which raises your cortisol levels. Is erectile dysfunction mental? Yes, serious causes of impotence include bipolar disease, and schizophrenia. Impotence psychological causes like interpersonal stress make erectile dysfunction more likely. 

Performance anxiety

It’s normal to want to impress a new partner but the desire to make everything perfect for your lover can cause a build-up of stress hormones. Relaxation techniques are the easiest way to treat this problem. 

Stress and anxiety

There can also be a lot of stress in relationships like marriage or long-term partnerships. Dealing with work life and private life and struggling with financial problems can sometimes place a considerable strain on a bond and in so doing loving feelings and sexual desire may lessen.


Clinical depression is more than just feeling low or sad for a few weeks. When depression is acute or long-term it can interrupt the smooth flow of chemical and hormonal messengers that give rise to sexual desire and good erections. 

What are erectile dysfunction risk factors?

The little blue pill

It's the active ingredient in Viagra. Clinically proven to be highly effective in helping you get and keep an erection by increasing blood flow to the penis. Easier erections, happy days.
Start from £15

Lifestyle choices and health problems make erectile dysfunction more likely. Aging can make getting and sustaining erections more challenging.

Risk factors include a family history of low testosterone, depression and anxiety, taking certain medications (like antihistamines and drugs to control high blood pressure), diabetes and heart problems, being overweight, smoking and drug and alcohol use and even excessive bicycling (by putting pressure on the perineum) can cause erectile problems.


What are the myths around erectile dysfunction?

The weekend pill

It's the active ingredient in Cialis. Known as the "weekend pill" for its long lasting effects, it's clinically proven to help you get an erection when you need it - for up to 36 hours!
Start from £15

Erectile problems are not just the domain of older men. The condition affects men of all ages. Contrary to the popular mythology erectile dysfunction does not have an impact on infertility and cannot be caused by having a vasectomy. But excessive masturbation to pornography results in a progressively stronger level of visual and physical stimulation being required to achieve a result. This sets the threshold higher when it comes to a stimulus required when with a partner.