Take a look at the possible causes for ED outlined here and see if any of the conditions may be relevant to you. You’ll then have a compelling reason to have a conversation with your doctor.

Risk Factors for ED
Seven Major Causes of ED

Lifestyle Choices


Heart Disease and High Blood Pressure

Prostate Surgery


Spinal Cord Injury

Some Common Medications

Risk Factors for ED

Briefly, the most common risk factors for ED include:

  • Medical conditions like high blood pressure, high cholesterol, diabetes and hardening of the arteries
  • Spinal cord injury, multiple sclerosis, stroke and surgery of the prostate or colon
  • Anxiety, stress and depression
  • Alzheimer’s disease and multiple sclerosis
  • Hyperthyroidism, hypothyroidism, hypogonadism and hyperprolactinemia
  • Pelvic injury, surgery and irradiation of the pelvic region
  • Medications like diuretics (water pills), high blood pressure medications, anti-depressants, some types of drugs used to treat cancer and epilepsy medications
  • Cigarette smoking, obesity, alcohol abuse and drug use

Seven Major Causes of ED

Lifestyle Choices

Certain lifestyle factors can contribute to ED. Changing or eliminating them can improve your overall and sexual health. Listed are some lifestyle factors you may be able to change.

  • Cigarette smoking. If you smoke, stop. In addition to causing cancer and emphysema, among other things, smoking adversely affects circulation. In one study, male smokers with high blood pressure and/or other risk factors were more than twice as likely to have complete ED than those who didn’t smoke.
  • Excessive alcohol consumption. If you drink, do so in moderation – no more than two drinks a day. Alcohol sedates your central nervous system and can interfere with your ability to get an erection.
  • Illicit drug use. In addition to numerous other health risks, the use of drugs such as marijuana and cocaine has been reported to cause ED.
  • Stress. Learn to relax. Stress and anxiety can adversely affect arousal and intimacy. Find a way to reduce stress – exercise, meditate, practice yoga, dance – whatever works for you.


Those with diabetes know about all the ways to manage the disease: watching diet, exercising and taking medication. What’s less well known is that between 35% and 75% of all men with diabetes also have ED. In fact, ED usually occurs 10 to 15 years earlier in men with diabetes than in the general population.

Sometimes, when diabetes is poorly controlled, ED can occur temporarily until the right medication is prescribed and the proper changes in diet are made. In other cases, where a man has had diabetes for many years, ED may not be reversible, but it is treatable.

There are two different types of diabetes: Type 1 (insulin-dependant) and Type 2 (non-insulin-dependant), each with a different time of onset for ED. Because Type 1 usually develops in young men, they are more likely to develop ED at an earlier age. On the other hand, Type 2 does not develop until adulthood, so the onset of ED is likely to be later in life.

Heart Disease and High Blood Pressure

Erections are dependant on an adequate amount of blood flowing to the penis. So conditions that affect the health of your blood vessels – like hardening of the arteries, high blood pressure and high cholesterol – are all risk factors for ED.

High blood pressure not only makes your heart work harder, but it also puts unnecessary strain on your blood vessels, which may become hard or narrow as a result. When this happens, the arteries are less able to deliver the amount of blood the body’s organs – like the penis – need. Without sufficient oxygen and nutrients, the tissues of organs like the penis can become damaged and less able to function.

Additionally, when high blood pressure is combined with other conditions that undermine the health of a person’s organs (such as heart disease, high cholesterol and diabetes), ED is more likely to develop. An estimated 80% of men with narrowing of the arteries, 64% of men who have had a heart attack and 57% of men who have had coronary bypass surgery will also experience ED.

Complicating matters is the fact that ED can also be a side effect of some of the medications used to treat high blood pressure. But treating this kind of ED may be as simple as switching to an equally effective drug that may be less likely to cause ED.

Prostate Surgery

Prostate surgery is a positive step toward solving a significant medical problem. Unfortunately, one of the side effects is ED. If the nerve connection between the brain and the penis is severed or the blood supply to the penis is disturbed, ED can be the result. If you experience ED as a result of prostate surgery, you’re not alone – it’s estimated that more than 50% of men who have the surgery develop ED.


Depression can rob you of the ability to experience many of life’s pleasures – including sex. That’s because ED is a common side effect of depression. In one study, men with depression were found to have some degree of ED, ranging from 20% to 90% depending on the severity of the depression. These emotional disturbances can create physical conditions that make it harder to get an erection.

If you have depression, the cause of your ED can be psychological, physical or even brought on by medication used to control the depression. That means there are a number of avenues open to you for treatment, from psychotherapy and behaviour modification to switching medications.

Spinal Cord Injury and Trauma

Spinal cord injury and trauma can affect virtually every system of the body but the degree of damage to erectile function depends on the severity of the injury and its location on the spinal cord. Approximately 75% of patients with a spinal injury can have erections, although the erections are not always rigid enough for intercourse.

Because healthy, intact nerves and blood vessels are necessary for an erection to occur, ED can be associated with trauma or surgery that affects the nervous system or interferes with the blood supply to the penis. Patients with serious injuries to the lower part of the spinal cord will generally have a higher incidence of ED than those patients with less serious injuries or injuries to the upper part of the spinal cord.

Some Common Medications

Common medications may bring about ED as an unwanted side effect. These include some drugs in the following categories:

  • High blood pressure medications (diuretics or water pills, beta-blockers)
  • Antidepressants
  • Some types of drugs used to treat cancer and epilepsy medications

If you suspect you have ED and that it may be the result of a medication you have been prescribed, DO NOT STOP TAKING THE MEDICATION, speak with your doctor. It may be possible for him or her to prescribe an equally effective drug that may be less likely to cause ED.

October 2017
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