What Causes Erectile Dysfunction in Males?

Erectile dysfunction or impotence is commonly caused by psychological factors. Vascular trauma or other medical conditions may also compromise a mans ability to perform sexually.

Erectile dysfunction (ED, or impotence) describes a condition in which men cannot acquire or maintain an erection.

What Are Symptoms of Erectile Dysfunction?

Symptoms of erectile dysfunction include:

• Being unable to get an erection every time you want to have sex
• Being able to get an erection, but not having it last long enough for sex
• Being unable to get an erection at any time

Erectile dysfunction can also be a symptom of other health problems.

Causes of erectile dysfunction include: 

• Limited blood flow to the penis
  • Cigarette smoking
  • Diabetes
  • High blood pressure (hypertension)
  • Obesity
  • Aging
  • Prescription medications, such as antihypertensive medications
• Neurological causes 
  • Stroke
  • Diabetes
  • Spinal cord or back injury
  • Prostate surgery that damage nerves to the penis
  • Multiple sclerosis
  • Dementia
  • Pelvic trauma
  • Previous episodes of prolonged erection (priapism)
• Drugs that affect the nervous system or that lower testosterone levels or inhibit testosterone action 
  • Opioids 
  • Blood pressure medications, such as beta-blockers
  • Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
  • Spironolactone
  • Sympathetic blockers such as clonidine, guanethidine, or methyldopa
  • Thiazide diuretics
  • Ketoconazole
  • Cimetidine
  • Nicotine
  • Alcohol
  • Recreational drugs, such as cocaine and heroin 
• Psychological causes
  • Depression, which may include loss of sex drive
  • Performance anxiety
  • Lack of focus 
• Other risk factors
  • Chronic kidney disease 
  • Peripheral neuropathy
  • Autonomic dysfunction
  • Peripheral vascular disease
  • Hypogonadism
  • Endocrine disorders 
  • Cumulative damage from years of bicycling
    • Don't avoid this sport if you enjoy it; cases of ED linked to bicycling are reported mostly in people who are professional cyclists or hardcore daily hobbyists -- more than three hours a week. Improving cardiovascular health with exercise like bicycling may actually reduce symptoms of ED.
    • Research special replacement seat types and height adjustments that don't put as much pressure between your legs if you are concerned your cycling hobby could affect your sexual performance.

Treatment for erectile dysfunction is aimed at enabling a man to achieve and maintain an erection for sexual intercourse. 

Lifestyle modifications to treat erectile dysfunction may include:

• Weight loss in men who are obese
• Exercise regularly
• Eat a healthy, balanced diet 
• Don’t smoke
• Limit or avoid alcohol

Talk to your doctor about using different medications to treat hypertension and pain. Do not stop taking any prescribed medication without first talking to your doctor. 

Medications used to treat erectile dysfunction may include:

• Phosphodiesterase-5 inhibitors 
  • Sildenafil (Viagra) 
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)
  • Avanafil (Stendra) 
• Testosterone replacement therapy 
  • Used when man's testes do not make enough of the hormone testosterone
  • Does not work to improve sexual function in men produce normal amounts of testosterone
• Medications for depression and/or anxiety

Medical treatments used to treat erectile dysfunction may include:

• Penile self-injection in which a man injects a medication (alprostadil or papaverine) into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection 
• Intraurethral alprostadil (MUSE) uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection
• Vacuum-assisted erection devices involve placing the penis in a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis. A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect. 
• Penile prostheses are surgically implanted devices that inflate to allow the penis to become erect
• Revascularization is a surgical procedure used for young men who have experienced pelvic trauma

Because depression and anxiety can cause erectile dysfunction, psychotherapy and psychoactive medications may be recommended. Counseling with a sex therapist may be helpful for men with performance anxiety.