ERECTILE DYSFUNCTION
Physical causes
About 8 in 10 cases of ED are due to a physical cause. Causes include:
•
Reduced blood flow to the penis. This is, by far, the most common cause of ED in men over the age
of 40. Like in other parts of the body, the arteries which take blood to the penis can become narrowed. The
blood flow may then not be enough to cause an erection. Risk factors can increase your chance of narrowing
of the arteries. These include getting older; high blood pressure; high cholesterol; smoking.
•
Diseases which affect the nerves going to the penis. For example, multiple sclerosis, a stroke, Parkinson’s disease, etc.
•
Diabetes. This is one of the most common causes of ED. Diabetes can affect blood vessels and nerves.
•
Hormonal causes. For example, a lack of a hormone called testosterone which is made in the testes.
This is uncommon. However, one cause of a lack of testosterone that is worth highlighting is a previous head
injury. A head injury can sometimes affect the function of the pituitary gland in the brain. The pituitary gland
makes a hormone that stimulates the testis to make testosterone. So, although it may not at first seem connected, a previous head injury can in fact lead to ED. Other symptoms of a low testosterone level include a
reduced sex drive (libido) and changes in mood.
•
Injury to the nerves going to the penis. For example, spinal injury, following surgery to nearby structures, fractured pelvis, radiotherapy to the genital area, etc.
•
Side-effect of certain medicines. The most common are some antidepressants; beta-blockers such as
propranolol, atenolol, etc; some ‘water tablets’ (diuretics); cimetidine. Many other less commonly used tablets
sometimes cause ED.
•
Alcohol and drug abuse.
•
Cycling. ED after long-distance cycling is thought to be common. It is probably due to pressure on
the nerves going to the penis, from sitting on the saddle for long periods. This may affect the function of the
nerve after the ride.
•
Excessive outflow of blood from the penis through the veins (venous leak). This is rare but can be
caused by various conditions of the penis.
In most cases due to physical causes (apart from injury or after surgery), the ED tends to develop slowly.
So, you may have intermittent or partial ED for a while, which may gradually get worse. If the ED is due to
a physical cause, you are likely still to have a normal sex drive apart from if the cause is due to a hormone
problem. In some cases, ED causes poor self-esteem, anxiety, and even depression. These reactions to ED can
make the problem worse.
ERECTILE DYSFUNCTION
•
Excessive outflow of blood from the penis through the veins (venous leak). This is rare but can be
caused by various conditions of the penis.
In most cases due to physical causes (apart from injury or after surgery), the ED tends to develop slowly.
So, you may have intermittent or partial ED for a while, which may gradually get worse. If the ED is due to
a physical cause, you are likely still to have a normal sex drive apart from if the cause is due to a hormone
problem. In some cases, ED causes poor self-esteem, anxiety, and even depression. These reactions to ED can
make the problem worse.
Mental heath (psychological) causes
Various mental health conditions may cause you to develop ED. They include:
•
Stress - for example, due to a difficult work or home situation.
•
Anxiety.
•
Relationship difficulties.
•
Depression.
Typically, the ED develops quite suddenly if it is a symptom of a mental health problem. The ED may resolve
when your mental state improves - for example, if your anxiety or depression eases. However, some people
become even more anxious or depressed when they develop ED. They do not realise it is a reaction to their
mental health problem. This can make matters worse and lead to a vicious circle of worsening anxiety and
persisting ED.
As a rule, a psychological cause for the ED is more likely than a physical cause if there are times when you
can get a good erection, even though most of the time you cannot. (For example, if you can get an erection by
masturbating, or wa