What Causes Erectile Dysfunction?

Erectile dysfunction is a common condition that affects up to half of men in the UK. It occurs when a man is having difficulties getting or keeping an erection. There are many different causes, from psychological factors such as stress or anxiety, to physical problems with your circulation or nervous system. Often, there are several factors causing erectile dysfunction, not just a single cause.

Find out what the possible causes of erectile dysfunction are and what you can do about it.

Dr Babak Ashrafi Clinical Lead for Service Development

Medically reviewed by

Dr Babak Ashrafi

Last reviewed: 09 Dec 2020

What Are the Main Causes of Erectile Dysfunction?

The most common cause of erectile dysfunction in the UK is being overweight, which is a factor in 79% of cases of ED. Heart conditions are also a major cause of erectile dysfunction, affecting 57-64% of men with ED.The table below shows some of the possible causes of erectile dysfunction, and how common they are. A person can have more than one possible cause, and some of these causes can be closely related.

Possible Cause % of men with erectile dysfunction it applies to
Being overweight 79%
Heart conditions 57-64%
Sleep disorders 54-60%
Metabolic syndrome 48%
Drinking 47-71%
High cholesterol 42%
High blood pressure 41%
Smoking 40-70%
Medication side effects 25%
Diabetes 20%
Prostate disorders 16-28%
Anxiety 15-22%
Depression 10-16%
Peyronie’s disease 8%
Atherosclerosis 6-13%
Low testosterone 4-9%
Spinal cord injury 3-5%

Other possible causes:

  • Parkinson’s disease
  • Multiple sclerosis
  • Stroke
  • Liver or kidney problems
  • Chronic obstructive pulmonary disease
  • Penis injuries
  • Hyperprolactinemia
  • Lower urinary tract symptoms
  • Thyroid disorders
  • Illegal drug use
  • Cycling a lot

Is Age a Cause of Erectile Dysfunction?

Age itself isn't a cause of erectile dysfunction, but erectile dysfunction does become more common as men get older. This is because physical conditions such as heart problems and prostate disorders, which can cause ED, become more likely as you age.

Age % of men with erectile dysfunction
Below 40 5-10%
40 22%
70 59

While ED is more common as you get older, some younger men also experience it. While older men are more likely to get erectile dysfunction due to an underlying health condition, there are psychological causes of ED that can affect younger men - such as anxiety. In fact, psychological causes of ED are more common than physical causes for younger men.

How to Tell What’s Causing Your Erectile Dysfunction

There’s no foolproof way to figure out what’s causing your erectile dysfunction, but we can help you narrow it down to the more likely possible causes.

  • Do you only have trouble getting erections every now and then? – You could be having temporary erectile dysfunction caused by one off situations
  • Do you regularly find it hard to get and keep erections, except when you’re alone or when you wake up? – You could be having erectile dysfunction related to psychological causes (more likely if you’re under 40)
  • Do you regularly find it hard to get and keep erections in all situations? – You could be having erectile dysfunction related to physical causes (more likely if you’re over 40)
one-off erectile dysfunction causes

Drugs, alcohol, and erections

Alcohol does the exact opposite of erectile dysfunction medication. It reduces how much blood flows to your penis, so getting hard is more difficult. Some illegal drugs do almost the same thing.

To see if this is causing your erectile dysfunction, try an experiment – try getting an erection without drinking first and compare it to times where you have been drinking first and see if there’s a difference.

Drinking heavily and taking drugs long-term can make your erection problems last longer, even when you’re sober.

Stress, fatigue, and erections

Anxiety and stress can affect the blood flow to your penis, and the chemical signals your brain is putting out to get erections going. And, fatigue and tiredness can stop you feeling aroused altogether.

Making sure you’re well-rested and relaxed before sex, and comfortable during, can improve your chances of getting and staying hard. Chronic stress can be managed with relaxation techniques, exercise, and counselling. Fatigue should go away with rest. If it doesn’t, then you might want to talk to a doctor and consider chronic fatigue or depression as possible causes.

physical causes of erectile dysfunction

Performance anxiety

Performance anxiety, sometimes called ‘stage fright’, is when you can’t do what you’re trying to do because the experience of being watched is too overwhelming for you to focus.

When it comes to sex, the same thing can happen. The pressure to perform can make you feel less aroused, and also cause erectile dysfunction.

Other reasons for performance anxiety can include worrying about ejaculating too quickly, fear of STIs, and even fear of erectile dysfunction itself.

When you’re feeling anxious, your blood is pumped away from places like your penis, and into the heart and lungs to try and help you get ready for ‘fight or flight’. It can also get in the way of you releasing the chemical from your brain that causes erections.

Other mental health causes

Depression and anxiety can both affect erections. Anxiety can increase your stress levels and distract you, making it difficult to feel aroused. Depression can also limit arousal and interest in sex.

The main treatments for both depression and anxiety – selective serotonin reuptake inhibitors (SSRIs, antidepressants) – can also cause erectile dysfunction as a side effect. They can also make it difficult to orgasm, too.

Relationship problems

It’s never good to jump to conclusions about your relationship because you’re having erection problems. There are lots of causes of erectile dysfunction that have absolutely nothing to do with your partner(s). On the other hand, the stresses and pressures of being in a relationship, or certain relationship dynamics, can sometimes be a cause of erectile dysfunction.

If you find that you often lose erections with one person then it could be your feelings towards them are getting in the way. It doesn’t necessarily mean you aren’t still attracted to them (but this is a possibility).

psychological causes of erectile dysfunction

Health conditions

There’s a lot of different health conditions that can cause erectile dysfunction. It is important to have a check-up with your GP if you are having problems with your erections as there may be an underlying health condition causing them.

Common conditions that can cause erectile dysfunction, and how they cause it:

Conditions How they cause erectile dysfunction
  • Heart conditions
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Metabolic syndrome

These conditions can all affect blood flow to the penis, making erections more difficult. Scientists think that smooth muscle damage could also link heart conditions with erectile dysfunction.

Diabetes can also cause nerve damage, which can affect the nerves that control your ability to get erections.

Metabolic syndrome is a term used to describe a combination of high blood pressure, diabetes, and obesity. This makes it far more likely that you will get ED than have just one of these conditions.

  • Sleep disorders
Certain sleep disorders such as sleep apnea can cause erection problems. This is because sleep apnea can affect your testosterone levels making it harder for you to get an erection.
  • Prostate disorders
Prostate infections and treatments for other prostate problems can cause erectile dysfunction. This happens in a number of different ways, including nerve damage during prostate surgery, side effects from medications, or as a direct result of infection.

Other medications

Erectile dysfunction can be a side effect of a number of different medications. Below is a list of some medications that are known to cause erectile dysfunction in some men:

  • Diuretics – used to treat high blood pressure and some other conditions
  • Antihypertensives – used to treat high blood pressure
  • Fibrates – used to lower cholesterol (but not the same as statins)
  • Antipsychotics – used for some mental health conditions, like schizophrenia
  • Antidepressants – used for anxiety, depression, premenstrual syndrome and other conditions
  • Corticosteroids – a type of steroid used for asthma and other conditions
  • H2-antagonists – used for stomach ulcers
  • Anticonvulsants – used to treat epilepsy
  • Antihistamines – used for allergies like hay fever
  • Anti-androgens – used to treat a number of conditions related to male hormones, like testosterone
  • Cytotoxics – used in cancer treatment

If you suspect that your erectile dysfunction is caused by a medication that you are taking, speak to your GP as soon as possible. Your GP may be able to suggest an alternative treatment or advise you on how to lessen this side effect.


Definitely one of the more surprising causes, but it’s true – spending a lot of time on a bike can throw a bit of a spanner in your works.

Regular cycling puts a lot of pressure on the area below your penis – the perineum, or ‘gooch’. This can affect the blood flow to the area around your penis, which can make erections less reliable.

What Are the Symptoms of Erectile Dysfunction?

Technically the only ‘symptom’ of erectile dysfunction is not being able to get or keep erections hard enough to have sex with. But, there are a lot of symptoms that you could get alongside your erectile dysfunction which are coming from one of the conditions that are causing it.Since there are so many conditions that can cause erectile dysfunction and they each have a lot of different possible symptoms, it’s hard to say which symptoms point to which causes. You can use an online symptom checker to suggest possible conditions but the best thing to do is check with your doctor.

Getting Tested for the Causes of Erectile Dysfunction

You can order an erectile dysfunction test kit online which checks for signs of:

  • High cholesterol
  • Thyroid disorders
  • Low testosterone
  • Prostate disorders
  • Hyperprolactinemia
  • Diabetes

If you go to see your doctor they may test for the conditions above, perform a physical exam, and ask questions about your health and lifestyle.

What to Do About the Causes of Erectile Dysfunction

Some things you can try based on what's causing your erectile dysfunction include:

Cause Solution
Health conditions
  • Start or switch treatments
  • Lifestyle changes
  • Cut down on, or quit, smoking
Sleep disorders
  • Review medications with your doctor
Psychological causes
  • Start or switch treatments
  • Get counselling
Stress or fatigue
  • Rest
  • Practice relaxation techniques
Drugs or alcohol
  • Cut down or quit
Prostate disorders
  • Cut down
  • Get a better seat

Depending on what the causes are, you might also be able to get treatment for your erectile dysfunction. Erectile dysfunction medications can help many people get their erections back quickly and easily.

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