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What causes erectile dysfunction?

Erectile dysfunction (or “ED”) is the term used 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 conditions that affect your circulation or nervous system. It may be the case that more than one of these factors is affecting you. 

Studies show that almost half of all men aged 40-70 have had difficulty getting an erection at some point and, although it is more common later in life, 1 in 10 men under 40 have also reported that they have experienced ED.

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Man thinking about the causes of ED

More Information

As we mentioned earlier, there can be physical and psychological reasons for erectile dysfunction.

It is important to have a check-up with your GP if you cannot achieve or maintain an erection. Your GP will check whether there is an underlying cause for your ED.

Physical causes of erectile dysfunction include:

  • High blood pressure, high cholesterol and smoking, all of which can damage your blood vessels over time
  • Problems with the heart or circulatory system
  • Obesity
  • Diabetes
  • Hormonal Conditions, for example, overactive or underactive thyroid, Cushing’s syndrome or hypogonadism
  • Neurological conditions like Multiple Sclerosis, Parkinson’s disease, a spinal injury or a stroke
  • Anatomical Problems that change the physical structure of your penis, for example Peyronie’s disease
  • Binge drinking
  • Certain prescription medications (please ask your GP if the medication you are taking may be causing ED)
  • Recreational drug use
Which psychological causes are there?

Worrying about being able to get an erection is one of the most common psychological causes of erectile dysfunction.

If you have had a negative sexual experience, it can lead to you feeling anxious about sex. Similarly, stress, other types of anxiety and depression can also lead to erectile difficulties. Relationship problems can also affect your ability to gain an erection.

If you are suffering from ED, do not hesitate to speak to your GP or online doctor.

Does treatment vary?

Depending on the causes of your erectile dysfunction, the treatment options will also vary. Most of the times where the cause is physical, the most common approach is to treat the underlying physical condition that’s causing this issue.

If the causes are psychological, PDE-5 inhibitors such as Viagra or Cialis may be prescribed to help you treat ED. 

If you’re able to get erections in other occasions that don’t necessarily anticipate sex, such as when masturbating or when you wake up, it would indicate that your issue may be psychological. Being stressed or getting anxious about having sex are some examples of things that can cause “performance issues”. Not being able to get an erection in any situation often means that there may be a physical problem causing ED.

You should get a consultation with an online doctor or your GP if you’re not sure of what the reason could be.
Your GP will check your blood pressure, cardiovascular health (heart and blood vessels) and perform blood tests to check your cholesterol and blood sugar levels. If you are over 50, it is important that your GP also examines your prostate. Depending on your general health, the GP may need to do other tests, for example, blood tests for hormone levels.
Erection problems are a lot more common than most people think, and you shouldn’t be too alarmed if it happens to you once or twice. There are a few things that can cause one-off erection problems:

  • Stress – it’s normal to have periods of time when you feel stressed,  a more intense period at work or a personal issue.
  • First-time jitters –  if it’s your first time, or if you haven’t had sex in a while, it’s normal to have a bit of performance anxiety, and that can make getting and maintaining an erection more difficult.
  • Alcohol – a common cause of erection problems. Alcohol can inhibit your ability to get an erection and can be a cause of erectile dysfunction.
  • Anxiety – if you’re feeling anxious about sex, pleasing your partner, or any other matter, it can make it harder to get an erection.
Your ED can be indirectly caused by your diet. If you have a physical condition, such as diabetes or a heart condition, then improving your diet could make significant improvements to your overall health and your ability to get an erection.
Besides that, there aren’t any foods or non-alcoholic drinks that can directly cause erectile dysfunction.

Recreational drugs can cause erectile issues. Substances such as cocaine, marijuana, or heroin can cause impotence. Nicotine also plays a role in this, so quitting, or reducing the amount you smoke, may be effective. If you need some help to cut down on the amount you smoke, there is treatment available.

Some medicines can also cause ED:

  • Diuretics – Commonly used to treat high blood pressure, heart failure and kidney problems, they are sometimes referred to as a “water tablet” as they cause you to produce more urine
  • Antihypertensives – used to treat high blood pressure, e.g. beta-blockers
  • Fibrates – prescribed to decrease cholesterol levels
  • Antipsychotics – used for some mental health conditions, like schizophrenia
  • Antidepressants – prescribed to tackle depression or sometimes pain
  • Corticosteroids – contain steroids
  • H2-antagonists – used for stomach ulcers
  • Anticonvulsants – prescribed to treat epilepsy
  • Antihistamines – used to manage allergies, like hay fever
  • Anti-androgens – suppress androgens (male sex hormones)
  • Cytotoxics – used in chemotherapy
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.


If the causes of your ED are psychological, you should consider getting counselling in order to overcome these difficulties. Some issues may be solved with a bit of time and some lifestyle changes, but others require a more clinical approach. 

If you have an underlying physical condition for your erectile problems, you should consider getting treatment for it. Addressing the physical condition that is causing your erectile dysfunction may help you fully recover. 

Medications such as PDE5-inhibitors cannot treat the underlying physical or psychological causes of ED. But they can help you get normal erections while you’re getting treatment for them.