Causes of erectile dysfunction

To understand what causes ED, you have to first understand the main processes that result in an erection.

When you’re aroused, your brain sends a chemical message to the blood vessels in the penis. This causes the arteries in the penis to relax and open up, allowing more blood flow in.

Once blood is in the penis, pressure traps it within the corpora cavernosa (the spongy tissue that runs along the shaft), causing the penis to expand and hold the erection. The inflow of blood stops once you’ve stopped being aroused or after ejaculation, and the penis becomes soft again.

This process depends on a lot of systems in your body functioning properly. So in addition to sexual stimulation and desire, gaining and maintaining an erection therefore depends on four physical factors:

• nerve impulses being conducted successfully in the brain, spine and penis by a healthy nervous system
• healthy arteries that supply sufficient blood flow around the body, particularly to the corpora cavernosa.
• the muscles and fibrous tissues inside the corpora cavernosa remaining healthy and smooth.
• the penis containing adequate levels of nitric oxide.

Cardiovascular conditions

An umbrella term for a group of conditions that affect the functioning of the heart and, more crucially in the case of ED, circulation.

These conditions cause blood flow to be restricted to a lot of your essential organs, including your heart and brain. It puts you at a much higher risk of serious cardiovascular events (heart attack or stroke) but can also cause ED.

This is because, as well as the rest of your body, blood flow is restricted to the penis. The penis needs adequate blood flow to the arteries and blood vessels to get hard, so when you have a vascular condition, you are at a higher risk of ED.

Cardiovascular conditions that are ED risk factors include:

• high cholesterol
• high blood pressure (hypertension)
• atherosclerosis (clogged blood vessels)
• coronary heart disease

Diabetes

Diabetes, specifically type 2 diabetes, is another leading cause of ED. In fact, studies have estimated that 50% of men diagnosed with type 2 diabetes will develop ED within 5 to 10 years of their diagnosis.

Diabetes is an endocrine disorder that develops when blood sugar levels are too high. Over time and without intervention, this can damage the blood vessels. Similar to the cardiovascular conditions, this can limit blood flow to the penis.

Poorly controlled blood sugar levels also cause nerve damage, a phenomenon known as diabetic neuropathy. Whilst this is typically prevalent in the legs and feet, it can also be linked to impotence in men.

Neurological disorders

Impotence can also be a complication of neurological disorders, sometimes known as neurogenic ED. There are two main ways this can occur.

The first is that these disorders can interfere with the processing of sexual stimuli, affecting your sex drive and meaning it can be more difficult to get aroused.

The second reason is that they also disrupt the physical process, as these conditions can disrupt the neural pathways between the spinal cord (the central nervous system) and the pelvic nerves. The pelvic nerves are responsible for orgasm, ejaculation as well as erectile function.

Examples of neurological disorders that cause ED include:

• multiple sclerosis (MS)
• Parkinson’s disease
• multiple system atrophy (MSA)
• spinal cord injury
• Alzheimer’s disease
• epilepsy and other conditions that cause seizures

Whilst there are few studies on the effect of the nervous system on sexual dysfunction, one study found that almost 40% of men with a neurological disorder had ED, of which half had moderate to severe ED.

Alcohol

Alcohol is notorious for impeding sexual function in the short-term, a phenomenon sometimes known as “whiskey dick”.

However, many don’t realise that excessive alcohol use can cause long-term ED. Studies report that 72% of men who are dependent on alcohol suffer from sexual dysfunction, of which ED was found to be the most common sexual problem.

It is linked to ED in several key ways:

• interferes with neural pathways between the brain and the rest of your body
• causes dehydration, which can reduce circulation and blood flow to the penis
• alcohol is high in calories and sugars, which can clog the arteries and damage the blood vessels over time
• can cause low testosterone levels which is linked to ED and low libido
• affects your sleep, which can cause impotence in some men

Alcohol is also a huge risk factor for cardiovascular conditions such as high cholesterol and high blood pressure as well as type 2 diabetes, all of which can increase your risk of developing ED.

Smoking

Smoking can also cause erectile dysfunction. As well as being detrimental to your health in many ways, heavy smokers were found to be twice as likely to develop the condition.

Nicotine, the addictive substance in cigarettes, has been linked to ED. This is because the drug can affect the hormones responsible for penile tissue function. More specifically, it causes these tissues to rapidly contract and restrict blood flow to the key arteries.

In addition, much like alcohol, the toxic effects of smoking can damage your blood vessels which is both a risk for ED on its own as well as for cardiovascular disease.

Medicines

ED is also a potential side effect of certain prescription medications. There are more than 200 medicines that may cause it, but here is a list of the most relevant and most commonly prescribed:

• medicines to lower high blood pressure
• medicines to treat mental health disorders
• certain antihistamines (to treat allergies, sleep problems or heartburn)
• medicines to treat an enlarged prostate
• painkillers, opiates and NSAIDs (non-steroidal anti-inflammatory drugs)
• sumatriptan - for migraine
• pseudoephedrine - for nasal congestion
• finasteride - for male pattern baldness

Make sure you check the list of side effects of your medicine in the patient information leaflet. If possible, you may be able to switch to an alternative medication.

Other physical causes

There are a few other medical conditions that have been linked to ED. But for some of these conditions, the link is less understood.

Other causes include:

• kidney disease
• bladder or prostate surgery
• prostate cancer
• an enlarged prostate
• Peyronie’s disease
• low testosterone
• venous leak

Is erectile dysfunction a normal part of ageing?

ED is particularly prevalent in older men, with research finding the condition occurs in around 40% of men aged 40 and over, and 70% of men aged 70 and over.

However, this does not mean it should be deemed a normal part of ageing, as there could be a potentially serious health condition underlying your symptoms. In fact, many studies have found ED is a significant predictor for mortality caused by cardiovascular disease.

These statistics are particularly telling when you consider that men this age also have high rates of alcoholism, smoking and obesity - 3 of the leading preventable causes of ED.

Psychological problems, whilst less talked about among men, are closely linked to sexual health and impotence. This type of ED is more common in young men, and it is believed that changes in neurochemistry in response to stress and anxiety can cause sexual dysfunction.

The nature of the condition means it promotes many more negative emotions, such as shame or feeling embarrassed about their sex life, so ED is very closely linked to mental health.

Some psychological causes may include:

• stress due to your job, finances or any of your current circumstances
• relationship problems
• performance anxiety
• PIED (porn-induced erectile dysfunction)
• mental health disorders (e.g depression or anxiety)
• sleep disorders (e.g insomnia)
• other negative emotions (e.g guilt, embarrassment, low self-esteem)

This can also become a cyclical problem. A psychological problem causes ED and then ED perpetuates and worsens the symptoms of the original psychological problem. In fact, ED and other sexual problems such as delayed or premature ejaculation have been found to double the risk of having depression.

The issue is then further complicated as many men feel like they shouldn’t or can’t seek help. Men are statistically less likely to seek mental health guidance, according to the NHS Adult Psychiatric Morbidity Survey, which can make the problem worse as they won’t have an outlet for their issues.

Making positive lifestyle changes can lower your risk of some causes of erectile dysfunction such as cardiovascular disease and diabetes.

Some things you can do:

• eat a balanced diet
• increase your activity levels
• stop smoking
• lose weight
• reduce your alcohol intake
• manage stress

All of these will help to improve your circulation and reduce your risk of developing any serious health conditions associated with ED.

However, if you start to notice symptoms of erectile dysfunction, it’s important you seek medical advice from your healthcare provider first as there may be a problem underlying it.

Thankfully, there are many treatment options available.

By far the most effective, accessible and safe way of treating ED are a group of medicines known as PDE5 inhibitors. When taken just before sexual activity, they work by promoting blood flow to the penis, allowing you to more easily achieve an erection.

There are several different PDE5 inhibitors available:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)
• Avanafil (Spedra)

Surgery, penile implants and other treatments exist for ED, but oral medication is usually the first line treatment in most men.

At euroClinix, you can order these ED treatments discreetly online - no face-to-face appointments and no long pharmacy queues. All you have to do is fill out a short medical questionnaire and, if approved, your meds will be with you the next day.