Erectile Dysfunction

Erectile dysfunction (impotence) occurs when a man can no longer get or keep an erection firm enough for sexual intercourse. Penile erection is a complex process involving hormones, nerves, muscles, blood vessels and your brain.  A problem with any of these organ systems can cause erectile problems. Physical causes of erectile dysfunction most often erectile dysfunction is caused by something physical.

Physical Causes

By far the most common physical cause of ED is atherosclerosis or blood vessel blockage which is in turn is caused by:

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Tobacco use
  • Obesity
  • Heart disease
  • Parkinson’s disease
  • Multiple sclerosis
  • Low testosterone
  • Peyronie’s disease, development of scar tissue inside the penis
  • Medications including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate cancer
  • Alcoholism and other forms of substance abuse
  • Radiation, Surgeries or injuries that affect the pelvic area or spinal cord
  • Prolonged bicycling, which may compress nerves and affect blood flow to the penis, can lead to temporary erectile dysfunction

Psychological Causes

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

Risk Factors

As you get older, erections may be more difficult to develop. This isn’t necessarily a consequence of getting older instead a result of underlying health issues or taking medications, which is more common as men age.


Drugs – These three drugs listed below enhance the effects of nitric oxide, a natural chemical your body produces that relaxes the blood vessels in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation. Possible side effects include flushing, nasal congestion, headache, visual changes and stomach upset.

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra, Staxyn)

Testosterone replacement – Some men have erectile dysfunction caused by low levels of the hormone testosterone, and may need testosterone replacement therapy.

Penile implants – This treatment involves surgically placing semi-rigid rods into the penis. The inflatable devices allow you to control when and how long you have an erection. This treatment is usually not recommended until other methods have been tried first.

Penis pumps – A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is slides over the penis, and the pump is used to suction out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse.

Psychological Counseling

Stress, anxiety or depression are common causes of ED which may require a visit to a psychologist or counselor. Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension.