Erectile Dysfunction: Causes, Risk Factors, and Management

Learn about the causes of erectile dysfunction, risk factors for developing the condition, how it is diagnosed and treated, and what men can do to reduce their risk.

If you are like most men, you probably don’t think about your penis all that often. But when it comes to erectile dysfunction (ED), suddenly the health of your penis is of utmost importance. ED is a common problem affecting tens of millions of men in the United States alone and can be caused by various factors. This article will discuss some of the most common causes of ED, how it is diagnosed and treated, common risk factors, and ways to manage the condition. 

What is Erectile Dysfunction (ED)?

Erectile Dysfunction is the inability to achieve or maintain an erection over a period of time. It is common for this to happen periodically, but not persistently. The significance of the problem can change by a person. It can be mild to severe. Sometimes it can happen when with a partner or in solo practice. There are many causes and risk factors for ED that may make it temporary and others might require further treatment. Let’s review the causes and risk factors. 

What are the causes and potential risk factors of ED?

Causes and risk factors can both be an issue depending on where you are in your life. Some people smoked early and quit in their twenties creating a risk factor that may not have been a cause years after quitting. Some may have taken medications to get through a difficult time in one’s life which caused a risk factor. However, age and other medical conditions may be related to a different lifetime. Some of these factors can be situational or more significant requiring treatment. 

Age Doctors reported 50 to be the age risk increases, but it also happens for those who are younger. Testosterone decreases with age though everyone is different when they start to decrease enough to notice changes. Some might see less frequent morning erections. 

Obesity is a risk factor for many medical issues and ED is also one due to the potential for it to limit blood flow.

Medications There are a variety of medications that can cause ED. Common groups of medications include Antihypertensives (e.g., alpha and beta blockers, diuretics), Psychotropics (SSRIs and other antidepressants, antipsychotics, anxiolytics), Anticonvulsants, AntiParkinsonian, and Hormone impacting (antiandrogens, corticosteroids, chronic opioid use).

Diabetes impacts blood flow and there may be damage to the nerves that control an erection.

Cardiovascular issues can impact blood flow to the penis. Limited blood flow causes problems with getting an erection.ED can be one of the first signs of cardiovascular problems. 

Smoking causes problems similar to cardiovascular issues. Smoking reduces blood flow to the penis. There is evidence that smoking can impact those as young as 20 years old. 

Substance use alcohol and illicit drugs can impact erections for physical and mental health reasons. They reduce blood flow or cause challenges with focus. Both will cause problems. 

High Blood Pressure damages the lining of blood vessels causing them to harden and restrict blood flow.

Surgery to the bladder or prostate can cause potential challenges that impact one’s ability to achieve an erection. Depending on what is done, functioning may return or other treatments may be needed to assist with improving erectile functioning. 

Endocrine conditions (e.g. thyroid) that impact testosterone can cause decreased desire and arousal issues that may result in ED. 

Psychological conditions such as anxiety, partner-related stress, low self-esteem, history of sexual abuse, and restricted or shame-inducing sexual upbringing can all impact one’s ability to relax and feel comfortable with sexual experiences. Intrusive thoughts related to these issues impact focus and thus create ED. 

Related to or a part of other sexual disorders such as premature ejaculation, anorgasmia, and sexual aversion disorder often impact erectile functioning.

Neurological conditions such as Altzheimers, Parkinson’s, Multiple Sclerosis, Stroke, Spinal cord injury, and Diabetic Neuropathy have physical and psychological factors that may cause problems with achieving or maintaining an erection.

Penile structural issues such as  Peyronie’s Disease and venous leak are rare conditions that cause physical challenges with achieving an erection. 

As you can see from the above list, there are many potential reasons why someone would struggle with erectile functioning at different times in their life. These factors will be reviewed during an assessment to help understand more about any contributing or aggravating factors that may need to be considered in the treatment plan. Let’s now talk more about how it is diagnosed and assessed.

How is Erectile Dysfunction diagnosed?

Doctors will want to conduct a thorough assessment and physical examination to rule out potential causes. It is important to find the contributing issue(s) so that an appropriate treatment plan can be formulated. To get the information needed, doctors may ask several historical questions related to the above risk factors. They will ask how long the problems have been happening, any conditions in which it doesn’t happen, and may also ask about your mental health and any relationship challenges. 

There is also a possibility that you might be asked to try a few things to fully assess the problem. For instance, since men typically get erections during the night depending on their sleep cycle, you may be asked to put a thin paper-like ring around your penis to determine if you are still getting erections during the night (Lehmiller, 2018). Doctors will likely do some blood work to see if any of the medical issues above may be a factor that you have been unaware of. Some people find out about cardiovascular issues or Diabetes because they have ED. 

An important distinction will be to determine if there may be issues with premature ejaculation. Some men can have erectile dysfunction and premature ejaculation at the same time or confuse one for the other. For instance, someone with premature ejaculation may say they have erectile dysfunction because he loses his erection soon after ejaculation. The individual with erectile dysfunction may indicate he has premature ejaculation because he rushes to ejaculate quickly before he loses his erection. It is important to assess the problem from many angles. This will help create a more effective treatment plan. 

How is ED treated?

There are many ways to address erectile dysfunction and the treatment plan may vary depending on the assessment results. For instance, if the erectile dysfunction appears to be from performance anxiety, then sex therapy will likely be recommended. A urologist may also recommend a few other options:

Penis Pump/Vacuum: they aren’t just a device you see on TV. They can be helpful for some men especially those with Diabetes, Spinal cord injury, or after a prostatectomy

Kegel Exercises (yes men have pelvic floors): pelvic floor muscles in men can help with pressure to the deep dorsal vein that carries blood away from the penis. After three months of regular kegel exercise, many men regain erectile functioning or see a significant improvement (Lehmiller, 2018). 

Shockwave therapy: this is said to cause neovascularization which promotes the development of new blood vessels, which increases blood flow. This will help with the firmness of the erection as well as the greater likelihood of spontaneous erections. COREWAVE therapy is a low-intensity shock wave with up to 70% effectiveness rate in those with mild to moderate ED. 

Medications: Viagra and Cialis can also be options for those with mild to moderate ED. These can be challenging options as there is often a window that it needs to be used in. 

Injections: The medication injected into the penis improves blood flow, which then allows for a firmer erection. The response is usually 10-15 min from injection to erection capability. 

Penile Implant: After all other treatments have been tried, there is also the possibility of surgically implanting a pump. It allows him to obtain and sustain an erection. Alabama Sexual Medine, a group of urologists, reported that over 93.8% of patients reported satisfaction, which is much higher than satisfaction levels for Viagra (51.6%) or injection therapy (40.9%). The penis appears the same and the recovery time is 4-6 weeks. They provide answers to more FAQs on their website.

There are many treatment options available for ED. Start with the least intrusive and comfortable first—the most significant being the penile implant, which is irreversible. While ED is normal to experience at some point in your life, it is when it persists that you may need some help. 

What can men do to reduce their risk of developing ED?

Given the causes or risk factors above, there are ways you can prevent the occurrence or persistence of ED from happening. Here are a few ideas:

  • Eat healthily: this will prevent cardiovascular problems, diabetes, and obesity
  • Exercise: it will help in the same way as eating healthy as well as keeping the blood pumping!
  • Be sure to attend your annual physical and get the blood work done. It can be easy to skip the bloodwork due to being busy, but it is an important screening for medical issues that can cause ED
  • Communicate your with sexual partner(s) about sex. Incorrect assumptions and beliefs that you believe others may have of you can cause anxiety leading to ED. Try to reduce the pressure of measuring sex as “successful” when both partners orgasm. 
  • Quit smoking: this will help address many of the risk factors
  • Address high blood pressure and high cholesterol
  • Limit alcohol use as it can cause risky health issues over time. Impairment can also cause ED. 
  • Don’t use illicit drugs for many reasons with your health being the most important
  • Manage stress and emotions in a way that doesn’t increase other risk factors. Find ways to soothe and calm your emotions internally. 
  • Address relationship problems rather than letting them build-up

If you are concerned about ED, it is important to see a doctor for diagnosis and treatment. Don’t let embarrassment keep you from getting the help you need – ED is a very treatable condition! We are here to help you at Sexual Health and Healing. We also have a few book recommendations in case you would like to learn more about ED and related topics. 

Book Recommendations:

Coping with Erectile Dysfunction: How to regain Confidence and Enjoy Great Sex by Barry McCarthy, Ph.D. & Michael Metz, Ph.D

Couple Sexuality over 60 by Barry McCarthy, Ph.D

Contemporary Male Sexuality: Confronting Myths and Promoting Change by Barry McCarthy

Men’s Sexual Health: Fitness for Satisfying Sex by Barry McCarthy


Alabama Sexual Medicine, group urologist practice

Lowy, M. & Ramanathan, V. (2022). Erectile dysfunction: causes, assessment, and management options.

The Psychology of Human Sexuality by Justin Lehmiller, Ph.D

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