About ED | Expert opinion | Understand Erectile Dysfunction

What are the main causes of ED?

It can be difficult to talk about Erectile Dysfunction (ED), but ED is more common than you think. There’s a good chance that the guy sitting next to you might have ED, or that the woman across the room is wondering how to help her partner find answers. Understand the causes of ED in this article. 

What cause erection - couple - banner

Expert Opinion – What are the most common causes of ED?

Expert Opinion from David Ralph Andrologist

What Is Erectile Dysfunction (ED)?

Erectile dysfunction is when a man either can not achieve an erection or can not keep an erection long enough to have sex. Your ED may have a physical cause. Over 80% of men suffering from ED can trace its origin back to a problem or disorder2. When the causes of your ED is due to a physical condition, your ED is not a reflection on you or your sexual partner, since lack of arousal is not usually the problem.

Physical causes of ED

  • An injury (for example brain injury, spinal cord injury, penile injury)
  • A disease (for example diabetes, high blood pressure, high cholesterol, cardiovascular disease or Peyronie’s disease)
  • An operation (for example prostate removal)
  • Substance use (for example drugs, alcohol or some medications)

Conditions that can cause ED

ED can be caused by one of several medical conditions that reduce blood flow and nerve functioning. If a medical problem is causing your ED, it means there are treatment options.


Diabetes can cause nerve, blood vessel, and muscle damage that results in problems like pain, numbing or loss of sensation in the hands and feet3. These issues can also result in ED problems, because nerve signals and blood flow are a necessary part of the process in getting an erection4. Also as men with diabetes become older, ED problems can become more common5.

Finding the right treatment option

Most causes of ED can be treated, and oral medications are often the first step. However, they have been shown to be less effective for men with diabetes, and more advanced treatment options may be needed6. In those cases, ED treatment options such as injection therapy, vacuum devices, or a penile implant may be recommended7.

What does it mean for you?

If you are a diabetic and experiencing ED, talk with your doctor or diabetes nurse specialist about the treatment options that may be best for you. They may refer you to a Urologist or a nurse specialist who have specialised in treating men with ED. Learn more on the link between “Diabetes and ED“in our article.

3 times men of other age have ED
95 Nearly all men over age 70 are likely to have ed

Heart Disease

Did you know that erectile dysfunction precedes coronary artery disease in almost 70 percent of cases?

ED can be an early warning sign of heart problems

8 A buildup of plaque inside the arteries can limit the amount of blood that is able to flow through them with coronary artery disease. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked by this hardening of the arteries, the result can be angina (chest pain) or a heart attack9. Because the arteries that supply blood to the penis are much smaller than the ones that feed the heart, the problem may show up earlier as having difficulty getting an erection10.

ED is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD, and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two clinical manifestations of the same systemic disease.11

In one study that followed men for an average of six years, those with ED were:

62 are more likely to have a heart attack
44% Men more likely to have a cardiovascular event

What does it mean for you?

If you are experiencing ED, you should talk with your doctor about your potential risk for cardiovascular disease. And, if you’re already taking certain medications such as nitrates for your heart or alpha-blockers to manage blood pressure, your doctor will discuss whether ED medications are right for you or whether other options may be more appropriate. Learn more about ED & Cardiovascular disease in our article.

Prostate Cancer

Prostate cancer12 is not considered a cause of ED. Due to potential treatment for prostate cancer, for example radiation treatments, hormone therapy, and surgery to remove the entire prostate gland,  the development of a difficulty in getting or keeping an erection may occur. Sometimes, erectile dysfunction related to prostate cancer treatment is only temporary, but there are many men who experience ongoing difficulties, that need to be addressed by other means.

Your ability to orgasm is not connected to the prostate gland, although a man who has had a radical prostatectomy, will have a dry orgasm with no ejaculation. As long as you have normal skin sensation, you should be able to have an orgasm with the right sexual stimulation. This means that treating your ED should allow you to resume a normal, healthy sex life.

Kidney Disease

13Hormones, blood flow, and parts of your nervous system must all work together to get and maintain a healthy erection, but kidney disease can affect all of the above.

Neurological Problems

14Parkinson’s, Alzheimer’s, and MS (multiple sclerosis) can lead to ED because they all interfere with the brain’s ability to communicate the sexual desire to the reproductive system.

Talk to your doctor or nurse to understand the causes. The proper treatment can be recommended to help you return to a satisfying life.

Untreated ED can damage your self–confidence, causing a lot of stress— even depression and anxiety. Many guys with ED feel like their lives are out of their control. The good news is there’s hope.

Take back control. Use our Specialist Finder tool to locate a doctor in your area who can provide information on how to best treat your ED.

Watch our Expert’s testimonials videos for more advice

Share this article