Erectile dysfunction (ED) happens when you can’t get hard or stay hard enough to have satisfying sex. 

Age is the most common cause of ED. But erection problems can have many different causes at any age. Medical causes like heart disease and emotional and lifestyle causes like anxiety and a lack of regular activity can all cause ED.

Learn about the different causes of ED, how to recognize the symptoms of ED, and how you can get diagnosed with ED so that you can access the right kinds of treatment to improve your sexual health.

What is erectile dysfunction and impotence?

Erectile dysfunction (ED) is a condition that makes it difficult to get an erection or to keep an erection long enough to have sex until you reach orgasm. 

Over 30 million American men report symptoms of erectile dysfunction (ED). It’s estimated that 150 million men worldwide have ED. And your risk of getting ED goes up after 40 years old, peaking between 60 and 69 years old.

It’s not uncommon to have trouble with erections every now and then. But ED means that you have trouble every time you try to get hard enough for sex. Other common symptoms of ED include:

• Not being able to get an erection even when stimulated by things that used to sexually arouse you
• Not being able to keep an erection long enough to reach orgasm or satisfying a sexual partner
• Having lower sexual desire than usual

Impotence is another name for ED that’s not used as often because it’s associated with shame or embarrassment for most men with ED. Impotence may also include other sexual dysfunction like premature ejaculation, a lower sex drive than usual, or the inability to get your partner pregnant. 

Even if it's temporary or you have a clearly diagnosed cause, ED or impotence can cause you to lose confidence in your sexual abilities. ED can also impact your self-esteem, your personal and romantic relationships, and even affect your sense of identity. 

Other less common signs and symptoms of ED or impotence can include:

• Unusual mood swings or irritability
• More stress or strain than usual in your personal relationships
• Anxiety about sex or intimacy

Medical causes of ED

The most common causes of ED usually relate to underlying medical conditions that affect the organs or systems that are involved in helping you get aroused and erect – especially the cardiovascular system, nervous system, and hormone-regulation systems throughout your body.

Cardiovascular disease

• Heart disease: Conditions that affect your heart function, such as heart failure or vascular disease, can make it difficult for the heart to pump blood to your penis when you’re aroused. 
• Atherosclerosis: Also called hardening of the arteries, this condition happens when a substance called plaque builds up in your blood vessels from high cholesterol.
• High blood pressure: Over time, high blood pressure (hypertension) can break down the tissues in your vascular system. 

When you’re overweight or obese, your heart and cardiovascular system can have a harder time pumping blood throughout your body. Plaque build-up in your blood vessels can also block enough blood flow from getting to your penis quickly when you’re aroused.

Imbalances in your hormones

Several hormones are involved in sexual stimulation and erections, including testosterone.

Testosterone is produced by your testes. The amount of testosterone that you produce is controlled by your hypothalamus and your pituitary gland. Conditions that affect your testes, hypothalamus or pituitary gland can result in low testosterone, which is a risk factor for ED. Some conditions which can affect testosterone production and cause ED include: 

• Hypogonadism
• Testicle injury
• Hypopituitarism
• Hyperprolactinemia

Thyroid conditions may also cause symptoms of ED. Your thyroid is a gland in your neck that produces hormones to manage many body functions, including your metabolism, your heart and digestive function. Conditions that affect your thyroid may cause a decreased libido or fatigue, which may lead to ED symptoms. Some thyroid conditions that can cause ED include:

• Thyroid inflammation
• Thyroid nodules
• Enlarged thyroid gland (goiter)
• Thyroid cancer
• Hashimoto’s disease

Diabetes is another condition that can lead to ED symptoms. It happens when your pancreas doesn’t make enough insulin to break down sugars in your blood effectively. This can cause your blood sugar to reach high levels, requiring insulin injections or other medications to keep your blood sugar in check.

Untreated or poorly managed diabetes can result in injury to your blood vessels and cause nervous system pain known as diabetic neuropathy. This can make it more difficult for you to respond to physical stimulation before sex and get enough blood flow into your penis for an erection.

Not being able to get enough sleep can also have a dramatic impact on your production of hormones like testosterone. 

Feeling tired and fatigued from a lack of sleep due to sleep disorders like obstructive sleep apnea (OSA) can make you feel less able to get sexually aroused.

Brain conditions

Your brain sits at the center of many of the processes that lead to an erection, including processing nerve signals that stimulate sexual arousal and lead to physiological changes necessary for getting hard.

Some conditions that can cause ED by affecting your brain function include:

• Brain injuries or strokes that damage parts of the brain involved in sexual activity
• Parkinson’s disease (up to 70% of people with Parkinson’s report ED)
• Multiple sclerosis (MS)

Medications

ED can be a side effect of medications that are used to treat:

• Hypertension (high blood pressure)
• Depression, including antidepressants
• Epilepsy or seizures
• Hormone deficiencies that result from prostate cancer
• Sleep disorders, such as sedatives
• Chronic pain, such as opioids or narcotics

In addition, taking anabolic steroids can also cause ED to occur. 

Prostate conditions or surgery

Your prostate gland plays a small but significant role in the erectile function of your penis and other reproductive organs. 

A condition called benign prostatic hyperplasia (BPH), or enlarged prostate, can cause ED symptoms. BPH can affect the way your blood vessels or nerves work when you get an erection. 

BPH can be treated by surgically reducing or removing the prostate gland. Damage to any blood vessels or nerves from prostate surgery can also cause ED symptoms.

Prostate cancer is another possible cause of ED symptoms related to your prostate. Cancerous tissue can damage pelvic blood vessels and nerves, leading to ED symptoms.

Emotional causes of ED

Erectile dysfunction can be caused by a physical condition, especially as you age or if you develop health problems. 

But emotional causes of ED can be just as common as physical causes – and you can experience symptoms of ED that have an underlying cause related to your mental health even if you’re in good physical health.

Stress and anxiety 

Stress and anxiety can both affect your circulation and nervous system in ways that can make it hard to get an erection. 

Both stress and anxiety can trigger your body’s “fight-or-flight” response. This response can disrupt the neurotransmitters that signal your brain to stimulate your arousal and smooth muscle responses that allow blood to flow smoothly into the penis.

Stress and anxiety can be especially frustrating causes of ED because it’s not always clear exactly what’s stressing you out or making you anxious. Some possible triggers include:

• Work, including difficult projects or relationships with colleagues
• Money, including financial strain or having trouble keeping up with bills
• Personal relationships, including unresolved issues with partners or family members
• Fear, especially fear of failure or not accomplishing personal or professional goals
• Performance anxiety about not being able to get hard, finishing too early, or not being able to satisfy your partner

Depression

Having depression can make you feel less desire to have sex or not get pleasure from having sex. 

When your sex drive is low or you’re not able to feel the usual satisfaction, you might find it harder to get an erection or keep one long enough to ejaculate. This may occur more often if you’re distracted or feeling distant.

You may also feel a sense of shame from being depressed if you don’t have the confidence or the vocabulary to speak openly with a partner or with a therapist about your depression.

 Shame can also introduce difficulties into your sexual relationship that interrupt your communication or your intimacy with your partner. These relationship troubles can also result in symptoms of ED.

Relationship problems

Relationship problems that erode trust or intimacy in a relationship can be a major factor in your ability to get hard enough for sex. These issues can take many different forms, including:

• Anger with your partner or yourself
• Fighting
• Difficulty communicating
• Feeling emotionally distant
• Feeling physically or psychologically unsafe with your partner or in a home you share with them
• Fear of rejection, especially when trying to initiate sex or intimacy

 Relationship issues can also happen because of ED symptoms that might disrupt your sex life. The frustration that you and your partner both feel might be hard to talk about, affecting the intimacy you have with your sexual partner. 

You might also feel a sense of blame for not being able to perform, or blame your partner for not being able to give you what you need to feel your best in bed.

Societal pressure

Many societies expect men to perform consistently in bed, and many versions of masculine identity are closely tied to sexual performance.

This outside pressure that many men feel in their sexual relationships might result in male sexual dysfunction that adds to a sense of anxiety, shame, or frustration when they’re not able to fulfill the role that their sexual partner might expect of them in bed. 

If this pressure causes a man to have trouble getting or keeping an erection, that can result in even further negative emotions or self-esteem issues that get in the way of having a satisfying sexual performance for you or your partner.

Lifestyle causes of ED

In addition to medical and psychological causes of ED, lifestyle choices you make can also make a significant impact on your risk of ED at any age. 

Dietary or lifestyle habits that produce inflammation throughout your body are especially risky.

Inflammation can constrict your blood flow, disrupt hormones like testosterone, and limit how effective a substance called nitric oxide (NO) can be in helping your muscles relax and blood flow readily into your penis.

Some of the most common lifestyle causes of ED include:

• Smoking cigarettes, cigars, or other tobacco products
• Smoking or vaping products that contain nicotine
• Drinking alcohol, especially if you drink more than 1-2 beers or spirits per day
• Not getting enough exercise or regular activity to stay in shape
• Eating an unhealthy diet high in processed foods or other foods that restrict your blood flow, such as artificial sugars

Age as a risk factor for ED

ED becomes much more common as you get older. 

Research suggests that your risk for ED increases after 40 years old – and your risk for ED peaks between 60 and 69 years old. 

This heightened risk results from changes in your overall health and testosterone production as you age. Your risk of ED can increase more if you have any conditions that affect your heart, your circulatory system, your brain, or other major organs in your body involved in helping you get an erection.

ED doesn’t just happen when you get older, though. Many young men in their 20s are at an increased risk for ED for different reasons.

While younger men don’t typically experience as many health conditions as older men, the anxiety and depression that many young men face during major life changes in their 20s and 30s can contribute to ED at a young age.

Lifestyle choices like smoking and drinking can also increase your risk of ED at a young age. 

How to treat erectile dysfunction

Regardless of the cause, there are many options to treat ED using medication, dietary or lifestyle changes, and other treatments that can help resolve any underlying conditions that might be causing your ED symptoms.

Talk to a doctor or urologist about your symptoms so that you can get diagnosed with ED and better understand what conditions may be contributing to your ED symptoms. 

You can schedule an online consultation with a U.S.-licensed medical provider through Motivated for a diagnosis and treatment plan.

Medications

The most common medications used to treat ED are called phosphodiesterase type 5 (PDE5) inhibitors. 

Usually taken as an oral pill right before sex or once daily, PDE5 inhibitors help relax smooth muscles in your body and allow blood to flow effectively into the penis. This helps you get erections more easily and keep them longer.

The most common PDE5 inhibitors include:

• Viagra®: Viagra is an effective, well-studied PDE5 inhibitor released to the public after being approved by the Food and Drug Administration (FDA) in 1998. 
• Sildenafil: A generic version of Viagra first released in 2017. Sildenafil is just as effective as Viagra but is much more affordable than brand-name Viagra.
• Cialis®: Another PDE5 inhibitor similar to Viagra released in 2003, Cialis is known to produce longer-lasting effects – up to 36 hours – when taken daily 
• Tadalafil: A generic version of Cialis released in 2018 that, like sildenafil, is a much more affordable version of brand-name Cialis. Tadalafil has been proven to have the same effectiveness as Cialis at treating ED.

You can get any of the PDE5 inhibitors listed above through Motivated.

After a consultation with a U.S.-licensed medical provider, you’ll be able to order your medication within 2 hours. You’ll also receive free 2-day shipping in discreet packaging to save you the awkward trip to the pharmacy.

Therapy and Counseling

Psychological treatments like therapy and counseling may be good treatments for ED caused by anxiety, depression, or difficulties with your personal relationships. 

Some common therapeutic options for ED treatment include:

• Individual therapy sessions, such as talk therapy, that can help you articulate the causes of your anxiety, depression, or feelings of fear or pressure
• Cognitive-behavioral therapy (CBT), which can help you address the ways you think or what you believe to help you resolve underlying emotional causes of ED
• Couples therapy, which can help you and your partner talk openly about the underlying personal or emotional issues that might be causing ED
• Sex therapy, which allows you to focus talk therapy sessions on anxiety or pressure that you might feel about sex with an expert

Diet and lifestyle changes 

Conditions like diabetes or obesity that might contribute your ED symptoms can be treated with changes to your diet and lifestyle, including:

• Getting regular exercise for 15 to 30 minutes a day, including aerobic activities like walking or cycling
• Eating a healthy diet limited in processed foods and rich in fruits with antioxidants, leafy vegetables, and whole grains
• Reducing or quitting smoking to prevent damage to your heart and circulatory system
• Reducing your alcohol use to help you get aroused more effectively and improve blood flow to your penis
• Losing weight to limit the complications of being overweight or obese on your sexual function and your overall health
• Managing your other medical conditions, with prescription medications or other treatments recommended by your doctor