Guys, if you find that your sex life is suffering from a major slump, you may be suffering from one or more of the 20 most common causes of erectile dysfunction, also referred to as ED. ED is typically caused by one or more physical symptoms or ailments, psychological issues, or a combination of both. It’s also a fact that every man will suffer an episode of it at least once in his life. Read on to find out what may be causing your episodes and what you can do about it.

Physical Causes

There are several different physical causes of ED, most of which can be detected and treated by your doctor. Before this can happen, though, you actually have to SEE your doctor, so swallow your pride, shed your fears, and make that all-important phone call to your doc today.

Diabetes

Diabetes causes nerve and artery damage that makes achieving and maintaining an erection difficult. Between 20%-75% of men with diabetes also suffer from ED. If you suffer from diabetes, it’s a safe bet that you will also suffer from ED, as this more than doubles your risk. Since diabetes can cause such side effects as kidney problems and high blood pressure, these ailments also play a part in whether a man will suffer from ED. These adverse effects of diabetes, as well as the medications used to treat them, are also common causes of erectile dysfunction.

Kidney Disease

Kidney disease causes unpleasant and adverse changes in your body that affect things such as hormone levels, circulation, and energy levels, just to name a few. These changes will often cause reduced sex drive and/or sexual ability. It’s also a fact that chronic high blood sugar levels can actually destroy blood vessels and also cause nerve damage and pain, more commonly known as neuropathy. Drugs used to treat kidney disease will also cause ED. Over 50% of men who suffer from kidney disease or kidney failure will also suffer from ED. Since some men also develop high blood pressure directly in their kidneys as a result of either diabetes or another underlying cause of their kidney disease, the high blood pressure, as well as the particular medication(s) used to treat it, are often typical culprits when it comes to erectile dysfunction. Since diabetes is also linked to heart disease, which often involves narrowing of the arteries and vessels, this too is a common cause of ED.

Neurological Diseases (Affecting The Brain, Nerves, And Spinal Cord)

Since the nervous system is vital when it comes to achieving and maintaining an erection, men who have suffered from a stroke, Multiple Sclerosis (MS), Alzheimer’s Disease, Parkinson’s Disease, or any other type of brain or spinal cord injury are particularly prone to suffering from ED. These neurological malfunctions, as well as brain or spinal cord injuries, may also cause a condition known as priapism, which I will discuss in further detail later in this article. The disease or injury causes an interruption in the transmission of nerve impulses between the brain and the penis, making it difficult, if not impossible, for a man to achieve and maintain an erection.

Vascular Disease

Vascular disease refers to any disease that results in an impairment of the circulatory system. Arteriosclerosis/atherosclerosis (hardening of the arteries), hypertension (high blood pressure), and high cholesterol levels are responsible for over 70% of ED cases. Since all of these conditions involve restricted blood flow to the heart and brain (e.g. heart disease, heart attacks, and stroke), it also means restricted blood flow to the penis, hence the likelihood of ED. If blood isn’t going in, then it’s not going up.

Prostate Enlargement/Prostate Cancer

Prostate enlargement has been shown to be associated with the development of ED. Since the prostate is directly linked to vital nerves and pathways that are crucial to a man’s ability to achieve and maintain an erection (it’s all connected, guys–the prostate, penis, testicles, seminal vesicles/ducts, and the epididymis play a part in determining whether a man will be able to get an erection, as well as his fertility), any type of prostate problems can cause ED. In the case of prostate cancer, however, it isn’t the cancer itself that causes ED, but the treatments that are given for the cancer. In this case, the treatments for prostate cancer, which may involve radiation, chemotherapy, hormone manipulation and/or therapy, and surgery are the usual causes of ED. Total removal of the prostate is also responsible for the complete inability to achieve an erection.

Peyronie’s Disease

Peyronie’s disease is caused by scar tissue or plaque, which forms on the inside length of the penis (referred to as the corpora cavernosa) and often results in the penis becoming bent. This condition often makes intercourse difficult and sometimes painful, thereby resulting in ED. While the causes of Peyronie’s disease are unclear, it is thought to be related to penile injuries that result in localized bleeding inside the penis, as well as injuries such as trauma that may cause a bending of the penis. These injuries can actually occur and go unnoticed. Peyronie’s disease can also be genetic and/or hereditary in nature. While certain medications list Peyronie’s disease as a side effect, the risk of developing Peyronie’s disease as a side effect is very low. Only one percent of men will develop Peyronie’s disease, and while the majority of those are middle-aged men, younger and older men can develop Peyronie’s disease. Peyronie’s disease often resolves on its own between 5%-19% of the time, but surgery is often necessary to remove the plaque. Vitamin therapy is also a viable treatment. Pain management is often necessary for men who suffer from this condition.

Not all physical causes of ED are disease-related. Other physical causes of ED can range from surgery to drug use, as I will describe below.

Surgery

Surgeries for ailments such as prostate and bladder cancer often require the removal of nerves and tissue surrounding the penis, which in turn can cause ED. While some of these surgeries cause temporary cases of ED that typically last between six to eighteen months and resolve on their own, other surgeries can cause damage to vital nerves and tissues that require treatment in order for a man to be able to once again achieve and maintain an erection.

Injuries

Injuries to the pelvis, bladder, spinal cord, and penis can also cause ED, especially injuries that require surgery. One particular penile injury that can occur involves the actual bending or breaking of the penis. Even though there are no bones located in a penis, there are soft/spongy tissues that can be bent or broken, resulting in severe damage to the penis and the occurrence of ED. In these cases, ED results from inadequate blood flow into the penis, or the inability of the veins inside the penis to retain enough blood for the man to achieve and maintain an erection.

Hormonal Imbalances

Hormonal imbalances that are linked to thyroid problems or a lack or deficiency of the hormone testosterone (also referred to as “Low T”), can affect a man’s response to sexual stimulation, as well as his ability to achieve and maintain an erection. Hormonal imbalances may also be the result of pituitary gland tumors, kidney disease, liver disease, any adrenal gland issues, and any other hormonal treatments.

Venous Leak

Venous leak occurs when the veins in the penis are unable to retain enough blood in the penis to sustain an erection. Venous leak is often the result of a traumatic injury that causes a bent or broken penis, and it is also common in the case of Priapism. There are two variations of venous leak associated with Priapism known as low-flow and high-flow. However, a case of venous leak is not always associated with Priapism, and vice versa.

Priapism

Since I have already touched on this rare but very real and often dangerous cause of ED, here are the facts. Priapism is actually a persistent, often painful, and dangerous erection that lasts for four hours or more and occurs without sexual stimulation. Priapism results when blood becomes trapped in the penis and cannot drain. Priapism can happen for any number of reasons, including injuries to the penis, brain, spinal cord, or as a result of surgery. Priapism can even occur in newborns. If not treated, priapism can lead to permanent scarring and damage, which leads to a permanent case of ED. There are two different types of priapism, referred to as low-flow and high-flow. Low-flow priapism is the more common type and refers to blood being trapped in the penis. It can occur with no known cause in men who are otherwise healthy, but it can also be a side effect of sickle-cell anemia, leukemia, and malaria. High-flow priapism is the more rare form of the disorder and results from a ruptured artery or injury to the penis or perineum (the area between the scrotum and anus). High-flow priapism prevents the blood in the penis from circulating normally. Other causes of priapism include black widow spider bites, certain medications such as Thorazine and Desvrel, both of which are used to treat depression and other mental disorders, carbon monoxide poisoning, and the use of illicit drugs such as marijuana and cocaine. In rare cases, priapism has been linked to certain cancers that prevents the draining of blood from the penis. Priapism is a serious condition that requires immediate medical care. Typical treatments for priapism include the application of ice packs, surgical ligation, in which the doctor ties off the ruptured artery that is causing the priapism, thereby restoring normal blood flow, a surgical shunt, which is typically used for low-flow priapism and involves inserting a surgical passageway (shunt) which allows excess blood to drain and restores normal blood flow and circulation, and aspiration, in which the doctor inserts a needle into the penis to draw off excess blood.

Tobacco, Alcohol, or Drug Use

Erectile dysfunction is common in men with vascular conditions or diseases who also smoke. Since tobacco and other drug use has been shown to narrow the blood vessels and arteries, this means that the blood flow to a man’s penis is also compromised. While alcohol has long been known to lower a person’s inhibitions, it also lowers a man’s ability to perform sexually. The same applies to certain illicit, as well as prescription, medications. There are currently over 200 known prescription drugs which cause ED.

High Blood Pressure

High blood pressure is referred to as “the silent killer.” This also holds true for a man’s sex life. If you suffer from high blood pressure, this condition alone can cause ED, since blood pressure is an indicator of a person’s vascular/circulatory health. In addition, the medications often used to treat high blood pressure can also cause ED, which means you may find yourself caught in a vicious cycle of trying to treat a serious condition while putting your sex life on hold. Depending upon your particular medical situation, your doctor may decide that prescribing a popular ED treatment medication will eradicate your ED and improve your sex life, thus helping your frustration and high blood pressure.

Aging

Most men are at their sexual peak early in their teens and twenties, and as they become older, their sex drive tends to decrease. By the time a man reaches his forties, he may already be struggling with ED. By the time a man reaches his fifties and beyond, ED is often a common problem. This can be the result of lower hormonal levels (testosterone), or medical issues such as prostate problems. However, just because a man has reached a certain age doesn’t mean that his sex life is over. By seeking appropriate medical advice and treatment, as well as psychological counseling if warranted, men can often enjoy sexual activity well into their golden years.

Psychological Causes of ED

Not all cases of ED are caused by physical ailments. Erectile dysfunction can also stem from psychological issues, which I will address here.

Stress

Regardless of your age, every man has experienced stress. While there is good stress and bad stress, it’s usually the bad stress that causes ED. Typical stress-related causes of erectile dysfunction involve job stress, money worries, marriage problems, and the like. Stress releases excess amounts of the adrenal-based hormone cortisol into your blood, which can in turn cause adverse effects such as high blood pressure. Since we already know that high blood pressure is a nasty contributor of ED, it’s best to deal with excess or chronic stress as soon as possible. If the amount of stress you’re under is affecting your sex life, seeing your medical doctor in addition to receiving psychological counseling may offer the best recourse in resolving your ED.

Anxiety

Once you suffer from a single episode of ED, chances are you are going to worry endlessly about having another episode. This is known as “performance anxiety”, which is a fear of sexual failure. This is not only detrimental to you and your physical and mental health, but it’s also detrimental to your partner. Once again, talking to your medical doctor, as well as seeking treatment for any recurring anxiety episodes, will be beneficial to your physical and mental health. As for your partner, a change of pace and/or scenery may be in order. Instead of the same old routine, try booking a nice room at a local hotel for a romantic evening alone with your partner. A short, weekend getaway can also work wonders for your troubled sex life. Anything out of the norm that puts you in a better, relaxed frame of mind is bound to increase your optimism, as well as your libido.

Guilt

While it’s been said that guilt is the most useless emotion on the planet, that doesn’t stop the majority of people from feeling it at some point in their lives. For men, guilt is often associated with the fear that they aren’t pleasing their partner. Guilt can also occur because a man has done things in his past that he isn’t proud of and certainly doesn’t want his partner to find out about. An example of this would be an extra-marital affair that is causing the man extreme guilt, or, if he is still involved with his mistress, it may be a case of reduced attraction to his marriage partner, which can still cause enormous amounts of guilt. In the case of a frigid partner, a man may begin to feel guilt if he thinks he is the cause for his partner’s anxiety and pain regarding intercourse. All of these factors can lead to ED. Open communication with your partner, as well as any needed medical attention and/or psychological counseling, will often resolve the occurrence of ED. At any rate, getting rid of your feelings of guilt is monumental to getting your sex life and relationship(s) back on track.

Depression

While there are actually different types of depression–acute, chronic (referred to as Dysthymia, a type of low-grade depression that lasts for two years or more), and seasonal (referred to as Seasonal Affective Disorder, or SAD for short, in which people experience depression during the winter months due to a lack of sunlight), all types of depression result from chemical imbalances in the brain. This in turn is responsible for the common symptoms of depression, which include lack of enjoyment in activities that the person once found enjoyable. Since one of those activities is most likely sex, depression is often the culprit behind a man’s struggle with ED. Depression can even cause ED in a man who is otherwise comfortable with sex. In addition, medications that are used to treat depression can also cause ED. Only your doctor and/or counselor can advise you in situations like this.

Low Self Esteem

When a man feels that he just isn’t good enough, whether in bed or out, it’s going to affect him in a variety of ways, and one of those ways is likely going to be ED. Whether it’s body issues, appearance issues, financial issues, job issues, or relationship issues, if a man feels he isn’t good enough in general, then he isn’t going to be good enough, especially in bed. Not only will he suffer, but so will his partner and anyone else he interacts with on a regular basis. By tackling the underlying source, such as body issues (begin a regimen of proper diet and exercise), appearance issues (maybe it’s time for a new hairstyle?), financial issues (keep track of your money to see just where it’s going), job issues (resolve issues with your co-workers and/or boss), or relationship issues (similar interests, open communication, and honesty are key), a man can often resolve his problem with ED. Otherwise, a medical and/or psychological consult is often necessary.

Indifference

Indifference often results as a man becomes older. Loss of interest in sex is an indicator that he is suffering from indifference. Any or all of the aforementioned psychological issues can also cause indifference, which is definitely going to impact a man’s sex drive and performance in bed. While it’s been proven that all men will suffer an episode of ED at least once in their lives, only when it becomes persistent, meaning it occurs more than half the time, and also causes your partner distress, does it also become problematic. When you find yourself in this situation, seeking medical and/or psychological advice is the best way to go in order to get your sex life back on track.

So, How is All This Usually Treated?

Some of the most common treatments for ED involve prescription medications such as Viagra and Cialis. However, these medications are not safe or appropriate for all men, especially those who already suffer from certain heart and other medical conditions. Other treatments range from hand-operated penis pumps, which draw blood into the penis, thereby helping the man to achieve an erection, to surgically-implanted penis pumps, which use basic hydraulics to help the man achieve and maintain an erection. One drawback of surgically-implanted penis pumps is that the man must forego the possibility of fathering a child or children, as this particular surgical procedure will leave the man sterile. Also, as with any surgical procedure, there is no guarantee that such a device is going to work for you. If the cause is deemed to be psychological, counseling (whether singular or couples-based), sex therapy, and even biofeedback methods have been met with success. Sometimes a combination of medical treatment and psychological counseling is the best way to ensure a happy, healthy, and satisfying sex life for you and your partner.