ERECTIONS ∙ 4 minute read

What are the common causes of erectile dysfunction?

By Saskia Verhagen

It can be difficult to pinpoint the causes behind individual cases of erectile dysfunction in men but there are a number of common factors.

When it comes to erectile dysfunction (ED), data about exactly which men get it and why is a little difficult to come by. Firstly, this is because ED is fundamentally not a disease, it’s a symptom. And symptoms, of course, can mean very different things to different people.

NICE (National Institute for Clinical Excellence) defines ED as “the persistent inability to attain and maintain an erection that is sufficient to permit satisfactory sexual performance” - but one man’s idea of what’s persistent can vary greatly to another’s.

The second reason is that it’s challenging to estimate the number of people with a condition where each person who is affected isn’t always likely to seek help.

Whereas most people with diabetes will have encountered a doctor at some point in their lives — providing a major source of epidemiological data — ED can be a source of embarrassment, leading to men avoiding seeing a medical professional, and an underestimation of the problem as a result.

Having said that, based on the data that we do have, there are certain trends which have emerged, showing some of the more common causes for ED.

Depression and anxiety

As we’ve mentioned in the Book of Erections, both physical and mental health conditions can affect erectile function. There is strong evidence showing that you’re more likely to have ED if you have symptoms of depression, and that more severe depression is associated with more severe ED.

It can work the other way around too - men who report having ED are at higher risk of developing depression than men who don’t.

Anxiety, as we’ve previously discussed, is associated with increasing activity of the sympathetic nervous system, which pretty much prevents erections from taking place. There are figures to back this up: the incidence of ED rises to 37% in men with moderate anxiety and 75% in those with severe anxiety.

Alcohol and substance abuse

We’ve written a comprehensive guide to how recreational drugs can affect erectile function and your sex life in general. And the numbers back up the science - several studies have found men who have problems with substance and alcohol abuse are more likely to report ED.


Diabetes mellitus is a condition where you have high circulating levels of sugar in the blood - mellitus comes from the Latin meaning ‘honey-sweetened’. Having diabetes makes you more susceptible to developing blockages in your blood vessels - a process called atherosclerosis - which can lead to ED.

Around 20-67% of men with diabetes report having ED, which is considered to be a reliable indicator of diabetes-related vascular complications. Although - good news - these can be avoided with proper diabetic control, normally supervised by a doctor or specialist nurse.

Cardiovascular disease

Cardiovascular disease refers to diseases affecting the heart and blood vessels. As you might already be aware, these can be a cause of ED because efficient blood supply to the penis is crucial to healthy erectile function.

Men with cardiovascular disease are more likely to report severe ED (39%) compared to the general population (9.6%). It’s essential to be aware that ED can be an early sign of such diseases - it’s important to check in with your doctor so that they can assess for other cardiovascular risk factors (like high blood pressure, cholesterol levels and diabetes) and intervene and treat them where needed.

Smoking and high BMI (body mass index) are also important cardiovascular risk factors - it’s a very good idea to stop smoking and keep a healthier diet and exercise routine too.

Older age

Unfortunate, but true: the chance of having ED increases as you get older. Most men continue to feel interested in sex - in a 2017 poll of people aged 65-80, 76% agreed that sex is an important part of a romantic relationship at any age, with 70% of men agreeing that sex is important to their overall quality of life. Despite this, only 40% of men and women surveyed reported being sexually active.

The reasons for this vary - from medical factors which cause ED such as diabetes and certain medications, to psychosocial factors such as loss of a partner or a lack of privacy in residential or nursing homes - but it’s worth noting that of the 18% of men and 3% of women who had tried medications or supplements to improve their sexual functioning, 77% reported that it had been helpful.

The numan take

There are lots of different underlying causes for ED - some of which you can control, and some which you can’t. But identifying what’s causing your ED can be the key to finding the best long-term treatment for you.

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