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Is a physical condition causing my ED?

Is a physical condition causing my ED?

Erectile dysfunction is a condition where a man isn’t able to get or keep an erection hard enough for sex. The main causes of ED are physical, psychological or a mix of the two. Physical causes of impotence include everything from medication side effects to illnesses or even physical problems, like injuries. Psychological reasons for impotence, on the other hand, can be things like stress, poor mental health or relationship worries.

ED can feel like the end of the world, but it’s important to know that you’re not alone. There are many ED treatment options available depending on what the underlying cause of your ED is and what symptoms you’re experiencing. Talk therapy can help cure psychological erectile dysfunction, for example, while ED pills like Viagra are often prescribed for physical erectile dysfunction. And for both types, lifestyle changes like getting more sleep and exercise can help too.

If you want to know more about the physical reasons you’re not able to get an erection, we’re here to help. Below, we’ll go over the most common ED causes and solutions that can help you get back to normal.

Craig  Marsh
Medically reviewed by
Craig Marsh, Specialist Pharmacist Prescriber (UK)
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Medically reviewed by
Mr Craig Marsh
Specialist Pharmacist Prescriber (UK)
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It’s a good question. When you see (or feel, smell, hear, etc) something sexually stimulating, your brain sends a message to your body. The blood vessels in your penis relax and blood rushes in to fill them, creating an erection as your penis expands.

The part of your penis containing all the blood vessels (aka the corpora cavernosa) is surrounded by a membrane which helps keep the blood in place so you stay hard long enough for sex.

Erectile dysfunction can be a sign of an underlying medical condition. In fact, a physical cause can be identified in about 80% of cases. These causes fall into four main categories:

Vasculogenic conditions like cardiovascular disease, diabetes and high blood pressure affect how blood flows to your penis.
Neurogenic conditions like spinal injury, Parkinson’s disease and multiple sclerosis impact your nervous system, which can lead to ED.
Hormonal conditions like hyperthyroidism, hypothyroidism, low testosterone levels or Cushing’s syndrome can make it more difficult to get and maintain an erection.
Anatomical conditions like Peyronie’s disease, which happens when scar tissue forms over the penis, can cause ED.

Especially when erection issues appear suddenly or for the first time, it’s best to get them checked out in person by a doctor in case there’s an underlying illness that needs treatment.

Does diabetes cause ED?

Does diabetes cause ED? Yes, diabetes often causes erectile dysfunction. In fact, studies have shown that 35-75% of men with diabetes experience erectile dysfunction, versus only 26% of men in the general population. Additionally, erectile dysfunction tends to appear 10-15 years earlier in men with diabetes. This is because diabetes can damage your nerves and blood vessels, making it difficult to get and maintain an erection.

For men with diabetes, ED medications like Viagra can be a good solution. But because diabetes often comes hand-in-hand with other health conditions like high cholesterol or high blood pressure, it’s important to make sure that the erectile dysfunction treatment doesn’t interfere with any other prescribed medication.

But having both diabetes and ED isn’t a done deal. Lifestyle changes that help manage conditions like diabetes, high blood pressure and high cholesterol can also help improve erectile function. Quitting smoking, exercising more and eating a healthy and varied diet have all been found to lower the chance of ED.

Enlarged prostate and ED

Can prostate problems cause ED? Prostate health and erectile function are linked, but it’s complicated. Benign prostatic hyperplasia (BPH) is a condition in which the prostate becomes enlarged and presses on the urethra in the penis. Prostate enlargement and ED are both more common in older men than younger men and while one doesn’t cause the other, some medications that treat BPH can have sexual side effects.

Generally, alpha blockers like tamsulosin have a lower chance of contributing to erectile dysfunction than 5-alpha reductase inhibitors like finasteride. A 2015 study of 407 men treated with finasteride and 230 men treated with tamsulosin found that the finasteride led to erectile dysfunction that didn’t improve when treatment was stopped. Tamsulosin, on the other hand, did not negatively impact erectile function or testosterone levels.

Some prescriptions can be used to treat both ED and BPH at the same time. The erectile dysfunction medication tadalafil (sold under the brand-name Cialis) was FDA-approved as a treatment for benign prostatic hyperplasia in 2011. That’s because PDE5 inhibitors like tadalafil relax the bladder and prostate, which helps alleviate lower urinary tract symptoms (LUTS) attributed to BPH in much the same way as relaxing the blood vessels in the penis helps a man get an erection.

Can ED be a sign of prostate cancer?

No, ED is not a sign of prostate cancer. But while the condition itself doesn’t cause ED, its treatment can. Some of the specific procedures that can lead to erectile dysfunction include hormone and radiation therapy as well as prostate surgery, where the prostate gland is removed. Sometimes, erectile function can be regained a few years after surgery.

High cholesterol and erectile dysfunction

Can high cholesterol cause ED? Yes. There are actually a few different ways in which high cholesterol can contribute to erectile dysfunction. High cholesterol makes it more difficult to produce certain chemicals and hormones in the body, like nitric oxide (necessary for erections) and testosterone (which impacts sex drive). Additionally, too much cholesterol creates plaque in your blood vessels, limiting blood flow to the penis.

STDs and erections: is ED a sign?

A sexually transmitted disease, or STD, is what happens when a sexually transmitted infection (STI) goes untreated. Although the two terms are often used interchangeably, they’re not quite the same. But in any case, erectile dysfunction is not usually a sign of an STI or STD.

That’s not to say they’re completely unrelated. Can an STD cause a man not to get hard? Possibly. STIs and STDs can both affect self esteem and cause psychological erectile dysfunction. Additionally, a painful STI can make it uncomfortable to have sex.

Can chlamydia cause ED? Yes, but this usually happens when untreated chlamydia causes prostatitis (an infection of the prostate) or epididymitis (swelling of the back of the testicles). Chlamydia can also make sex painful, so it’s important to get tested for STIs and STDs regularly.

Heart problems and ED: what’s the link?

Erectile dysfunction can be a warning sign of heart disease, and treating diagnosed heart disease can also help treat ED. But how exactly are these two conditions connected?

One heart problem that often appears alongside ED is coronary heart disease, which can cause a painful feeling of pressure in your chest called angina. Coronary heart disease happens when plaque builds up in the arteries and blocks blood flow to your heart and the rest of your body. Because the blood vessels in the penis are so small, ED can be a clue that something is also going on in the heart. Chronic heart failure and ED can also occur together. Erectile dysfunction and libido issues (low sex drive) were reported by up to 75% of patients with heart failure.

If you’re experiencing erectile dysfunction, it’s important to rule out heart problems before beginning treatment. Medications like nitrates, which are used to treat some heart problems, aren’t safe to use with ED pills like Viagra. It’s also possible that if you have an unstable heart condition, you’ll be advised against having sex at all as elevating your heart rate can be dangerous.

Around 25% of all erectile dysfunction is caused by medication according to one Harvard report. However, some medications list erectile dysfunction as a possible side effect even though it’s actually caused by the underlying issue the medication is addressing. Always read the patient info that comes with a new prescription, and talk to your doctor about side effects and contraindications (reasons why you shouldn’t take a specific medication).

Types of medication that can cause erectile dysfunction include:

  • Antidepressants and anti-anxiety medication
  • Medication for Parkinson’s disease
  • Non-steroidal anti-inflammatory drugs
  • Antihistamines
  • Antiarrhythmics
  • Medication for prostate cancer
  • Muscle relaxants
  • Diuretics
  • Medication for high blood pressure
  • Chemotherapy drugs

High blood pressure medicines and ED

Having high blood pressure is a risk factor for erectile dysfunction, but did you know high blood pressure treatments can cause ED as well? Here’s the scoop on some common medications prescribed to treat high blood pressure (also called hypertension), and how likely they are to cause ED.

Amlodipine and ED: calcium channel blockers like Amlodipine, which lower your blood pressure by blocking calcium from entering your heart and arteries, rarely cause erectile dysfunction.
When it comes to angiotensin-converting enzyme (ACE) inhibitors like lisinopril, ED is occasionally reported but is not a statistically significant side effect of the medication.
Does Losartan cause ED? No. In fact, the angiotensin II receptor blocker (ARB) Losartan has been found to improve the sexual function of men with hypertension.
When taking a high dose (greater than 50mg) of the diuretic hydrochlorothiazide, ED is more likely to be reported as a side effect. Reducing the dose or switching to a different medication is an option.
And for men taking the beta blocker metoprolol, ED was again frequently reported as a side effect.

Researchers have discovered, though, that some of these cases might actually be psychological erectile dysfunction. One study found that for men taking beta blockers, ED was reported more frequently by those who were told it was a possible sexual side effect than by those who weren’t.

Erectile dysfunction and high cholesterol medicines

We’ve already talked a bit about the link between high cholesterol and erectile dysfunction. But like with high blood pressure, there is also a link between treatments for high cholesterol and ED.

Wondering about atorvastatin and ED? Statins are medications commonly prescribed to treat high cholesterol. For men who take the atorvastatin Lipitor, ED is rarely reported as a side effect. A 2014 study found that statins could possibly make erectile dysfunction worse if you already had it; that same study also found that ED tended to improve over time in men who were taking statins for their high cholesterol.

More research is definitely needed before we have a clearer understanding of how statins and ED go together.

Antidepressants and erectile dysfunction

Selective serotonin reuptake inhibitors (SSRIs) like Prozac are the most commonly prescribed antidepressants. They treat depression and anxiety by increasing levels of serotonin in the brain, but can cause sexual side effects for both men and women.

If you’re taking Prozac and otherwise responding well to it, erectile dysfunction doesn’t have to get in the way of your treatment. One option is to talk to your doctor about adding a second medication like Wellbutrin (bupropion), which is often prescribed to help mitigate antidepressant side effects like sexual dysfunction and weight gain. ED pills like Viagra or Cialis can also alleviate SSRI-induced erectile dysfunction.

Alternatively, it might be worth switching to an entirely different medication. Antidepressants that don’t cause erectile dysfunction, or at least are less likely to than SSRIs, include Wellbutrin (bupropion), Remeron (mirtazapine), Viibryd (vilazodone), Trintellix (vortioxetine and serotonin-norepinephrine reuptake inhibitors.

If you’re medically treating your anxiety and experiencing erectile dysfunction, Xanax can be another culprit. Xanax is a fast-acting benzodiazepine medication and isn’t prescribed the same way as antidepressants, which are normally taken daily. Instead, Xanax is taken as-needed and usually for a short period of time. After you’ve taken it, Xanax remains in your body for up to 15 hours. That means it should have a more temporary impact on your ability to get an erection. However, if you’re prescribed Xanax and struggling with ED, we still suggest talking to your doctor. They might recommend finishing your treatment or switching to another medication.

Does Adderall cause impotence?

Adderall is a stimulant medication prescribed to treat attention deficit hyperactivity disorder, or ADHD. It’s an effective medication that can help you regain your focus, but can cause sexual side effects in those who take it.

Adderall contains amphetamine and dextroamphetamine, so it’s also possible to develop ED while taking other ADHD medications with these ingredients. If you need your prescription medication to function but don’t want to deal with unwanted side effects, you have options.

If you’re not taking extended-release medication (Adderall XR), it’s likely that you feel the effects of your pill more at specific times of the day. Scheduling sex around the time before your take your medication, or modifying your dosage on days you want to have sex, is one way of fighting Adderall-induced ED. Prescription ED medications like Viagra can also be helpful in treating erectile dysfunction caused by Adderall.

Can recreational drugs cause ED?

Recreational drug use changes how your body works and can cause lasting damage, including erectile dysfunction. By “recreational drug,” we mean illegal drugs, misused prescription drugs like Adderall and legal drugs like tobacco products.

Because drugs all impact the body in different ways, the ways they can contribute to erectile dysfunction are different, too. For example, the nicotine in tobacco products can keep blood from reaching your penis while heroin or barbiturates can decrease your libido.

It’s important to let your doctor know about drug use when you’re getting help for ED. Doctors aren’t here to judge you, but to help you make the best choices for your body. Without knowing the full picture, medical professionals can’t help you as effectively.

There are many lifestyle choices that can cause erectile dysfunction. While this might sound ominous, it’s actually good news — lifestyle factors are things you can control, and changing any of these behaviors is likely to help cure your erectile dysfunction.

The main lifestyle factors that can cause ED include:

  • Smoking
  • Lack of exercise
  • Poor diet
  • Overweight or obesity
  • Metabolic syndrome
  • Alcohol and recreational drugs

Smoking and erectile dysfunction

Does smoking cause ED? Absolutely. In fact, if you’re experiencing erectile dysfunction, one of the best lifestyle choices you can make is to stop smoking. Research has continually shown that men who smoke have a higher risk of developing erectile dysfunction. And in 2014, ED was added to the list of conditions caused by smoking.

But how does smoking affect you sexually? Well, to get an erection, you need to be able to have proper blood flow to your penis. Cigarettes contain up to around 41,000 chemicals, including nicotine, arsenic and carbon monoxide. All of these can have a negative effect on the health of your blood vessels and your ability to become erect.

Does chewing tobacco cause ED?

Many people mistakenly chew tobacco thinking that it is less harmful than smoking. However, there aren’t really any harmless tobacco products and chewing tobacco has many of the same risks as well as some additional ones.

Nicotine, the ingredient in both chewing and smoked tobacco, has been linked to decreased libido, infertility and, yes, erectile dysfunction. This is because it can affect (and in some cases damage) your blood vessels, which can make getting and keeping an erection difficult. For healthy erections, it’s best to stay away from all types of tobacco, including chewing tobacco and vaping.

Sleep hygiene and erections

Sleep hygiene (good sleep habits) is an important part of your general health, along with diet and exercise. Skipping sleep can make it hard to focus the next day and like all habits, the effects stack up. Studies have shown a link between poor sleep hygiene and negative health outcomes and, yes, being tired can cause ED.

Alcohol and ED

Can alcohol cause ED? Yes and no.

If you’re out drinking and have one too many, it’s quite possible you’ll have difficulty getting an erection later that night. However, occasionally being unable to get an erection is totally normal — you don’t need to worry about erectile dysfunction unless it’s happening so frequently it’s affecting your quality of life.

But while one wild night of drinking won’t give you ED, chronic alcohol use could. Long-term alcohol use can also cause other health problems as well, so try to drink in moderation.

Diet and ED

There aren’t any specific foods that cause erectile dysfunction, or specific foods that can cure it. But while obesity doesn’t cause ED, poor diet and being overweight are both risk factors. That’s because being overweight increases the risk of health conditions like diabetes and heart disease — and those conditions can and do cause erectile dysfunction.

If you’re eating well and exercising, a bit of belly fat won’t lead to impotence. But if you’re concerned that being overweight is the cause of your ED, talk to your doctor. They’ll be able to help you create a plan for weight management that includes minor lifestyle changes.

There are a few injuries which can cause temporary or long-term erectile dysfunction, and they tend to fall into several categories.

First, there are injuries to the penis itself which, fortunately, are quite rare. Erectile tissue damage usually consists of acute rupture to the corpora cavernosa, which is the part of your penis containing all of the blood vessels that help it get hard when you’re aroused. If the injury happens over and over, scar tissue can form on your penis and cause a curved, painful erection. This condition is called Peyronie’s disease and can be treated with surgery or non-surgical injections.

Neuropathy, or nerve damage, also contributes to erectile dysfunction. Penis nerve damage caused by diseases like diabetes and multiple sclerosis can lead to a feeling of numbness. Certain medications like selegiline, which is used to treat Parkinson’s disease, can also cause a loss of sensation in the penis. If your penis feels numb, it’s best to head to the doctor and get checked out for nerve damage. This feeling can also be described as tingling or burning, like the pins and needles you get when an arm or leg falls asleep.

Some studies have found that head injuries like concussions can cause erectile dysfunction as can injuries to the spine.

Can a hernia cause ED?

The short answer is no. A hernia occurs when an internal part of your body, like an organ, pushes through a more external part, like your muscles or tissue walls. There are several different types of hernias depending on where in your body they happen — a hernia next to your groin is called an inguinal hernia.

While the hernia itself won’t cause erectile dysfunction, it might cause some discomfort. Some inguinal hernias present as lumps in your groin area with no other symptoms while others can cause nausea, vomiting or stomach pain. Oftentimes, men with inguinal hernias choose to get surgery, which is a relatively quick procedure that’ll have you home that day or the next day.

Although getting surgery anywhere near your penis can be incredibly stressful, there’s good news. These surgeries are very common and rarely have side effects. And because it’s possible that the hernia was causing you discomfort, studies have shown that it’s likely you’ll actually have better sexual function after your operation.

Will I get ED after a vasectomy?

Many people find vasectomies to be the best form of birth control — they’re the most effective method after abstinence, have a 99% long-term success rate, are non-hormonal and can sometimes be reversed.

If you’re considering a vasectomy, ED might be on your mind. But you don’t need to worry. No physical link has been found between the vasectomy (a sterilization procedure that blocks sperm from reaching semen) and erectile dysfunction, so feel free to get that snip.

Although some men experience vasectomy impotence, it’s likely that this is psychological erectile dysfunction and not a result of the surgery. Psychological erectile dysfunction (also called psychogenic or mental ED) happens when you’re unable to get an erection but there’s nothing physically wrong. It’s commonly caused by things like stress and performance anxiety, and treatment options are available.

Does chronic ED always have a physical cause?

Chronic (long-term) ED doesn’t necessarily have a physical cause. The other type of ED is psychological ED, where the cause is something mental (like stress) rather than something physical (like diabetes or heart disease). Both types of erectile dysfunction have treatment options, so the first step is to figure out which kind of ED you’re experiencing.

Physically induced ED tends to have a very sudden onset and no obvious cause. We recommend seeing your doctor and making sure everything is working as it should. Your doctor will be able to test for physical causes of ED and can suggest lifestyle changes — medication like Viagra is also a treatment option for physical erectile dysfunction.

Man with grey hair and beard wearing baseball cap and smiling in the woods

Psychological causes of erectile dysfunction

If you’ve seen your doctor and there’s no physical reason for you to be unable to have an erection, you might have psychological ED.

While we always recommend seeing your doctor for tests, you can also try to figure this out at home. If you’re still able to get erections early in the morning or while masturbating but struggle during partnered sex, this usually indicates psychological ED.

To treat psychological ED, you need to treat the underlying cause. That can be stress, problems in your relationship or even excitement and nerves over a new relationship. Without treatment, it’s possible that both kinds of erectile dysfunction can be chronic.

Treatments available for physical ED

There are many ways to treat physical erectile dysfunction, and a few tricks you can try at home if you don’t want to make an appointment with your doctor quite yet.

  • Lifestyle changes like changing your diet, quitting smoking, limiting alcohol and exercising more often are both good for your general health and your ability to have erections.
  • Adjusting your medication can help with erectile dysfunction, if ED is a side effect of a prescription you’re taking. You can also talk to your doctor and see if there’s a different medication without that side effect you can try.
  • Treating the root cause of ED is important, as sometimes it’s the result of a physical condition like diabetes or a psychological condition like depression. When you treat the underlying problem, you’ll have a better result than if you try to treat erectile dysfunction alone.
  • Surgery can help if your erectile dysfunction is the result of some sort of injury, like an inguinal hernia. Though getting surgery in your groin area can be stressful, such surgeries are very safe.
  • ED medication like Viagra, Cialis or Stendra can be very useful in treating physical ED. In fact, clinical trials showed that Viagra worked for about 3 in 4 men.
How we can help treat erectile dysfunction

If you’ve read this far and are ready to take the next step, we can help you treat your physical erectile dysfunction. It all starts with a short online consultation where we’ll learn more about you and the symptoms you’re experiencing, as well as your medical history. We’ll connect you with a doctor licensed to practice in your state who can make some treatment recommendations.

Talk to an expert and find out if ED medication is right for you.

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