Understanding the problem

There are physical as well as psychological causes of erectile dysfunction, and most men will experience a combination of both, with one type affecting the other and vice versa. 

Physical causes 

Men whose ED is due to a physical cause often experience a gradual onset of problems. These physical causes can include: 

• Cardiovascular disease (CVD) 
• Diabetes
• Raised blood pressure (hypertension) 
• Hormone problems 
• Drinking alcohol
• Smoking
• Lack of exercise 
• Using illicit drugs
• Some prescription medicines (e.g. some diuretics, antidepressants and hormone modifying drugs). 

ED can be an early warning sign of future cardiovascular problems, appearing up to five years before a cardiovascular event, such as a stroke or heart attack.

Future heart problems may be prevented if treatment for ED is undertaken soon after symptoms start, particularly if lifestyle changes are adopted. 

Psychological causes 

A psychological cause is more likely if a man only has erection problems some of the time. This can include: 

• Performance anxiety and the fear that ED will keep occurring
• Depression. ED may be a symptom of depression. The emotional stress commonly associated with loss of sexual function may also lead to, or aggravate, depression 
• Lack of arousal and/or inhibition 
• Major life stress, such as money worries or a bereavement. 

Typically, ED develops quite suddenly if it has a psychological cause. It may resolve when the person’s state improves – for example, if their anxiety or depression eases.

For some men, ED can exacerbate anxiety and depression, leading to a vicious circle of worsening mental health issues and persistent ED.