ED results from disruptions to blood flow, nerve signaling, hormones, or psychological state. Identifying the dominant cause guides treatment selection.
Vascular Causes
- Atherosclerosis narrows penile arteries, often linked to high cholesterol, diabetes, or smoking.
- Hypertension stiffens vessel walls and accelerates endothelial dysfunction.
- Venous leak prevents blood from staying trapped in the corpora cavernosa.
Neurological and Hormonal Factors
- Nerve damage from diabetes, spinal cord injury, or pelvic surgery disrupts penile signals.
- Low testosterone reduces sexual desire and weakens erectile response.
- Thyroid disorders and elevated prolactin can suppress libido and erections.
Medication-Related ED
- Beta-blockers, certain antidepressants, and antiandrogens frequently impair erections.
- Opioids suppress testosterone production and neural signaling.
- Recreational substances, including alcohol and cannabis, can worsen performance in high doses.
Psychological Contributors
- Performance anxiety triggers fight-or-flight responses that reduce penile blood flow.
- Depression and relationship stress diminish libido.
- Past trauma or negative sexual experiences create avoidance patterns.
Comprehensive Evaluation Checklist
- Medical history covering chronic disease, surgeries, and medications.
- Physical exam evaluating pulses, sensation, and penile anatomy.
- Laboratory panel: fasting glucose, lipids, testosterone, thyroid, and prolactin as indicated.
- Special tests such as nocturnal penile tumescence or Doppler ultrasound for complex cases.
Because ED often has multiple contributing causes, combine medical therapy with lifestyle and psychological support for best outcomes.