How do erections work?
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.
What underlying illnesses cause ED?
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 Efil) can be used for treatment for benign prostatic hyperplasia. 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.
What medications can cause erectile dysfunction?
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
- Medication for prostate cancer
- Muscle relaxants
- 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 atorvastatin, 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 was likely 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 Nexito (escitalopram) or Fludac (Fluxetine) 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 Buspin (bupropion), which is often prescribed to help mitigate antidepressant side effects like sexual dysfunction and weight gain. ED pills like Viagra or Suhagra 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 Buspin (bupropion), Mirtaz (mirtazapine), Vilano (vilazodone), Brintellix (vortioxetine and serotonin-norepinephrine reuptake inhibitors.
If you’re medically treating your anxiety and experiencing erectile dysfunction, Alprax can be another culprit. Alprax is a fast-acting benzodiazepine medication and isn’t prescribed the same way as antidepressants, which are normally taken daily. Instead, Alprax is taken as-needed and usually for a short period of time. After you’ve taken it, Alprax 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 Alprax and struggling with ED, we still suggest talking to your doctor. They might recommend finishing your treatment or switching to another medication.
Does medications used to treat ADHD cause impotence?
Amphetamine and methylphenidate are central nervous system (CNS) stimulant medications prescribed to treat attention deficit hyperactivity disorder or ADHD. They are effective medications that can help you regain your focus, but can cause sexual side effects in those who take it.
It’s also possible to develop ED while taking ADHD medications. 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, 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 ED induced by amphetamine and methylphenidate medications. Prescription ED medications like Viagra can also be helpful in treating erectile dysfunction caused by these medications.
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 all drugs 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.
What lifestyle factors can cause ED?
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:
- 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 too much of it, 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 very frequently and 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.
What injuries can cause ED?
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.