Getting Physical with ED

Erectile dysfunction physical causes

/ Author:  / Reviewed by: Joseph V. Madia, MD

Erectile dysfunction (ED) can be a difficult and frustrating problem.  Characterized by the inability to develop or maintain an erection sufficient for sexual intercourse, ED may make some men feel embarrassed and ashamed.

However, this is not a rare condition. According to National Institutes of Health, approximately 30 million American men are affected by ED. 

The condition can have a wide range of underlying physical causes.  Because of this, the presence of ED may mean there is another issue at play. In some cases, treating the underlying problem may improve symptoms of ED.

Causes Far and Wide

A wide variety of conditions can lead to ED. According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), “Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.”

For an erection to occur, various parts need to function together. Nerves in the brain, spine and penis are involved, as well as arteries, veins, tissues and muscles around the penis.

If an interruption occurs at any point in the process, it can disrupt the erection and prevent it.

"ED is commonly the complaint that I see patients for, but there may be a lot more to it besides the ED itself," said Parviz Kavoussi, MD, of Austin Fertility & Reproductive Medicine in Austin, Texas in an interview with dailyRx News. "ED can be an indicator of diabetes, cardiovascular disease, low testosterone and an indicator of overall health status."

A visit to the doctor will help patients determine what is at the root of their ED and how their specific case of this common condition should be treated.

"It is recommended that men who have ED have cholesterol levels, blood sugar and testosterone levels checked," said Dr. Kavoussi. "Although it is certainly important to treat the presenting symptom of ED, that may just be the tip of the iceberg."

Nerve Damage

According to Dr. Kavoussi, “Ten to 20 percent of ED has a neurogenic cause, including any nerve problem affecting the brain, spinal cord, or the nerves that directly innervate the penis for erections.”

Many conditions could potentially cause these nerve problems, including Alzheimer’s disease, strokes and Parkinson’s disease.

Surgery can also cause nerve damage leading to ED. NKUDIC reports that major bladder or prostate surgery (for cancer, for example) can sometimes be to blame. 

Blood Flow and Cardio

Dr. Kavoussi told dailyRx News that decreased blood flow to the penis can also cause ED. This reduced blood flow can stem from issues like diabetes, high cholesterol, high blood pressure and smoking. 

In a 2011 article published in the journal Circulation, Bryan G. Schwartz, MD, and Robert A. Kloner, MD, PhD, both of the Heart Institute at the Good Samaritan Hospital in Los Angeles, explored the connection between cardiovascular issues (particularly a type called atherosclerosis) and ED.

In atherosclerosis, the blood vessels do not dilate correctly. Cholesterol gathers and forms plaques in the walls of these blood vessels. A heart attack can occur due to this condition, but that may not be the only result.

“Atherosclerosis affects not only the blood vessels supplying the heart (coronary arteries), but also blood vessels throughout the entire body,” explained Drs. Schwartz and Kloner. “Atherosclerosis affects different people in different places, but it often affects the penis first, then the heart and brain, and the legs last.”

Because of this, Drs. Schwartz and Kloner warned that “ED can be a warning sign that a heart attack or a stroke may follow, often in the next three to five years.”

ED in this sense may be a blessing in disguise, in that it might alert patients of a serious problem that needs to be addressed before a major health event occurs.


Hormone imbalances can also be to blame for ED, though according to NKUDIC, this is a less common cause.  Low testosterone, or hypogondism, is one example of a hormone condition that can play a role in ED.

In a 2011 article published in The Canadian Journal of Urology, Jack Barkin, MD, of the University of Toronto discussed the connection.

“Testosterone is essential for a normal erection because of its impact on nitric oxide production,” said Dr. Barkin.

Problems with testosterone deficiency can begin in men around age 40, though it will not affect all men the same way.

“Some men with low testosterone levels can have normal erections, and some men with normal testosterone have poor erections.  Therefore, it is important to assess a patient for both conditions,” concluded Dr. Barkin.

Dr. Kavoussi told dailyRx News that treating low testosterone levels may not only help ED, but can also improve symptoms like irritability, low sex drive, decreased muscle mass, sleep disturbances and depressed mood. 

Lifestyle Decisions

“Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED,” reports the NKUDIC. 

These decisions can affect heart and nerve health and interrupt a step in the process required to create and maintain an erection.

“The most common habits that can negatively impact erections are tobacco and alcohol use,” said Dr. Kavoussi. “Cessation or decrease in usage can often improve erections.”

Side Effect Source

According to NKUDIC, ED can also develop as a side effect from certain medications, including common prescriptions that may be necessary for treating separate conditions.

For some patients taking certain antidepressants, antihistamines, appetite suppressants, ulcer drugs or blood pressure drugs, ED can be an unwelcome side effect.

It is important to discuss this possible cause with a doctor, and never discontinue a prescription drug without consulting a physician.

“Sometimes dose adjustments or other agents can be used to improve erectile function. Many times, the medications are needed as prescribed and then treatments can be used to overcome their effects,” said Dr. Kavoussi.

The Importance of Discussion

These are just a few potential physical causes for erectile dysfunction. Psychological or mental causes are also often at the root of this common problem, and as NKUDIC reports, “Even when ED has a physical cause, psychological factors may make the condition worse.” 

Discussing any mental issues like depression, stress, anxiety or low self-esteem with a doctor may make treating ED more effective. 

Drs. Schwartz and Kloner encouraged patients to be open and talk to their doctor about ED.

“Do not be shy or embarrassed. Your doctor has probably dealt with this issue before. If your doctor is an older man, he might even have ED,” wrote Drs. Schwartz and Kloner.

Dr. Kavoussi agrees that patients should speak up, and told dailyRx News, “Men with ED should keep in mind that over 30 million men in the US are diagnosed with ED every year and that is only the men who are coming forward complaining of it, so there are surely more out there.”

Dr. Kavoussi added, “The point is that [ED] is really common and doctors are used to talking to men about it every day, so the sooner a man brings up ED, the sooner he is on the path to treatment and improvement of his and his partner's quality of life."

Once the discussion is begun, steps can be taken to start to treat ED and any underlying physical causes.

Review Date: 
February 1, 2013