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What Causes Erectile Dysfunction (ED)?

It isn't always a natural part of the aging process—see how to reverse ED and take control of your sex life.

Many men associate virility with youth, so it's no wonder that the idea of diminished virility or erectile dysfunction (ED) can be a dismal thought. No one wants age to interfere with a full, satisfying sex life. Understanding what causes erectile dysfunction, how to prevent it and how to treat it—whether naturally or with your healthcare provider’s help—can help you take control of your sexual health and satisfaction through the years. 

According to Mehmet Oz, MD, almost every man experiences ED—the inability to get or maintain an erection—at some point in his life. Newer research shows that more than half of men over the age of 60, and nearly 20 percent of men over the age of 20, are affected. If that's true, why aren't more men talking about it? 

"Experts say that most men blame themselves, thinking that emotions are at the root of the problem," notes Dr. Oz. But in most cases, ED is caused by medical problems—such as high blood pressure, diabetes, obesity and smoking. 

Jan Shifren, MD, an associate professor at Harvard Medical School agrees, "In the past, most cases of erectile dysfunction were considered psychological, the result of such demons as performance anxiety or more general stress." While these factors do cause some cases of ED, about 70 percent of erectile disfunction cases are caused by age-related changes or a physical problem that interferes with blood flow, nerve function or both. The upside for men and their partners? Most causes of ED can be reversed or treated. 

What causes erectile dysfunction? 
The causes of ED are varied. Countless muscles, tissues, veins, nerves and arteries are involved in the natural processes that lead to an erection, so anytime this complex sequence of events is interrupted, ED can result. 

Certain surgeries and injuries can cause erectile dysfunction. It can also be caused by diseases that affect the tissues, nerves or arteries involved in erections. These diseases include diabetes, kidney disease, vascular disease and neurological disease. Some medications, such as blood pressure medication, antihistamines and antidepressants, may have ED-related side effects. For 10 to 20 percent of men, the culprits are psychological factors such as stress, depression, anxiety and low self-esteem. Sometimes a combination of physical and psychological factors is what causes ED. 

Medically reviewed in July 2018. Updated in March 2021. 

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