Understanding the Causes of ED

This is why evaluation by a board-certified urologist is so important. A one-stop shop peddling injections or devices is highly unlikely to discover any underlying, potentially life-threatening causes.

Central Nervous System Disease

The brain generates the directive to get an erection, carried to the pelvic nerves by the spinal cord. Diseases affecting the CNS — dementia, stroke, Parkinson's, temporal-lobe epilepsy, trauma, multiple sclerosis — can lead to ED.

Peripheral Nervous System Conditions

Pelvic nerves can be damaged by trauma or surgery. Radical prostatectomy, radical cystectomy, and abdominoperineal resection are known causes. Diabetes mellitus can also damage these nerves.

Psychogenic Erectile Dysfunction

Because the brain is where an erection originates, psychological factors sometimes play a role: situational stress, performance anxiety, depression and other problems can lead to profound sexual dysfunction.

Endocrine Disorders

Testosterone deficiency is one correctible cause. Hyperprolactinemia, hypo- or hyperthyroidism can also cause ED if not treated appropriately.

Arterial Insufficiency

Reduced arterial blood flow caused by atherosclerosis, smoking, and diabetes can lead to "vasculogenic" ED. Pelvic trauma and radiation can also damage the arteries.

Venous Insufficiency

Blood leaking out of the penis during erection leads to reduced rigidity. Diabetes, penile injury, and Peyronie's disease can cause venous leakage.

Drug-Induced ED

Certain blood-pressure medications, antidepressants, psychiatric medications, over-the-counter drugs, and recreational substances such as marijuana can cause ED through various mechanisms.