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What are the causes of erectile dysfunction?


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Erectile dysfunction or impotence has two underlying causes; psychological problems and physical problems. Sometimes the two can overlap. Men who experience ED as a side effect of a physical problem, often develop depression, anxiety, or feelings of inadequacy as a consequence of being unable to achieve an erection and have sex. If communication with your partner is difficult, or your partner feels rejected by your inability to have sex, the problems may be compounded.

Psychological causes of erectile dysfunction

There are many psychological causes of erectile dysfunction. These range from temporary problems, to deep underlying issues like childhood sexual abuse, that need long-term treatment. Men who are willing to explore and deal with the psychological causes of impotence will usually be able to overcome their ED.

If you experience any of the following problems, your erectile dysfunction could be psychological in origin. You may benefit from counselling and cognitive behaviour therapy, as well as a prescription medication for the treatment of erectile dysfunction. Men who undertake this treatment may also experience a wider improvement in self confidence and quality of life. 

  • Significant stress at work
  • Financial worries
  • Problems in your current relationship
  • Anxiety about your own body or sexual performance
  • Difficulties relating to women (or your preferred sexual partners)

Physical causes of erectile dysfunction

Men who have enjoyed a healthy sex life for years, and have no obvious psychological issues, may suddenly find that they suffer from erectile dysfunction. This is particularly true for men over 40. 

In these cases, the causes are usually physical in origin. The sudden inability to achieve an erection can be deeply worrying and can also place a lot of strain on a relationship. 

The physical causes of erectile dysfunction can be divided into four main categories. 

  • Vasculogenic
  • Neurogenic
  • Hormonal
  • Anatomical


When a healthy man becomes sexually aroused, his penis fills with blood, becoming erect. To achieve an erection, the blood supply to your penis may have to increase by up to 40%. If you’re highly aroused, this can be almost instantaneous, and can result in a firm and long lasting erection. 

If you are suffering from a vasculogenic condition, the blood supply to your penis may be reduced or interrupted. Cardiovascular disease, high blood pressure and diabetes can all cause impotence or erectile dysfunction. 


Neurogenic conditions are related to the central nervous system (brain, spinal cord, and nerves). Serious illnesses like multiple sclerosis and Parkinson’s disease can produce a range of unpleasant side effects, including erectile dysfunction. 

A stroke, spinal condition, or diabetes can also result in neurogenic erectile dysfunction. Men who suffer spinal injuries in traffic accidents, falls, or during sports may also face erectile dysfunction. For a young, physically active man, this can be particularly difficult to deal with. 


Most people probably associate hormonal issues with women, but men may also be affected by changes in their hormonal balance. A change in hormone levels can sometimes result in impotence. If you are experiencing erectile dysfunction, your GP may check how your thyroid gland is functioning and may also check for Cushing’s syndrome or hypogonadism. You may be referred to an endocrinologist for specialist treatment. 


An injury or nerve damage to the penis or pelvic area, as well as conditions like Peyronie’s disease, or certain cancer treatments, can cause impotence. If you are suffering from any of these conditions it is very important to be open about them with your GP. 


Order your erectile dysfunction treatment

Viagra is one of the treatments prescribed by our doctors to treat erectile dysfunction. Learn more about our prices and how to order your treatment.

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Additional erectile dysfunction at a glance

If you have any of the following medical conditions, they may be contributing to your erectile dysfunction.

Lifestyle related issues

  • Alcoholism or drug abuse
  • Smoking and tobacco use
  • Obesity
  • High cholesterol
  • Type 2 Diabetes
  • Lifestyle related fatigue

Some of these conditions may be side effects of other medical problems rather than poor lifestyle choices, but they can all be improved or ameliorated by leading a healthier lifestyle. 

Medical conditions and illnesses

  • Heart disease
  • Atherosclerosis
  • High blood pressure
  • Diabetes
  • Metabolic syndrome 
  • Parkinson's disease
  • Multiple sclerosis
  • Peyronie's disease 
  • Sleep disorders
  • Prostate cancer or enlarged prostate
  • Injuries to the pelvic area or spinal cord
  • Prescription medicines that can cause erectile dysfunction

Some prescription medicines have side effects which can cause erectile dysfunction. This may complicate how you manage your ED, but the problems can often be overcome. Your GP may change or reduce your prescription medication, or give you a prescription for a compatible erectile dysfunction pill. When you complete your online medical questionnaire it is extremely important that you mention any prescription medications that you are currently taking. 


Order your erectile dysfunction treatment

Viagra is one of the treatments prescribed by our doctors to treat erectile dysfunction. Learn more about our prices and how to order your treatment.

Read More

Prescription medications for the following conditions may interfere with your ability to achieve a functioning erection. 

  • Diuretics: Causes your body to increase the amount of urine it produces. Commonly used to treat high blood pressure, heart failure, and kidney problems
  • Antihypertensives: Used to treat high blood pressure, e.g. beta-blockers
  • Fibrates: Prescribed to decrease cholesterol levels
  • Antipsychotics: Used for some mental health conditions, like schizophrenia
  • Antidepressants: Prescribed to tackle depression or sometimes pain
  • Corticosteroids: Contain steroids (these are a type of hormone)
  • Antagonists:  For stomach ulcers
  • Anticonvulsants: Prescribed to people with epilepsy
  • Antihistamines: Used to manage allergies, like hay fever
  • Anti-androgens: Suppress androgens (male sex hormones)
  • Cytotoxics: Used in chemotherapy

Consulting with an online GP is usually enough to determine whether the cause of your erectile dysfunction is an underlying physical problem or illness. The doctor will be able to explain your options and discuss a treatment plan which usually involves a trial prescription for an erectile dysfunction medicine. 

Everything you need to know about Erectile Dysfunction

Additional factors that impact ED

Erectile dysfunction can also be caused by leading an unhealthy lifestyle. 

Excessive consumption of alcohol damages the nerves in the brain or spinal cord, which can affect the quality of your erections. Being seriously overweight, heavy smoking, recreational drug use and leading a highly stressful life can all contribute to erectile dysfunction. Certain medications like beta-blockers (taken for high blood pressure) can also cause ED as a side effect. Erectile dysfunction can also be a symptom of more serious illnesses like diabetes. 

When should I get treatment?

If you’re unable to achieve a firm erection for long enough to have normal sex, and this occurs at least 50% of the time, it is likely that you suffer from erectile dysfunction and should seek treatment. Consult with an online GP to check for any serious medical and to discuss a treatment plan. 

Having erectile dysfunction can place severe strain on a relationship and can quickly damage your self-confidence and personal happiness. It is not unusual for men with ED to experience depression, anxiety and loss of self-esteem. GPs are used to treating ED and deal with it in a sympathetic and matter of fact way. You should never avoid treatment due to feelings of embarrassment or shame.

DoktorABC’s service allows you to quickly and conveniently attain and renew your prescription for ED medication. Complete a short online questionnaire which is reviewed by our GPs. If your order is approved, your prescription and medication will be sent for free next day delivery.

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