Erectile dysfunction: six common causes of impotence

Impotence, also known as erectile dysfunction, is when a man can’t get or maintain an erect penis. It affects their ability to have sex and though there is a lot of stigma around it, it affects half of all men aged 40–70.

What is erectile dysfunction?

Erectile dysfunction can affect people in different ways. Some men have problems with getting an erection, some have difficulty maintaining an erection while others can’t ejaculate. A lot of the time, it’s an occasional or short-term problem, but for some men it can become a more frequent issue.

Causes of erectile dysfunction

1. Medication and drugs

A number of medications list erectile dysfunction as a possible side effect. Some beta blockers, chemotherapy medications, SSRIs such as fluoxetine, medications that affect your central nervous system, including codeine, diazepam and recreational drugs such as cocaine, can all cause erectile dysfunction.

2. High blood pressure and high cholesterol

Hypertension (high blood pressure) and high cholesterol can affect your health in many ways, including causing erectile dysfunction. Keeping your blood pressure and cholesterol levels in check can help reduce your risk of developing a number of health conditions.

3. Heart problems

An erection happens when more blood is pumped to the penis. So if your heart isn’t working efficiently to pump blood around your body, it can lead to problems with getting and maintaining an erection.

4. Neurological disorders and nerve problems

The brain needs to send messages to the penis in order for you to get an erection. So if there is a problem with either your brain or the nerves that carry these messages it can cause erectile dysfunction. There are a number of neurological and nerve disorders known to lead to erectile dysfunction, including:

• Alzheimer’s disease
• Brain tumours
• Multiple sclerosis (MS)
• Parkinson’s disease
• Stroke

Long distance cyclists sometimes have erectile dysfunction as prolonged pressure on the buttocks and genitals can affect the nerves that stimulate an erection. This is usually temporary.

Some types of injury and surgery can also cause nerve damage, such as spinal injuries, a fractured hip, and surgery or radiotherapy on the groin area.

5. Diabetes and endocrine problems

Your hormones control sexual function and your endocrine system produces hormones. So if there’s a problem with your endocrine system it can affect your sexual health, including your ability to get or maintain an erection.

Complications from diabetes can also cause erectile dysfunction due to nerve damage and impaired blood flow.

6. Mental and emotional problems

Ironically, fear of impotence can trigger erectile dysfunction. Performance anxiety affects most men at some stage in their life. Being unable to get an erection once can lead to a fear that it will happen again, which can stop you from getting aroused.

Depression and anxiety are also linked to erectile dysfunction, both as a cause and as a result of not being able to maintain an erection. 

Your emotions play a role in being able to get and maintain an erection. If you have a lot of stress or anxiety in your life, it can effect your sex life. 

Diagnosis and treatment

A lot of men are embarrassed to go to their GP with erectile dysfunction, but there’s no need for embarrassment. It’s a very common condition, especially in men over 40, and it’s important to get checked to make sure there are no underlying causes such as nerve or endocrine problems.

Your GP will talk to you about what you’ve experienced and they may check your blood pressure, weight and heart rate. They may also suggest a blood test to check your cholesterol and hormone levels.

There are a number of prescription and over-the-counter medications available for erectile dysfunction, including sildenafil and tadalafil. While some medications can be obtained without a prescription, it’s always a good idea to check with your GP before taking something new.

Lifestyle changes and equipment

A penis pump can help you to get an erection. This is a tube that fits over your penis with a pump that removes the air to create a vacuum. This encourages blood to flow into your penis, and you can then place a constriction ring at the base of the penis to help maintain the erection.

Lifestyle changes can also help, such as lowering your stress levels, giving up smoking and reducing your alcohol intake. Getting regular exercise and following a healthy diet can improve your health in general, including your sexual health.

When it comes to relationships, it’s important to communicate with your partner. Sharing your worries can reduce stress and you can work together to make changes to improve your sex life.