Causes of Erectile Dysfunction

Anything that decreases a man's energy level (such as illness, fatigue, or stress) can make erections difficult. Mental and emotional factors that can interfere with erections include depression, worrying about performance during intercourse (performance anxiety), guilt, stressful relationships, a change of sex partner, and fear of intimacy.

Disorders that damage any of the body parts involved in producing erections can cause erectile dysfunction. These disorders are much more common among older men.

• Arteries: Atherosclerosis and diabetes can damage arteries, causing them to become gradually blocked. Then arteries may not be able to carry enough blood to the penis, and the penis cannot become rigid.
• Veins: Some conditions make the veins of the penis drain blood back to the body too rapidly during erections. Then an erection cannot be maintained. These conditions include Peyronie's disease, injuries (including those that may occur during surgery), and scarring in the penis. As men age, scarring becomes more likely. But aging alone does not cause scarring.
• Nerves: If the nerves of the penis are damaged, control of blood flow in and out of the penis may be disrupted. Such damage may be due to a stroke, a spinal disorder, peripheral neuropathy, diabetes, or multiple sclerosis. The nerves can be damaged by some surgical procedures, particularly those used to treat prostate gland disorders. Examples are transurethral resection of the prostate gland (TURP) and removal of the prostate (prostatectomy, usually used to treat prostate cancer).
• Hormones: Infrequently, a low level of testosterone causes erectile dysfunction.

Drugs can interfere with erections. Examples are antihypertensive drugs, antidepressants, antipsychotics, certain sleep aids, cimetidine, digoxin, and lithium. Drinking too much alcohol can cause temporary erectile dysfunction. Shakespeare commented on this effect of alcohol: "It provokes the desire, but it takes away the performance."

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