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What causes erectile dysfunction?

What causes erectile dysfunction?

Erectile dysfunction (ED) is a condition which makes it difficult to obtain or maintain an erection long enough to have satisfying, penetrative sex. Most men have occasional times when they experience difficulty in getting an erection (e.g. when tired, stressed, distracted or after drinking too much alcohol). However this is usually only temporary and an erection occurs most times when they are sexually aroused. However some men have persistent or recurring ED, which is when it becomes a problem. 

ED is very common in Ireland, particularly for men over 40. However, ED can effect men of all ages and can be very distressing and many men are reluctant to seek treatment as they feel embarrassed.

What are the main causes of erectile dysfunction?

There are many physical and psychological causes for ED and often it is a combination of both. Physical causes (about 8 in 10 cases) include diseases that affect the nerves (e.g. Parkinson's disease, Multiple Sclerosis, prostate surgery), hormone problems (e.g. low testosterone levels), diabetes, high blood pressure and vascular disease (narrowing of the blood vessels).

Most cases are due to narrowing of the arteries that take blood to the penis and can be an "early warning" sign of heart disease, particularly in men over the age of 40. Psychological causes include stress, anxiety and depression. 


Lifestyle choices play a big role in ED such as smoking which roughly doubles your chance of getting ED and is one of the biggest risk factors for developing a narrowing of your blood vessels (atherosclerosis). Being overweight, having high blood pressure, diabetes, high cholesterol and drinking excess alcohol are also risk factors for atherosclerosis.

The good news is that exercising, stopping smoking, reducing your alcohol intake, eating a healthy diet, controlling your diabetes and blood pressure can help reduce these factors and have a positive impact on ED.

Psychological factors

Erectile dysfunction can also be caused by psychological or emotional factors such as relationship difficulties. Typically the ED develops suddenly when it is a symptom of a psychological problem but improves as the stress, anxiety or depression resolve. Often the ED can add to the underlying stress and anxiety which can lead to a vicious cycle. A loss of confidence can also make this worse. Even if you think your cause is likely to be psychological we would advise having the follow up tests we recommend.

Is erectile dysfunction treatable?

It is really important to treat the underlying factors which are causing ED which is why our doctors will ask you to see your regular doctor for some tests. ED treatments such as Viagra (Sildenafil), Cialis and Levitra can help you reach and maintain an erection as well help to break a negative cycle and boost confidence however, they do not treat the underlying causes of the ED so it is really important to have the follow up tests we recommend. 

There are many treatments available which can help so if you think you have erectile dysfunction you can try our free assessment or take a consultation for one of our treatments. Our doctors can assess you and prescribe treatments online through our discreet service.

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Authors and editors

Reviewed and updated by: Our clinical team Date reviewed: 21-01-2023