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Causes of Erectile Dysfunction in Men

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1,2 It is a common condition, and recent estimates suggest that 15 million to 30 million American men are affected by ED.3 Many men with ED also have cardiovascular disease; thus, ED may represent a “silent marker” of underlying cardiovascular disease and require a comprehensive cardiovascular evaluation.4 Although the prevalence of ED increases with age, it is not an inevitable consequence of aging.5 Other risk factors for ED include diabetes mellitus, hypertension, and cigarette smoking.6

Although most cases of ED have a physical cause,7 psychological factors may also contribute to the condition.8 In some men, psychological issues are the primary cause of ED.9

Psychological Causes of ED

Anxiety, depression, and relationship problems can all interfere with a man’s sexual functioning.10 Anxiety about sexual performance (performance anxiety) can be a cause of ED.11

Depression is a common psychological cause of ED.12 A 2005 study13 found that about one in eight men who see a primary care physician for ED will be referred to a psychiatrist.

Relationship problems are also a common cause of sexual dysfunction.14 If a man is anxious about a particular sexual encounter, he may develop ED.15 His anxiety may be the result of his partner’s sexual demands, his own sexual performance, or a combination of both.16

In some men, ED may be the result of a combination of physical and psychological factors.17

Physical Causes of ED

The most common physical causes of ED are related to circulation and blood pressure.18 These include:

  • Atherosclerosis (hardening of the arteries)
  • High blood pressure
  • Diabetes

Other physical causes of ED include:

  • Neurological problems
  • Injury to the penis or testicles
  • Pelvic surgery
  • Hormonal problems
  • Certain medications
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