Understanding the issue

There are both physical and psychological causes of ED and most men will experience a combination of these causes, with one type affecting the other and vice versa. 

Physical causes

Men whose ED is due to a physical cause often experience a gradual onset of erectile problems. These physical causes can include:

• Cardiovascular disease (CVD)
• Diabetes
• Raised blood pressure (hypertension)
• Hormone problems
• Drinking alcohol
• Smoking
• Lack of exercise
• Using illicit drugs
• Some prescription medicines, e.g., some diuretics, antidepressants and hormone modifying drugs.

ED can be an early warning sign of future cardiovascular problems, appearing up to five years before a cardiovascular event, such as a stroke or heart attack. Future heart problems may be prevented if treatment for ED is undertaken soon after symptoms start, particularly if lifestyle changes are adopted.

Psychological causes

A psychological cause is more likely if a man has erection problems some of the time. This can include:

• Performance anxiety and the fear that ED will keep occurring
• Depression. ED may be a symptom of depression. The emotional stress commonly associated with loss of sexual function may also lead to, or aggravate, depression
• Lack of arousal and/or inhibition, e.g., premature ejaculation
• Major life stress, such as money worries or a bereavement.

Typically, ED develops quite suddenly if it has a psychological cause. It may resolve when the person’s mental state improves, for example, if their anxiety or depression eases. For some men, ED can exacerbate anxiety and depression, leading to a vicious circle of a worsening mental health issue and persisting ED.