Main Causes of Erectile Dysfunction: What You Need to Know

Page content

Brain and Spinal Cord Injuries

The brain and spinal cord play an important role in achieving and sustaining erection. After seeing or hearing something arousing, the brain sends signals through the spinal cord. Once the signals reach the T10 to L2 levels of the spinal cord, the spinal cord transmits the signals to the penis. This is what triggers an erection. After a brain or spinal cord injury, sexual function may change. The amount of change that occurs depends upon the location of the injury and the severity of the injury. The Spinal Cord Injury Information Network indicates that men who have low-level incomplete injuries have a higher likelihood of achieving erection than men who have higher-level incomplete injuries.

Reduced Blood Flow

Achieving an erection also requires adequate blood flow to the penis. Anything that constricts the blood vessels or damages the vascular system has the potential to interfere with a man’s sexual health. Causes of erectile dysfunction due to reduced blood flow include alcohol and tobacco use, high blood pressure, diabetes and atherosclerosis. Chronic high blood pressure and uncontrolled diabetes both cause blood vessel damage. Atherosclerosis refers to the buildup up plaque on the walls of the arteries. This makes it harder for the heart to pump blood to the penis and other areas of the body.


In cases of hypogonadism, the sex glands do not produce enough hormones. In men, the testes do not produce enough testosterone. Primary hypogonadism occurs when the tests do not function properly. This condition has several causes, including genetic defects, kidney disease, surgery, autoimmune disorders, infections, liver disease and the use of radiation therapy to treat some forms of cancer. Secondary hypogonadism occurs when the pituitary and hypothalamus do not function properly, rendering them unable to control the gonads. Causes of secondary hypogonadism include genetic disorders, trauma, cancer, surgery, radiation therapy, excess iron, infections, bleeding and the use of opiates or steroids. The lack of testosterone production makes it difficult to achieve erection, but research from Columbia-Presbyterian Medical Center indicates that testosterone therapy could be useful in treating erectile dysfunction associated with hypogonadism.

Psychological Stress

Psychological stress is also one of the causes of erectile dysfunction. Experts believe that 10 to 20 percent of erectile dysfunction occur due to guilt, anxiety, fear of poor sexual performance, depression and stress, according to the National Kidney and Urologic Diseases Information Clearinghouse. Men who experience ED due to psychological stress can participate in psychotherapy to relieve the anxiety that precedes intercourse. In some cases, the patient’s partner attends therapy sessions to enhance intimacy and improve communication.

Medication Use

Some medications affect the ability to achieve or maintain an erection.The types of drugs that could lead to ED include diuretics, high blood pressure medications, antidepressants, antihistamines, anti-anxiety drugs, NSAIDs, antiarrhythmics, medications used to treat Parkinson’s disease, muscle relaxers, chemotherapy drugs and drugs used to treat prostate cancer. If you take any of these drugs and have difficulty having an erection, discuss the problem with your doctor. There may be alternative medications with fewer side effects.

References Erectile Dysfunction (ED)

Spinal Cord Injury Information Network: Sexual Function for Men With Spinal Cord Injury

International Journal of Impotence Research: Hypogonadism and Erectile Dysfunction: The Role for Testosterone Therapy

PubMed Health: Hypogonadism

National Kidney and Urologic Diseases Information Clearinghouse: Erectile Dysfunction

WebMD: Drugs Linked to Erectile Dysfunction