Study data suggest that 3 million Canadian men over the age of 40 have erectile dysfunction (ED). It is a condition where the man is unable to get or maintain an erection firm enough for sexual intercourse. It is a common condition affecting men of all ages but becomes increasingly prevalent with age.

There are three types of erection, psychogenic (due to visual or mental associations), reflexive (due to physical stimulation), and nocturnal (during sleep). These types of erection involve your nervous system, blood vessels, muscles, emotions, and hormones. Problems with either of them can also contribute to ED. So, mental health concerns and stress can also cause or worsen erectile dysfunction.

In some cases, a combination of psychological and physical issues may cause ED. For instance, a physical condition that slows your sexual response may trigger anxiety about maintaining an erection. The resulting anxiety may further worsen your condition.

About 50% of Canadian men above 40 years of age have ED at some point in time, but only a few seek treatment. Understanding the exact cause may help you manage or even reverse your condition. It is thus essential to consult your physician, even if you are embarrassed.

Your doctor will ask for a detailed history and run a couple of tests to determine the exact cause of ED.


Erectile dysfunction can be due to a couple of causes, including:

Physical Causes

In many cases, ED is caused by something physical. Some common causes are:

  • Atherosclerosis, clogged blood vessels 
  • Hypertension
  • High cholesterol levels
  • Obesity
  • Multiple sclerosis
  • Peyronie’s disease, development of scar tissue inside the penis
  • Sleep disorders
  • Low testosterone
  • Heart disease
  • Diabetes
  • Metabolic syndrome, a condition with high insulin levels, hypertension, body fat around the waist, and high cholesterol
  • Parkinson’s disease
  • Certain prescription medications
  • Tobacco use
  • Alcoholism 
  • Treatments for enlarged prostate or prostate cancer 
  • Surgeries or injuries that affect the spinal cord or pelvic area 

Physical causes can be divided into the following types:

  • Neurological disorders: Nerves that communicate impulses to your penis may become damaged from diabetes, stroke, or other causes.
  • Vascular diseases: Blood supply to the penis may be altered or blocked due to vascular diseases such as atherosclerosis.
  • Trauma: An injury or surgery to the pelvic area may cause symptoms of ED.
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Psychological causes 

Your brain plays an essential role in initiating a series of physical events that results in an erection, starting with feelings of sexual excitement. Various psychological factors can interfere with sexual feelings and worsen or cause erectile dysfunction. Some of them are:

  • Depression
  • Stress
  • Anxiety
  • Relationship problems due to poor communication, stress, or other concerns
  • Other mental health conditions

Let us have a look at some common causes and how they cause erectile dysfunction.

Hypertension and Erectile Dysfunction

To understand the relation between these two conditions, it is important to know how an erection occurs.

An erection occurs when the blood flows into your penis. This blood flow is stimulated by direct contact with the penis or sexual thoughts. When a man is sexually excited, the penile muscles relax, allowing blood to flow through penile blood vessels and fill two chambers inside the penis. As the chambers are full of blood, the penis turns rigid.

The erection ends when the muscles contract and the collected blood flows out through penile blood vessels.

Hypertension prevents your blood vessels that carry blood to your penis from dilating. It also causes the smooth muscles of your penis to lose their ability to relax. All this keeps your penis from getting the adequate blood supply needed for an erection.

Further, medicines used to treat hypertension, such as diuretics and beta-blockers, hamper your erection. Diuretics decrease blood flow to your penis and thus make it difficult for you to get an erection. They also lower zinc levels, which interferes with testosterone production, which is a risk factor for ED.

If you have hypertension consult your doctor regularly and take medications as prescribed to lower the risk of ED.

Kidney disease & Erectile dysfunction

Long-term kidney disorders, such as chronic kidney failure, reduce the production of sperms and testosterone levels, which increase the risk of ED. Besides, kidney disorders are associated with heart diseases, which are again a risk factor for ED.

Cardiovascular disease & Erectile dysfunction

Experts believe that dysfunction of the inner lining of the blood vessels and smooth muscles present in individuals with heart disorders to be the cause of ED. The mentioned changes in blood vessels impair blood flow to the penis that increases the risk of ED.

If you have or are at an increased risk of cardiovascular disorders, your doctor will suggest lifestyle changes and medicines that may help to prevent ED.

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Diabetes and erectile dysfunction

Diabetes and ED occur together. It is seen that 50% of men having diabetes have ED within ten years of diagnosing it.

Diabetes is a condition where your body cannot metabolize glucose, and excess glucose is found in your blood. High blood glucose levels can damage your blood vessels and nerves. This damage may also affect the nerves and blood vessels located around your penis, causing difficulties in maintaining or getting an erection.

If you have diabetes, it is essential to work with your doctor to manage your blood glucose level under control. This will aid in preventing the damage that may cause ED.

Stress and Anxiety

Mental health disorders such as stress and anxiety affect how your brain signals your body’s response. In the case of an erection, anxiety and stress can alter brain messages that trigger your penis to allow extra blood flow.

Moreover, these disorders can also contribute to a cycle of ongoing ED. Experiencing erectile dysfunction may cause behavioral changes that result in anxiety and incidences of ED 

Some common causes include:

  • Professional and personal stress, such as relationship trouble
  • Psychological ED due to anxiety and nervousness
  • Physical ED (commonest cause for older men)

The following events may also cause anxiety and stress to cause ED:

  • Relationship conflicts and problems
  • Job stress or loss
  • Loss of a loved one
  • Changes in health
  • Financial burdens
  • Fear of aging

A study in veterans has shown that posttraumatic stress disorder (PTSD) increases the risk of ED by more than three times. Besides, long-standing anxiety and stress can increase hormone levels that interfere with your body’s normal processes. This can cause other health conditions, which may result in ED.

Counseling, sex therapy, or alternative therapies, such as yoga and meditation, can help you manage stress and anxiety and thus ED.

Increased age

The risk of ED increases with age due to declining testosterone levels. However, low testosterone levels and age aren’t the sole factors responsible for getting an erection.

In most cases, ED is not directly associated with age, but the underlying medical conditions. Your doctor will help you determine the exact cause of ED and help to manage the same.


As we have understood before, sexual excitement starts in your head. Depression may reduce your sexual desire and cause ED. Moreover, many drugs used to treat depression, such as selective serotonin reuptake inhibitors (SSRIs), may suppress your sex drive and make it difficult for you to get an erection or cause a delay in your orgasm.

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A psychologist or a psychiatrist will help you with counseling and medicines, if required, to manage depression and thus improve ED.

Sleep Disorders

Reduced sleep lowers your oxygen and testosterone levels, which are essential for a healthy erection. Studies have shown that treating sleeping disorders, such as obstructive sleep apnea improves ED.


Having a few drinks may help to improve your mood. But overindulging in alcohol makes it difficult to get an erection, but this effect is temporary.

The good news is that moderate alcohol consumption, one to two drinks a day, lowers the risk of heart disease and thus ED.


Certain medications are seen to affect your erection. Some of these medicines are those used to treat pain, depression, and anxiety.

But always remember to consult your doctor before stopping any medicines. Street drugs, such as cocaine, amphetamines, and marijuana, may also cause sexual problems in men.

Erectile Dysfunction Treatment

Multiple treatment options are available to treat or prevent ED. Some of them are:

  • Erectile Dysfunction Drugs: Medicines such as sildenafil, vardenafil, and tadalafil stimulate blood flow to your penis, helping you achieve and maintain an erection. These drugs have to be taken before engaging in a sexual activity.
  • Lifestyle changes: In cases where lifestyle factors such as lack of exercise, obesity, unhealthy diet are cause for ED, making healthy lifestyle changes may reverse your symptoms.
  • Psychotherapy: For psychological causes of ED, psychotherapy can be an excellent option. A commonly used treatment option is cognitive-behavioral therapy, which addresses negative thought patterns that cause performance anxiety.
  • Vacuum Constriction Devices: These devices create an erection by using vacuum pressure. Once you get an erection, a constriction band is placed on the base of your penis to maintain the erection.
  • Surgery: In cases where other treatment options have failed, surgery can help. Surgical options include malleable rods or inflatable devices that can be surgically implanted on either side of the penis, helping to get an erection.

Final Thoughts

Erectile dysfunction is a common disorder affecting almost 50% of Canadian men above 40 years of age. Getting an erection is a complex process involving various systems, and problems in either system can result in ED. 

But the good news is that in most cases, treating the underlying cause helps in reversing ED symptoms. So, if you feel you may have ED, consult your doctor, and they will help manage your condition.

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