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What causes erectile dysfunction?

It might have happened to you, or you may have heard a friend complain that he couldn’t ‘perform’ because he’d had one too many drinks.

While this is completely possible, there are other reasons you may have been let down.

Male sexual arousal is a complicated process which involves more parts of the body than what you’d expect. The brain, hormones, emotions, nerves, muscles and blood vessels all play a role1.

When getting hard is harder than it should be on more than just the odd occasion, rather have it checked out as ED is generally a yardstick for physical or psychological health.

The head/heart connection

ED can be an early warning sign of heart disease. It’s basic mechanics after all: the organ that pumps the blood around the body also needs to pump extra blood to what many men consider their most important organ for a while to sustain an erection2.

If something interferes with this blood flow, then an erection can’t happen. The medical term for what causes this is ‘atherosclerosis’, which means there is likely to be blockages somewhere in your heart arteries. These blockages are build-ups of cholesterol-filled plaque. Plaque hampers the blood flow2. Blood vessel problems are one of the main reasons for ED2.

The good news is that there’s something that can be done to remove these blockages – if you find them early enough; in other words, before you have a heart attack. So, on the bright side, ED could potentially save your life by detecting heart problems and getting treatment.

All in the, um, head?

What happens in your head can affect your performance in bed. Research shows up to 20% of ED cases are psychological3.

Psychological causes can all have a negative sexual impact include:

  • Stress
  • Anxiety
  • Relationship problems
  • Depression
  • Performance anxiety
  • Guilt
  • Low self-esteem

And then, as rotten luck would have it, stressing about it happening again can lead to it becoming a self-fulfilling prophecy.

When your brain experiences unhealthy stress, you body can release a hormone (called cortisol) which constricts blood vessels in your penis and negatively affects blood flow needed for an erection3. Chronic stress can also lead to low testosterone levels – a vicious cycle.

A trip to a mental health professional can do wonders to sort whatever’s getting you down. And remember there’s no difference between seeing a doctor for your heart or a psychologist or psychiatrist for the brain!

Depression can result in low sex drive and problems getting fully aroused. In turn however, ED is a possible side effect of some mental health medication4. Consult your doctor to see whether it’s possible to switch your prescription, and if not, you can use one of the effective treatments available for ED.

[1] Mayo Clinic. Erectile dysfunction. Accessed online:
[2] Harvard Health Publishing. Erectile dysfunction often a warning sign of heart disease. Accessed online:
[3] GoodRx. How Depression and Anxiety Can Lead to Erectile Dysfunction. Accessed online:
[4] GoodRx. Can medications cause erectile dysfunction? Accessed online: