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Causes of Erectile Dysfunction or Impotence

What are the Causes of Impotence?

There are many reasons why a man may suffer from erectile dysfunction and be unable to achieve an erection. In the past, people thought that the main cause of impotence is psychological factors. Research now shows that over 80% of the diagnosed cases of impotence can be traced to physical problems.

The causes of ED can be grouped into three main categories:

  1. Physical - aging, diabetes, nerve damage, heart and blood vessel diseases, hormonal imbalance, poor circulation, pain and others.
  1. Psychological - stress, anxiety, fatigue, depression, pain, lack of intimacy with sexual partner and others. Most of these factors are temporary. Fixing one or more of these problems may be enough.
  1. Drug/Medications/Chemicals - high blood pressure medications, antidepressants, cholesterol-lowering medications, anti-anxiety drugs, sedatives, illicit street drugs and others. leaf logo herbal plant natural remedies review

Causes of Impotence - A Complete Review

The Myth of Aging and Erectile Dysfunction

As you age, you are more likely to suffer from erectile dysfunction. However, the aging process in itself does not cause impotence although it may take a longer period of time before the penis becomes fully erect. The facts are, as you age, are more likely to suffer from atherosclerosis, high blood pressure, diabetes and nerve damage. These factors all contribute to impotence.

Atherosclerosis / Hardening of the Arteries

Hardening of the arteries blocks blood flow in the blood vessels throughout the body. If this happens in the coronary arteries (the blood vessels supplying blood to the heart), it can lead to angina and eventually a heart attack (myocardial infarction).

When this happens in the blood vessels supplying blood to the penis, it can lead to erectile dysfunction. This condition is the second leading cause of impotence (about 25% of all physical impotence).

This condition is not just limited to the older populations. Young men are being diagnosed with atherosclerosis at a earlier age. Expert believes it is, in part, due to poor dietary habits.

Hypertension (High Blood Pressure)

Untreated high blood pressure speeds up the hardening of the arteries. Over time, this will permanently reduce blood flow to the penis and lead to erectile dysfunction.


Men suffering from diabetes are at a high risk of developing erectile dysfunction. It is estimated that over 50% of men suffering from diabetes have partial impotence and eventually, the majority of them will become impotent.

This condition is a leading cause of impotence (about 33% of all physical impotence).

Nerve Damage

Damage to the nerves can reduce the sexual sensation transmitted from the glans penis (head of the penis) to the brain. A major cause of nerve damage is from people with diabetes that is poorly managed.

Fixing nerve damage caused by years of uncontrolled diabetes may not be possible. But you can prevent further damage by controlling diabetes.

Another is from prostate cancer surgery (see section on the next page on Prostate Cancer Surgery

Hormone Problems

Testosterone is required to create the sex drive or libido. Low testosterone levels would reduce the sex drive and thus make a man not interested in engaging in sexual intercourse.

Presence of Pain

If you experience pain during sexual intercourse (dyspareunia), you will be unable to enjoy the sexual sensation and the penis may become less firm.

If you are experience other pain such as lower back pain, it will also interfere with your ability achieve a full erection.

Low Libido / Low Sex Drive

If there is no sexual desire, then a man will have difficulty in achieving and maintaining an erection. A low testosterone (male hormone) level is one cause.

Low libido can be caused by prescription medications, depression, other medical conditions and a general lack of interest or attraction to the sexual partner.

Using Condom

Condom use during sexual intercourse prevents the transmission of sexually transmitted disease and pregnancy. It is a physical barrier that is placed over the entire shaft of the penis.

It will reduce the sensation felt by the man during sexual intercourse. This reduced feeling may be enough to cause the penis to become less firm.

This is only a temporary problem and will improve with the use of thinner condom made with polyurethane. (Polyurethane is stronger than latex so the condom can be made thinner to allow the penis to feel more stimulation during sexual intercourse.)


Using tobacco products can cause a variety of health risks that eventually will lead to permanent erectile dysfunction. Directly, nicotine, a stimulant found in tobacco smoke, causes blood vessels to constrict, reducing blood flow to various parts of the body, including the penis. It also interferes with the nitric oxide pathway needed for erection to occur. Over time, smoking speeds up atherosclerosis (hardening of the arteries) and reduces the amount of blood that can get to the penis. This will ultimately lead to permanent erectile dysfunction.

Excessive Alcohol Use

Excessive alcohol prior to sexual intercourse can make it difficult for a man to achieve an erection. It changes the way the sexual sensation and thoughts are perceived by the brain.

In the long term, excessive drinking damages the liver, increases the levels of triglycerides (a type of fat) in the blood and can increase blood pressure and heart failure.

Excessive Caffeine Use

There is debate whether the use of caffeine (found in coffee and tea) will limit the ability for a man to achieve a full erection. Too much caffeine over stimulates the nervous system and that would interfere with the process of achieving an erection. As well, excessive caffeine use may be linked to stress at work, lack of adequate sleep and other factors that may cause impotence.

Excessive Fatigue / Overworking

If you are very tired from work, you may not have the necessary physical energy or interest to achieve an erection. In other words, you rather go to sleep rather than have sex.

Lack of Sleep

If you do not get enough sleep, you will be overly tired the next day. Sexual intercourse requires physician energy. Moreover, not getting enough rest is unhealthy.

Psychology of Stress

It is not surprising that the sexual partners setup up the mood before they engage in sexual intercourse. These activities are designed to relax the partners and take away any stress that may be present. For example, after a very stressful day at work, it may be difficult for a man to relax and “wind down” enough to achieve an erection. Overall, chronic stress has a negative impact on your entire body system, not just on your ability to achieve an erection.

Anxiety or Fear

Anxiety or fear is one of the major contributing factors that causes erectile dysfunction. This can include fear of:
    • not sexually pleasing your partner,
    • getting her pregnant,
    • not being able to achieve orgasm (or ejaculate)
    • not being able to maintain a firm enough erection and
    • your kids coming into your bedroom by accident (because you forgot to lock your bedroom door!)

Depression and Though Disorders

If a man is suffering from depression, he will not be mentally prepared for sexual intercourse. Other disorder such as schizophrenia can cause erectile dysfunction as well as the mind is not in the mental state required for achieving an erection.


If you are angry with your partner or about some other event, you will have difficulties in achieving a full erection.

Prostate Problem

Enlarged prostate not only causes difficulties in urination, it can also prevent the penis from achieving a full erection. There are studies to show that men with an enlarged prostate have a higher rate of impotence.

After Prostate Cancer Surgery

During the surgical removal of the prostate (radical prostatectomy), nerves in that area may be damaged. This will lead to some amount of impotence. There are surgical procedures that can reduce the amount of nerves that a surgeon has to cut through. Look for medical clinics and surgeons that specialize in this.

As well, prescription medication used in prostate cancer or after prostate surgery can cause erectile dysfunction and a reduced sex drive (libido). Also, radiation therapy afterwards may slowly damage the blood vessels providing nutrition to the nerves in the penis.

Excessive Bicycling Riding (Cycling Impotence)

When riding the bicycle, the seat can put pressure on surrounding tissue and reduce the blood flow to the penis. This can cause temporary numbing and discomfort.

Over time, in theory, this will permanently damage the tissue. This condition is reversible when biking stops or is reduced.

This unfortunate condition does not happen to everyone who rides bicycle but research estimates that it does for 5% of the men surveyed. Getting a different bicycle seat design will prevent this problem.

The Myth of Excessive Heat

This is more a myth than fact. You would have to be exposed to extreme heat, like in sitting in a hot tub for an very long time practically every day for this to be a permanent problem.

However, in order for sperm production to occur, the testis (where sperms are made) need to be at a lower temperature than the rest of the body. Excessive exposure to heat does lead to a decrease in sperm count but is reversible when temperature is brought back to normal.

The Myth of Vasectomy and Impotence

Vasectomy does not cause erectile dysfunction. Vasectomy involves cutting the tube that conducts the sperms during orgasm (ejaculation).

It does not affect the testis (the male sex organ) in making testosterone. As well, it takes away the fear of getting your sexual partner pregnant, thus making love making more enjoyable.

Return to Erectile Dysfunction

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Return to Erectile Dysfunction


Revised: August 28, 2019

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