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Causes of ED/Talking with a Healthcare Provider

Erectile dysfunction (ED) – the inability to have an erection firm enough for sex - can be a sensitive topic. It not only affects a man’s sex life. It can weaken his self-esteem, his relationship with his partner, and his masculine identity. He may be angry and fearful that the situation won’t improve.

Fortunately, ED can be treated successfully, usually with medications or devices. However, sometimes targeting the cause of the ED helps alleviate it. ED can be linked to a number of conditions – both physical and psychological – and getting to the root of the issue can bring about positive changes in overall health and in a couple’s sex life.

Today, we’ll look at some of the more common causes of ED and offer some tips on discussing it with the doctor.

Physical Causes

For a man to have erections, he needs to have good blood flow to the penis. When he’s sexually aroused, muscles relax and arteries widen to let the blood in. Other blood vessels tighten to make sure it stays there, since the blood is what gives the penis the firmness it needs for penetration. Once the stimulation stops, or the man ejaculates, the blood leaves the penis and flows back into the body.

Some physical conditions can interfere with this process.

Diabetes can cause neuropathy, a nerve disorder that may prevent messages from transmitting between the brain and the penis. Without proper communication, the muscles and arteries won’t “know” it’s time to do their part. Stroke and multiple sclerosis can lead to similar communication problems.

Men with heart disease may have problems with atherosclerosis – hardening of the arteries. Atherosclerosis narrows the arteries, blocking the blood’s path into the penis. Diabetes, high blood pressure, and high cholesterol levels can impair blood flow, too.

ED can also be linked to certain medications, hormonal disorders, kidney disease, and obesity.

Psychological Causes

ED can have psychological roots, too. Conflict with a partner, an unhappy relationship, stress, and depression can all take their toll on a man’s erectile ability. Some men suffer from performance anxiety, so worried about pleasing their partner that they are unable to get a suitable erection.

Past sexual issues, such as abuse or guilt about sex, are other possibilities. A man could also be afraid of having a sexual relationship based on past experiences.

Sometimes, physical and psychological causes combine and worsen erectile function. For example, a man could have blocked arteries from heart disease and have stress from work. Both of these situations could join forces and lead to ED.

If you think you have ED, your first step toward treatment is seeing a doctor.

Talking to your Healthcare Provider

A urologist can assess your personal situation and work with you to find the best treatment for you and your partner, if you’re in a relationship.

Many men feel nervous and embarrassed about discussing ED with their healthcare provider. But it’s important to do so. As discussed above, ED can be a symptom of more serious health issues, like diabetes, heart disease, and kidney disease. ED can also signal high blood pressure, high cholesterol, low testosterone, and obesity.

Having a checkup with the doctor can benefit you in two ways. First, if your ED is a symptom of another medical condition, you can start treatment for that condition right away and improve your overall health. Second, treating that condition may be all you need to have better erections. Or, you may be able to start treatment specifically for ED. Either way, you should see improvements in your sex life.

For example, getting blood sugar under control can help a man with diabetes stay healthier longer and may alleviate complications like ED. If a man’s problem is obesity, dietary changes and exercise may be in order. Both are likely to improve his health and his erectile function.

So how do you start the conversation?

Take a deep breath. ED is common and, most likely, your urologist has treated it before.

Have some questions ready. You might write them down before your appointment to make sure you don’t forget anything. Your partner may think of questions, too. Feel free to ask any question. If something is troubling you, be sure to speak up! This list of ED questions (PDF) can get you started.

You might ask your doctor about the possible cause and what kind of testing might be needed to diagnose it. You might also ask what you can expect from treatment.

Remember that ED can have many causes, including psychological ones. Your doctor may ask you about your past sexual experiences and relationships. Be open and honest. Ask the doctor if counseling or sex therapy is appropriate for you.


Sexual Medicine Society of North America

“Common Causes – Erectile Dysfunction”

“ED as an Indicator”

“Questions to Ask Your Health Care Provider about Erectile Dysfunction (ED)”