What causes erectile dysfunction?

Missing out on sex is not your only option.

Written by
Joe Cutcliffe
Medically reviewed by
Last updated
May 26, 2022
min read
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It was the 2007 feel-good flick The Bucket List that gave us the sage advice to “Never pass up a bathroom, never trust a fart, and never waste a boner”.

Jack Nicholson’s misanthropic magnate Edward Cole utters the words while in hospital with Morgan Freeman’s gentler Carter Chambers, but some also attribute the words to Scottish comedian Billy Connolly.

Whoever said it, it’s a profound bit of wisdom for ageing well in a world where we’re living longer and with fewer social graces.

A weak bladder and the potential to shit yourself every time you break wind are inconveniences that’ll probably affect us all if we’re lucky enough to live that long. But when it comes to erections, age is not the only factor that comes into play.

The reasons for erectile dysfunction are many and varied: some are physical, some are psychological, and many of them can rear their ugly head and strike even a seemingly healthy man at any time.

So, in the interests of delivering some hard (heh) facts, here’s a list of the causes of erectile dysfunction.

Your brain’s signals are crossed

Ever drunk-texted your ex at 2am and then woken up with a pounding headache and a deep sense of regret? Well, that’s not the only way your brain can let you down. In fact, when it comes to sending bad messages, your brain doesn’t even need to use your fingers and phone to do the legwork.

Sometimes the messages your brain sends around to the rest of your body aren’t the right ones. This means that the arousal in your head doesn’t translate to an arousal in your jocks, and your penis will stay in hibernation for longer than is ideal.

This is why conditions that could potentially cause nerve damage, like diabetes, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease, are all potential causes of erectile dysfunction.

You watch WAY too much porn

Laugh all you like, but a common problem many young men are facing today is the inability to get hard when they’re with a real-life human because they’ve already jerked it too many times that day, week, or even month.

While “pornography addiction” is not yet recognised as an official addiction, there is some evidence suggesting that an overindulgence in internet smut is to blame for an increase in young blokes reporting to their local MD with ED.

The condition has even been dubbed “sexual anorexia”, in literal reference to the loss of sexual appetite that goes with watching too much porn.

Sow how does this happen? In short, watching porn is fun and triggers a dopamine release. Dopamine is addictive, and it’s not an outrageous suggestion to hint that porn could also be addictive.

Though this is not an exact science, and for the most of us, the occasional use of porn to get off probably isn't all that bad.

Watching porn can skew reality for many men who overindulge and then don’t have the ability to perform when faced with a real-life sex scenario.

If you’re a big porn guy and find you’ve struggled with getting it up, try laying off the skin flicks for a while and seeing if it helps.

Your dick has some damage

While we might all like to pretend that this definitely isn’t a thing and that the penis can’t really cop proper physical damage, we also know that is a complete lie and that, sadly, in rare instances, your dick can be traumatised.

The most obvious form of this is called Peyronie’s disease, which is fibrous scar tissue in the penis that can form after an injury (often sex-related or surgical). This can cause a curvature in the penis, painful erections, or it can also cause no erections at all.

Your blood flow is a bit off

An erection happens when the vessels in the shaft of your penis become engorged with blood.

For blood to enter the shaft of your penis (and stay there) it needs to be pumping at a healthy level. Conditions that have a negative effect on your blood flow like high blood pressure, diabetes, or your heart not working as well as it used to, can all be factors at play if you’re struggling to get an erection.

This means that persistent erectile dysfunction, especially in patients who have not had experiences with erectile dysfunction before, should be looked at by a doctor. It could be a warning sign that something more sinister is at play.

You have a new partner

Believe it or not, many men who have been married for a long time with no other sexual partners in that time report finding it hard to get an erection when they start a new relationship.

While there isn’t loads of information on hand about this, it could be a factor to consider if you’re reading this after not getting it up a couple of times with somebody new.

You’re stressed

Stress. It’s the most underrated and understood cause of many conditions, and erectile dysfunction is one of them.

Stress (and/or anxiety) can either directly cause erectile dysfunction, or indirectly (that is, by causing another condition which can in turn lead to erectile dysfunction).

Stress can also be responsible for illicit drug use, excessive alcohol consumption, and an increase in cigarette smoking, all of which can make your erections go bye-bye (at least temporarily).

Then there’s the other way erectile dysfunction can take grasp of your mind: by insidiously making you stress more and more about erectile dysfunction, making the loss of an erection a self-fulfilling prophecy.

Happens once? Eh, probably a big meal. Twice? Eh those times were weeks apart, it’s probably nothing. Again? … It’s easy to see how stress related to underperformance in the sack can slowly creep up on you until it starts causing said underperformance in the first place.


While this obviously includes overindulging in shots of whisky (causing “whisky dick”) and partaking in stuff like cocaine (a terrible idea if you hope to get an erection in any timely fashion), it also includes plenty of other legal medications that are known to trigger erectile dysfunction.

In fact, the list of meds that cite erectile dysfunction as a side-effect is enormous, and includes common drugs, many of which are available over-the-counter. Some of these examples are diuretics prescribed for high blood pressure, antidepressants, antiepileptic medications, antihistamines (often prescribed for sleep), non-steroidal anti-inflammatory drugs (NSAIDs), antiarrhythmics, prostate cancer medications, and some types of chemotherapy to name just a few.

In short, if you’re taking any medication it’s important to check with your prescribing doctor on what side effects to expect.

And if you find yourself partying with the wrong crowd (you know, the more fun one) on a regular basis, be aware that a line or two of coke is all it takes for your junk to take an early mark for the day.

You have other health issues

There are myriad health issues that can make achieving an erection difficult.

Vascular diseases, but also diabetes and nerve damage, can all take their toll on a man’s ability to get it up. A hormonal imbalance, such as a testosterone deficiency, can also cause erectile dysfunction.

And then there’s the bevy of psychological factors at play: depression, anxiety, guilt, or fear are just four examples of how your mind can play tricks on your dick.

Often, it’s two or even more of these factors, both physical and psychological, working together to cause erectile dysfunction.

Whatever it is, what’s important is that you seek answers and advice from a trusted resource, check in with a doctor (ideally one that specialises in men’s conditions) and explore treatment options.

Nobody’s ever died because they had trouble getting a stiffy, but they have when they’ve left underlying issues untreated. And if you’re in the majority of men for whom erectile dysfunction is just a part of getting older, treatment is generally as simple as a tablet before sex which is effective and affordable.

Whatever the cause, it’s always worth making sure your health is in check, and remember that a healthy sex life is an integral part of life. Missing out on it just because your penis sometimes doesn’t want to play ball is not your only option.

Photo credit: Getty Images / Amelia Hanigan


  1. http://apa.org/monitor/2014/04/pornography
  1. https://pilot.com.au/co-pilot/does-porn-cause-ed
  1. https://www.racgp.org.au/afp/2017/september/peyronies-disease/
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