What causes erectile dysfunction?

Missing out on sex is not your only option.

Written by
Joe Cutcliffe
Medically reviewed by
Last updated
May 2, 2024
min read
What causes erectile dysfunction?
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Erectile dysfunction (ED) is an incredibly common experience for men of all ages.

And, the causes of 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.

The good news is that treating erectile dysfunction is straightforward and you can even get help from the comfort of your own home. This means that your erectile function could be improved within a matter of days.

But, before we dive into treatment options, you're probably wondering what causes ED. With this in mind, we’re here to deliver some rock-hard facts about all things erectile dysfunction.

The signals in your brain are crossed

The first possible cause of erectile dysfunction has connections to your brain and the way it functions.

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 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 too much porn

Laugh all you like, but a common problem many young men are facing today is the inability to get hard for sexual intercourse with a real-life human because they’ve overdone it with porn.

While “pornography addiction” is not yet recognised as an official addiction, there is some evidence that porn can play a role in erectile dysfunction [1].

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

So, 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 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 it for a while and seeing if it helps.

You have a penis injury

While we might all like to pretend that this definitely isn’t a thing and that the penis can’t really cope with 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) [3]. This can cause a curvature in the penis, painful erections, or it can also cause no erections at all.

You’ve got excess body weight

Want to stay up but struggling? It could have something to do with your weight.

Men who are considered obese or overweight are more prone to developing health conditions such as heart disease and high blood pressure which can directly trigger erectile dysfunction.

Research shows that if you have a high body mass index of more than 28.7, you're at a 30% higher risk of experiencing issues with erectile function [4].

But, there is hope. If you're one of the 75% of men who struggle with their weight, Pilot's Metabolic Reset Program may be helpful.

Our holistic program uses modern medicines combined with health coaching, one-on-one goal setting and weekly check-ins with your medical practitioner to track your physical, mental and biometric progress so you can achieve weight loss success and keep it off in the long term.

Our program helps you lose weight and keep it off, which in turn can help treat your erectile dysfunction.

Your blood flow is a bit off

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

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 and it's best to have a physical examination and undergo some blood tests at the doctor's office.

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. Performance anxiety is a very real thing and not something to dismiss.

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 hold 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 sexual performance can slowly creep up on you until it starts causing said underperformance in the first place.

You indulge in smoking, drugs or alcohol

While this obviously includes overindulging in shots of whisky (causing “whisky dick”), frequent smoking or vaping, or partaking in the use of illegal drugs, 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 offered for high blood pressure, antidepressants, antiepileptic medications, antihistamines (often offered 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.

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 4 examples of how your mind can play tricks on you.

Often, it’s 2 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.

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.

This is where Pilot comes in — our clinically proven erectile dysfunction treatment is the first line of therapy for tackling ED and has helped improve the sex lives of 94% of patients [6].

These clinical-strength ingredients work by targeting the enzyme responsible for the contraction of blood vessels in the penis. This helps to improve blood flow and in turn, maintain firm erections throughout sex.

Simply take an online consultation and our Aussie practitioners will create a treatment plan for you, which is then delivered discreetly to your door so there's no need for a trip to the doctor's surgery or chemist.

Photo credit: Getty Images / Amelia Hanigan


  1. https://apa.org/monitor/2014/04/pornography
  2. https://www.healthline.com/health/what-sexual-anorexia
  3. https://www.racgp.org.au/afp/2017/september/peyronies-disease/
  4. DOI:10.1001/jama.291.24.2978
  5. https://www.aihw.gov.au/reports/men-women/male-health/contents/lifestyle-and-risk-factors/overweight-and-obesity
  6. PMC2387281
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