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What Is Erectile Dysfunction and What Causes It?

There’s nothing more frustrating than looking forward to a passionate night of sex with a partner, only to realize that parts of your body are not up to the task.

If you’re experiencing erectile dysfunction (ED), you’re not alone. If you live long enough, every man with a penis eventually has a change in how it functions. According to a literature review, up to 76.5% of men (to use the researchers’ language around gender) have experienced ED. It’s not just older men, either. ED affects 26% of men under 40, according to a study in the Journal of Sexual Medicine.

What is erectile dysfunction?

Erectile dysfunction (ED) is “the consistent inability to obtain and maintain an erection for satisfactory sexual relations,” according to Serkan Deveci and John P. Mulhall in Principles of Gender-Specific Medicine. In other words, it’s when you can’t get or stay hard over a substantial period of time. Everyone with a penis experiences losing or not getting an erection eventually. If it happens frequently, though, it could be ED.

How do erections work?

To understand ED, it can help to understand how erections work.

An erection happens when blood fills the penis, making the penis hard. More specifically, an erection is a neurovascular event that involves your psychological, hormonal, neurological, and vascular systems. If any of these systems is interrupted, erectile dysfunction can be the result.

Erections work similarly to lighting a Christmas tree. Without a strong, functioning power source; a working plug and cables; a sturdy stand to keep it upright; a string of lights in which every bulb lights up; and a festive mood to bring it all together, your shining tree will stay in the dark.

For erections, the power supply is your heart pumping blood. The cables that transmit the power are clear arteries. The tree stand is a strong pelvic floor that helps to keep the blood in your penis to maintain the erection. The lights are the tissue in your penis, which needs to be relaxed in order to open and fill with blood. The festive mood is being in touch with your sexual desire.

When all goes smoothly, your brain signals for the nervous system to release chemicals that relax and widen the arteries to the penis. Your heart then pumps blood through these widened arteries and into the penis, aided by the bulbospongiosus muscle. Here two cylinders expand and fill with the blood, building your erection. As they expand, veins on their surface compress against the outer layer of the penis and your pelvic floor contracts to trap the blood.

An erection is a complex chain reaction from mind to body. So it is no surprise that things don’t always go according to plan.

What are the physical causes of ED?

Since blood flow is such an important part of an erection, a lot of the physical causes of ED relate to circulation and blood pressure. That’s also why persistent ED can be a sign of a more serious underlying health issue. Some of these include:

  • Heart disease

  • Neurological conditions

  • Hormonal disorders, like low testosterone

  • Diabetes

  • Periodontal disease

Longer-term health issues, like obesity and Parkinson’s disease, can also impact blood flow.

Lifestyle can also play a role. For instance, ED risk is nearly double in men who smoke cigarettes. Alcohol affects sexual function. So does cocaine. “ED therefore presents a window of opportunity to motivate lifestyle changes toward greater health. One study found that men who seek treatment for ED may prefer alternatives to pharmaceutical intervention, such as lifestyle change,” Luke Fortney writes in Integrative Medicine.

What are the psychological causes of ED?

Your mental state has a major impact on your ability to get hard in the bedroom. Some of the main culprits that can interfere with the signals in your brain include:

How do the causes of ED intersect?

Every instance of ED involves a combination of physical, mental, relational, and social elements.

For example, say you get a groin sports injury that causes ED as it heals.

Once you’ve experienced the initial dysfunction a couple of times, you might start to worry that your sex life will never recover. You may develop performance anxiety around it. That anxiety might make it even more difficult to get erections, which leads to even more anxiety. Plus, you still have the groin injury. This is a psychological issue as well as a physical one, and depending on how you communicate with your partner it might be a relationship issue, too. If you link your ability to have an erection to your masculinity, you might also experience a self-esteem dip, which is a psycho-social issue.

So what do I do about my ED?

Physical and mental arousal are complicated, but they’re not impossible. Depending on your situation, you might benefit from a combination of learning, personal exercises, and brain training, which are the building blocks of Lover's app courses for erectile dysfunction. You might also benefit from chatting with an expert about what approaches could be a good fit for you.


Download the Lover app today for expert guidance, effective exercises, and proven techniques to help treat your sexual issues.


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