What causes erectile dysfunction?

An erection depends on sexual desire, healthy blood flow, nerve signals and responsive penile tissue. A disruption in any of these steps can make an erection difficult to achieve or maintain. More than one factor may be involved, and occasional difficulty can happen with tiredness, anxiety or alcohol.

Conditions that affect blood vessels can reduce the flow needed for an erection. High blood pressure, obesity and type 2 diabetes can affect the vessels over time; diabetes may also affect the nerves involved in sexual response. See more about [Hypertension](/conditions/hypertension/), [Obesity](/conditions/obesity/) and [Type 2 Diabetes](/conditions/type-2-diabetes/).

Nerve damage, pelvic surgery, spinal conditions and some neurological disorders can interrupt the messages between the brain and penis. Low testosterone can reduce sexual desire and sometimes contribute to erection problems, although hormone testing is needed before attributing symptoms to it.

Some prescription medicines, including certain medicines for blood pressure, mood and prostate symptoms, may contribute. Stress, relationship difficulties, performance anxiety and depression can reduce desire or interfere with arousal. Depression can also occur alongside erectile dysfunction and may need separate attention; learn more about [Depression](/conditions/depression/).

Arrange a medical assessment if erection problems keep happening, are changing, or are affecting your wellbeing or relationship. A clinician may ask when the problem began, whether morning or spontaneous erections occur, which medicines and supplements you take, and whether you have changes in desire, mood or urination.

Do not stop a prescribed medicine without advice. A clinician can review possible side effects and check contributing conditions, often with a physical examination and selected blood tests. Regular movement, limiting alcohol, avoiding smoking and addressing sleep, stress and weight may support sexual function while the cause is assessed.

Seek prompt medical advice for a new or persistent change, especially if it occurs with chest discomfort, breathlessness, reduced exercise tolerance, leg pain when walking, numbness, weakness, or symptoms of diabetes. Erectile dysfunction can sometimes accompany broader blood-vessel or nerve problems, so these associated symptoms should not be ignored.

Seek urgent care if an erection is painful or lasts unusually long, particularly after taking an erection medicine. Bring the medicine name and dose if known, and mention any recreational substances or supplements.

You could ask: Could a medicine or health condition be contributing? Do I need blood pressure, diabetes or hormone checks? Could stress, anxiety or depression be part of the picture? Which treatment options are suitable with my current medicines?