There are many underlying physical and psychological causes of erectile dysfunction.
Reduced blood flow to the penis and nerve damage are the most common organic causes.
Other underlying conditions associated with erectile dysfunction include the following:
- Psychological conditions like anxiety, stress, depression
- Spinal and pelvic trauma
- Pelvic surgery and radiation therapy, like in operations after prostate cancer.
- Penile deformity like Peyronie’s Disease which causes bending of the penis on erection
- Certain medical diseases – diabetes mellitus, hypertension, high cholesterol
- Drugs used for hypertension and depression
- Hormonal disorders like low testosterone as in andropause / late-onset hypogonadism
The common psychological causes of ED include:
- Stress: Stress can be job-related, money-related, or the result of marital problems, among other factors.
- Anxiety: Once a man experiences ED, he may become overly worried that the problem will happen again. This can lead to performance anxiety, or a fear of sexual failure, and consistently lead to ED.
- Guilt: A man may feel guilty that he is not satisfying his partner.
- Depression: A common cause of ED, depression affects a person physically and psychologically. Depression can cause ED even when a man is completely comfortable in sexual situations. Drugs used to treat depression may also cause ED.
- Low self-esteem: This can be due to prior episodes of ED (thus a feeling of inadequacy) or can be the result of other issues unrelated to sexual performance.
- Indifference: This may come as a result of age and a subsequent loss of interest in sex, be the result of medications or stemming from problems in a couple’s relationship.
The common psychogenic ED seen in young males are usually seen when they are recently engaged, just married or 1-2 years after marriage when the parents and in-laws exert pressure for children from the partners. This is due to performance anxiety.