22 Risk Factors for Erection Trouble: How Many Can You Name?
ED doesn’t just happen, but few people know more than one or two risk factors.
Posted March 16, 2020 | Reviewed by Ekua Hagan
Swiss urologists surveyed 126 men who complained of erection problems. Half could not name a single risk factor for ED. That’s a real shame. Minimizing risk factors help preserve erections and delay the onset of ED.
Until the 1980s, the vast majority of erection impairment was considered psychological—subconscious neuroses and relationship turmoil. Today, sexologists understand that ED is more likely to result from medical issues.
Major Risk Factors
1. Atherosclerosis. Once called hardening of the arteries, atherosclerosis involves the growth of fatty, cholesterol-rich deposits on artery walls. The deposits narrow the arteries, reducing blood flow. Atherosclerosis is a major cause of both heart disease and stroke. When it narrows the penile arteries, less blood enters the penis, meaning more difficulty raising and maintaining erections.
2. Tobacco. Smoking greatly accelerates atherosclerosis. Smokers have twice nonsmokers’ risk of heart disease and substantially greater risk of ED before 60. But by five years after quitting, the arteries recover, and erections may too. (Lung cancer risk remains high much longer.)
3. Heart disease. Atherosclerosis causes both heart disease and ED. Heart disease may be a harbinger of ED or visa versa.
4. High blood pressure . Hypertension damages the arteries and is a key risk factor for heart disease, which is strongly linked to ED.
5. Diabetes. Ninety-five percent of diabetics have Type-2 disease, usually caused by a combination of obesity and a sedentary lifestyle. Diabetes greatly accelerates atherosclerosis. Compared with healthy men, diabetics face three times the risk of heart disease and a considerably greater risk of ED.
6. Obesity. It takes energy to drag extra weight around, energy the body might otherwise invest in libido and erection. Obesity is also strongly associated with atherosclerosis, heart disease, diabetes, and high blood pressure, all contributors to ED.
7. Sitting. A sedentary lifestyle is strongly associated with obesity, diabetes, high blood pressure, and heart disease. They all damage the arteries and reduce blood flow into the penis.
8. Meats, cheeses, ice cream, fast food, and junk foods. They’re all high in animal (saturated) fat, the type that’s most strongly associated with atherosclerosis.
9. Lack of fruits and vegetables. Plant foods contain no saturated fat and are high in antioxidant nutrients that help maintain arterial health.
10. More than two alcoholic drinks per day. Alcohol is a leading erection-saboteur. A few drinks may not deflate young men, but after 50, even one beer, glass of wine, or cocktail may hit below the belt. Alcohol impairs arousal and depresses nerve function. Chronic over-indulgence raises blood pressure and accelerates atherosclerosis.
11. Obstructive sleep apnea. Apnea involves loud snoring punctuated by choking silences. It’s caused by excess tissue in the throat, typically the result of obesity. When excess throat tissue blocks the throat, breathing becomes momentarily interrupted. This sets off biological alarms that rouse apneic, restoring breathing. But frequent nightly rousings destroy sleep and raise blood pressure. Apnea is a major—and seriously underappreciated—ED risk factor.
12. Severe emotional stress. Whatever you call it—stress, anxiety, worry—emotional stress releases the hormone cortisol, which constricts the penile arteries, reducing blood inflow. Typical causes of erection-deflating stress include performance anxiety, relationship turmoil, family problems, and job, money, or legal woes—and the stress of having other sex problems, notably premature ejaculation (PE). Italian scientists analyzed 18 studies involving 57,229 men. Chronic PE tripled risk of ED.
13. Acute illness or injury. Don’t expect your penis to stand up if you can’t. Illness and injury cause stress, fatigue, pain, and other challenges that may impair erection. Decreased sexual interest and function are the body’s ways of focusing on healing.
14. Depression. At some point in life, around one American in eight suffers serious depression. In men, it may cause the classic symptoms: deep melancholy and feelings of helplessness and hopelessness. But male depression might also present as anxiety, anger, insomnia, alcohol or drug abuse, and/or self-harm. Chinese researchers pooled 49 studies involving several thousand men. Compared with mentally healthy individuals, men with depression had three times the ED risk.
15. Antidepressants. Many antidepressant drugs are as erection-killing as depression itself. The most popular mood elevators are the selective serotonin reuptake inhibitors (SSRIs), among them: Prozac, Paxil, Zoloft, Luvox, and Celexa. Around 10 percent of male users suffer ED as a side effect. Fortunately, another antidepressant is equally effective, but less likely to cause ED—Wellbutrin (bupropion). If you develop erection trouble within a few weeks after starting an antidepressant, ask your physician if you might switch to Wellbutrin.
16. Prostate cancer treatment. Treatments include removal of the gland (prostatectomy), hormone therapy, and radiation. All usually impair erection. “Nerve-sparing” surgery is somewhat less likely to leave men with ED, but it’s no guarantee of post-surgical firmness.
Lesser—but Still Important—Risk Factors
17. Neurological disorders. Multiple sclerosis, spinal cord injuries, and other conditions may damage erection nerves.
18. Anabolic steroids. Some athletes and bodybuilders take these drugs to increase muscle mass. Over time, they suppress testosterone and raise ED risk.
19. Significant prostate enlargement before 60 . As men age, their prostates grow larger (benign prostate hyperplasia, BPH). As the gland expands, it pinches the urine tube (urethra) causing: weak stream, trouble getting started and finishing, and the need to get up at night to urinate. Both BPH and ED affect older men, but until this century, physiologists considered them unrelated. Now a growing body of research links early-onset BPH with early-onset ED.
20. Drugs prescribed for BPH. Finasteride (Proscar, Propecia) and dutasteride (Avodart) are both associated with increased risk of ED. Italian researchers analyzed 17 studies involving 46,733 men. The use of these drugs raised risk 50 percent.
21. Gum disease (periodontitis). Chronic gum disease causes persistent inflammation. It impairs the body’s ability to raise blood levels of nitric oxide, a compound critical to an erection. Ten percent of American adults have periodontitis. Several studies show that it’s associated with ED. As gum disease becomes more severe, so does ED.
22. Vitamin D deficiency. Several studies show that low vitamin D is associated with ED. Some foods contain this vitamin: mushrooms, tofu, and soy and almond milks. But the skin produces most on exposure to sunlight. Unfortunately, many Americans spend little time outdoors, and when outside, they slather sunscreen, which suppresses vitamin D synthesis.
Bacon, C.G. et al. “A Prospective Study on the Risk Factors for Erectile Dysfunction,” Journal of Urology (2006) 176:217.
Barassi, A. et al. “Vitamin D and Erectile Dysfunction,” Journal of Sexual Medicine (2014) 11:2792.
Baumgartner, M.K. et al. “Patients’ Knowledge About Risk Factors for Erectile Dysfunction is Poor,” Journal of Sexual Medicine (2008) 5:2399.
Biebel, M.G. et al. “Male Sexual Function and Smoking,” Sexual Medicine Review (2016) 4:366.
Boeri, L. “Unrecognized Pre-diabetes is Highly Prevalent in Men With Erectile Dysfunction—Results from the Cross-Sectional Study,” Journal of Sexual Medicine (2018) 15:1117.
Budweiser, S. et al. “Sleep Apnea is an Independent Correlate of Erectile and Sexual Dysfunction,” Journal of Sexual Medicine (2009) 6:3147.
Cao. S. et al. “Association of Quantity and Duration of Smoking with Erectile Dysfunction: A Dose-Response Meta-Analysis,” Journal of Sexual Medicine (2014) 11:2376.
DiFrancesco, S. and R.L. Teneglia. “Mediterranean Diet and Erectile Dysfunction: A Current Perspective,” Central European Journal of Urology (2017) 70:185.
Hanak, V. et al. “Snoring as a Risk Factor for Sexual Dysfunction in Community Men,” Journal of Sexual Medicine (2008) 5:898.
Wei, M et al. “Total Cholesterol and HDL Cholesterol as Important Predictors of Erectile Dysfunction,” American Journal of Epidemiology (1994) 140:930.
Zhou, X. “Updated Evidence of Association Between Periodontal Disease and Incident Erectile Dysfunction,” Journal of Sexual Medicine (2019) 16:61.