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Erectile dysfunction is a man’s inability to get or keep an erection that allows sexual activity with penetration. Erectile dysfunction is not a disease, but a symptom of some other problems like physical, psychological, or a mixture of both.

Erectile dysfunction is a prevalent sexual health issue that can occur in the adult life of a man at any time, but it is more likely to occur with age. When a man can not get a hard enough erection to have sex, it can lead to a decrease in confidence and can even create relationship problems.

The global prevalence of erectile dysfunction was cited as 52 percent in a summary of the Massachusetts Male Aging Study results published in the Cleveland Clinic. They also found that with increasing age, it is becoming more prevalent. Around 40 percent of men have the condition at age 40, while around 70 percent of men suffer from erectile dysfunction at the age of 70.

Although in many men, the problem of erectile dysfunction may be similar, the causes are not. There are numerous reasons for the development of this issue, some physical and others psychological.

Causes of erectile dysfunction

Physical causes of ED: 

Erectile dysfunction is often associated with conditions that affect blood flow in the penis, such as diabetes, high cholesterol, high blood pressure ( Hypertension ), cigarette smoking, alcohol, obesity, cardiovascular disease, and multiple sclerosis.

• Diabetes: Diabetes is a condition where your body can not metabolize glucose, and there is excess glucose in your blood. Your blood vessels and nerves can be damaged by high blood glucose levels. The nerves and blood vessels around your penis may also be affected by this damage, causing difficulty in maintaining or getting an erection.
  Diabetes and ED occur together. It is seen that 50% of men having diabetes have ED within ten years of diagnosing it.

• Hypertension: An erection occurs when the blood flows into your penis. Hypertension prevents your blood vessels that carry blood to your penis from dilating(Become Wider). It also causes the smooth muscles of your penis to lose their ability to relax. All this keeps your penis from getting the adequate blood supply needed for an erection.
• Obesity: Obese men are at increased risk for erectile dysfunction (ED), likely caused by atherosclerosis-related hypertension and cardiovascular disease, as well as hormonal changes associated with obesity.
  The build-up of atherosclerotic plaque in the arteries of obese men can damage the arterial lining and contribute to elevated blood pressure. In addition to atherosclerosis, the hormonal changes that accompany obesity, including lower testosterone, increase the risk of ED. The risk factors for heart disease, such as excess weight, diabetes, and hypertension, are generally the same as those for ED. Studies have shown that weight loss and increased physical activity can improve ED.
• Smoking cigarette and alcohol: Male smokers have an increased risk of erectile dysfunction due to the chemicals like acetone, arsenic, and carbon monoxide present in cigarettes which can damage blood vessels, narrowing the arteries and causing the poor blood supply to the penis. Nicotine has a direct effect on the blood vessels that carry blood to the penis, by reducing the blood flow and this makes getting and maintaining an erection difficult.
  Having a few drinks may help to improve your mood. But overindulging in alcohol makes it difficult to get an erection, but this effect is temporary.
• Cardiovascular disease: Experts think that the cause of ED is a dysfunction of the inner lining of the blood vessels and smooth muscles present in people with heart disorders. The aforementioned changes in blood vessels affect the flow of blood to the penis, thereby increasing the risk of ED.
• Multiple Sclerosis(MS): One of the most common symptoms of multiple sclerosis (MS) in men, affecting 23% to 91% of men, is erectile dysfunction (ED). MS is a condition characterized by progressive nerve damage. ED may occur or worsen when nerves connected with the erectile response are involved, leading to impaired stimulation and arousal.

Psychological causes

The brain plays an essential role in initiating a series of physical events that results in an erection, starting with feelings of sexual excitement. Different psychological factors may influence and exacerbate sexual feelings or cause erectile dysfunction. Some of them are Depression, Stress, performance anxiety, Sleep disorder, etc

• Depression: Depression may reduce your sexual desire and cause ED. Moreover, many drugs used to treat depression, such as selective serotonin reuptake inhibitors (SSRIs), may suppress your sex drive and make it difficult for you to get an erection or cause a delay in your orgasm.
  A study published in a 1998 edition of Psychosomatic Medicine shows a clear link between depression and erectile dysfunction in middle-aged men. 
• Stress: When your brain is under unhealthy stress — for example, from traumatic events, relationship problems, or work stress — your body can release a hormone called cortisol instead of testosterone. Cortisol constricts the blood vessels in your penis. When blood can’t flow properly to your penis, that’s when you may have difficulty achieving an erection.
  Over time, chronic stress (chronically high cortisol levels) decreases the amount of testosterone your body makes, and this will, in turn, causes erectile dysfunction.
• Performance Anxiety: A sensation of nervousness and anxiety before and during sex is sexual performance anxiety. It is very widespread, influencing men of all ages and backgrounds. This may be because of sexual performance issues, or nervousness regarding sexual activity, or body concerns, etc. For many men, this can lead to erectile dysfunction, making sexual activity more difficult and less satisfying.
• Sleep disorder: Reduced sleep lowers your oxygen and testosterone levels, which are essential for a healthy erection. Studies have shown that treating sleeping disorders, such as obstructive sleep apnea improves ED.

Medications that can cause ED

Certain medications are seen to affect your erection. Some of these medicines are those used to treat pain, depression, and anxiety. A common side effect of a variety of prescription drugs is erectile dysfunction (ED). While these drugs may treat a disease or disorder, in doing so they may affect a man’s hormones, nerves, or blood circulation, resulting in ED or raising the risk of ED. Common medications that may list ED as a potential side effect include:

• Diuretics (pills that cause increased urine flow).
• Antihypertensives (high blood pressure drugs).
• Antihistamines.
• Antidepressants.
• Parkinson’s disease drugs.
• Antiarrhythmics (a drug for irregular heart action) etc

Street drugs, such as cocaine, amphetamines, and marijuana, may also cause sexual problems in men.