Urology Austin

Erectile dysfunction can occur from both physical and psychological causes.

What causes erectile dysfunction? Very often, an erectile problem will have more than one cause. Factors may be psychological, physical, or a combination of both. Distinguishing between a psychological and physical cause will help a urologist determine the best treatment option.

What causes erectile dysfunction?

There are several determinants that contribute to erectile dysfunction. These include: physical – also known as organic erectile dysfunction (neurology, vascular,  endocrine, other) and psychological. Reduced blood flow to the penis and nerve damage are common causes of erectile dysfunction. Underlying causes can include vascular disease, diabetes, lifestyle choices (such as alcohol or recreational drug use), medications, hormonal imbalances, neurological causes, pelvic trauma, Peyronie’s disease (penile curvature), and venous leak.

Vascular Disease: Low blood flow in and around the heart may cause a cardiac infarct. The same problem in the brain may cause a stroke, but in the penis, it causes erection problems. Another cause of erection trouble may be venous leak. When veins that drain blood from the penile cavernous bodies fail to sufficiently close during erection, this ‘leak’ will inhibit pressure buildup needed for a sufficient erection.

Diabetes: Diabetes is a major cause of erectile problems. High levels of blood sugar often damage small blood vessels and nerves throughout the body, which can impair nerve impulses and blood flow necessary for erection.

Lifestyle Choices: Recreational drugs, drinking alcohol, and smoking may damage the nerves and blood supply needed for normal erection.

Medications: Prescription drugs can contribute to impotence, including drugs for high blood pressure, heart disease, antidepressants, tranquilizers, and sedatives.

Hormonal Imbalance: Low testosterone can result in a loss of libido (sexual desire) and erection problems. Likewise, prolactin levels, hyperthyroidism, or hypothyroidism can also affect erection.

Neurological Causes: Multiple sclerosis, Parkinson’s disease, and spinal cord injuries are among the neurological conditions that may lead to impotency. Spinal cord and brain injuries can interrupt the transfer of nerve impulses from the brain to the penis.

Pelvic Trauma in Surgery: Surgery of the colon, prostate, bladder, or rectum, may damage the nerves and blood vessels involved in erection. Surgeries such as a radical prostatectomy (removal of the prostate) has the potential to injure nerves and arteries near the penis, resulting in erectile dysfunction. Injury to the penis, spinal cord, prostate, bladder, and pelvis, can lead to erectile dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Peyronie’s Disease: Peyronie’s disease is an abnormal curvature of the penis that can affect the ability to achieve an erection, or engage in sexual intercourse. Curvature is caused by scar tissue that forms in the wall of tissue that surrounds the corpus cavernosum.

Psychological Causes: Men who experience a sudden and consistent loss in their ability to achieve an erection, may have psychological concerns that need to be evaluated. Stress, anxiety, relationship problems, depression, concerns over sexual performance, low self-esteem, or negative thoughts can prevent an erection from occurring. Psychological factors that result in impotence are often secondary to physical causes, but they magnify their significance.

If you are interested in learning more about what causes erectile dysfunction, or you would like to be evaluated,  contact Urology Austin to schedule an appointment with one of our urologists.

Dr. Bryan Kansas, Board Certified Urologist at Urology Austin, discusses the causes and treatment options for Erectile Dysfunction, including penile implant surgery.


Dr. Bryan Kansas, Urologist at Urology Austin, presents a men’s health webinar titled Signs, Symptoms and Treatment Options for Erectile Dysfunction. This webinar was co-hosted by Boston Scientific.