If you’ve ever had trouble getting or keeping an erection, you’re not alone. However, there is a difference between the occasional inability to have an erection and erectile dysfunction (ED).

It’s normal for men to experience an inability to get an erection once in a while, but if you can’t get and keep an erection firm enough for sex more than half the time, it might be time to talk to your doctor about erectile dysfunction.

According to the Urology Care Foundation, it’s possible for men to have healthy sexual function into their 80s. However, ED is a complicated problem and many things can influence the condition. For an erection to occur, a combination of factors must be working properly: blood vessels, nerves, emotions, and hormone levels.

Some common causes of erectile dysfunction are:

  1. High blood pressure and heart disease. High blood pressure and heart disease have a common enemy: narrowing of the arteries caused by plaque buildup. As the arteries narrow, this results in poor blood circulation throughout the body, including to the penis when trying to get an erection. In fact, erectile dysfunction is often an early sign of high blood pressure and heart disease.
  2. Being overweight or obese. A healthy body mass index (BMI) is between 20 and 25, overweight is between 26 and 29, and medical obesity is achieved at a BMI of 30. Research published in the Annals of Internal Medicine found that men with a BMI of 28 or more had a 30% increased risk of erectile dysfunction. A separate study published in JAMA found that 31% of obese men with erectile dysfunction were able to regain their sexual function by losing weight and increasing their physical activity.
  3. Medication. Erectile dysfunction is a side effect of many medications. According to the American Academy of Family Practice, drugs that can cause or worsen erectile dysfunction include antidepressants, antihistamines and heartburn medications, beta-blockers used for high blood pressure, diuretics, painkillers and more. Be sure to discuss all medications you take with your doctor. In some cases, you may be able to switch to another medication to see if your ED improves.
  4. Diabetes. Research published in the journal Diabetes Care found that 58% of men with diabetes reported frequent or occasional erectile dysfunction. This can happen if blood sugar is poorly controlled and blood vessels or nerves have been damaged. Other underlying health conditions like high blood pressure or obesity can also be a factor for people with diabetes.
  5. Tobacco consumption. The Massachusetts Observational Study of Male Aging that looked at men between the ages of 40 and 69 found that those who smoked cigarettes nearly doubled their risk of moderate to complete erectile dysfunction over the next 10 years. Fortunately, quitting smoking now can reduce your risk of erectile dysfunction and potentially lower your risk of a myriad of other conditions, including many types of cancer.
  6. The Depression. Several studies have established a link between depression and erectile dysfunction. According to research published in the Journal of Urology, depression increases the risk of erectile dysfunction and erectile dysfunction increases the risk of depression. A vicious cycle can develop. sex. Often couples counseling and sex therapy can be very effective.
  7. Low testosterone levels. Testosterone is the main sex hormone in men. If testosterone levels drop below the normal range, the result can be an inability to get and keep an erection. According to American Urological Association guidelines, men who have a history of unexplained anemia, loss of bone density, diabetes, exposure to chemotherapy, direct or diffuse radiation therapy to the testicles, HIV or history of chronic drug use are at risk for low testosterone. Symptoms of low testosterone include reduced energy, reduced stamina, visual changes, depression, reduced motivation, poor concentration, impaired memory, irritability, reduced libido, and changes in erectile function . The condition can be diagnosed with a blood test by your doctor, and testosterone replacement can be prescribed if needed.
  8. Inactivity. A prospective study published in The American Journal of Medicine found that physical inactivity was an independent risk factor for developing erectile dysfunction. If exercise isn’t already part of your daily routine, walking is a good place to start.
  9. Red meat and charcuterie. Recent research published in JAMA Network Open examined the diets of over 21,000 men and found that those who closely followed a Mediterranean diet had the lowest risk of erectile dysfunction across all age groups. The more red and processed meat men ate, the greater their risk of erectile dysfunction.
  10. Obstructive sleep apnea. Obstructive sleep apnea is a sleep-disordered breathing disorder characterized by a cycle of pauses in breathing during sleep, brief awakenings, then falling back to sleep and then stopping breathing again, up to hundreds of times over the course of night. The disorder prevents quality sleep and has been linked to several conditions, including mood changes, diabetes, high blood pressure and weight gain. It can also contribute to ED. In a study published in the journal Sleep Medicine, 75% of men with erectile dysfunction and obstructive sleep apnea were able to reverse their erectile dysfunction after one month of CPAP treatment for their sleep apnea.

The reasons for erectile dysfunction can be complicated and many men have more than one contributing factor. A comprehensive review of your lifestyle and general health can identify problems, and testing can help determine if there is a medical reason for the condition. In many cases, treating erectile dysfunction can improve the underlying conditions as well as your overall health and quality of life.

Learn more about solutions for erectile dysfunction.

Talk to your primary care provider about a referral to a Samaritan urology clinic for help with erectile dysfunction.

Ross Wopat, MD, provides comprehensive urological care, with an emphasis on minimally invasive surgery, such as laparoscopy and robot-assisted laparoscopy, for diseases affecting the kidneys, ureters, bladder, and prostate. He can be reached at Samaritan Urology – Albany, 541-812-5800.