In short
Usually reduced blood flow, a psychological cause, or both. Because blood vessels are involved, erection problems can be an early sign of heart disease.
On this page
Erectile dysfunction usually has a physical cause, a psychological cause or both. The most common physical cause is reduced blood flow, which is why erection problems can be an early sign of heart and blood vessel disease.
How an erection works
Arousal sends nerve signals that relax the blood vessels in the penis. Blood flows in and is held there. Anything that affects the nerves, the blood vessels, the hormones or the state of mind involved can get in the way.
Physical causes
- Blood vessel disease. High blood pressure, high cholesterol, diabetes and smoking all damage the lining of blood vessels. The arteries in the penis are small, so they’re often affected first.
- Diabetes. It affects both blood vessels and nerves.
- Medicines. Some blood pressure tablets, antidepressants and prostate medicines can cause it. Don’t stop a medicine without talking to your doctor.
- Low testosterone. Usually with low sex drive as well.
- Nerve damage. After prostate or pelvic surgery, spinal injury, or with conditions such as multiple sclerosis.
- Alcohol, weight and sleep. Heavy drinking, obesity and sleep apnoea all contribute.
Want to talk it through in private?
An Australian GP can go through what’s happening and check for causes, by phone or video.
Psychological causes
- Performance anxiety. Worrying about getting or keeping an erection makes it harder to get one.
- Stress, depression and anxiety.
- Relationship difficulties.
A useful clue: if you still wake with erections or get them on your own but not with a partner, a psychological cause is more likely. If they’ve faded gradually in every situation, a physical cause is more likely. Often it’s a mix.
In younger men
Under 40, anxiety and stress are the most common causes, but physical causes still turn up, including diabetes, medicines, recreational drugs and hormone problems. It’s worth a check, not an assumption.
The link with heart disease
Erection problems can show up years before chest pain or a heart attack, because the same process is narrowing arteries throughout the body. That’s why a GP will ask about blood pressure, cholesterol, blood sugar and family history, and may order blood tests. Treating those risks protects your heart and can improve erections.
What a GP will check
- When it started, how often it happens and whether morning erections have changed.
- Your health conditions, medicines, alcohol and smoking.
- Blood pressure, and often blood tests for sugar, cholesterol and testosterone.
Once the cause is clearer, see erectile dysfunction treatment in Australia for the options.
Next step: talk to a GP
Request an appointment and we’ll be in touch to arrange a time. A consultation doesn’t guarantee a prescription.
References
- Healthy Male: Erectile dysfunction
- Therapeutic Guidelines: Sexual and reproductive health
- Healthdirect Australia: Erectile dysfunction
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.