Smoking.   Smoking and erectile dysfunction are related as smoking leads to plaque build up in the arteries called cardiovascular disease, which restricts blood flow through the veins.  Arterial sclerosis from smoking restricts blood flow, and thus can prevent the massive amount of blood required for you to achieve an eretion, resulting in erectile dysfunction.
Mental causes of sexual dysfunction include: depression, stress, anxiety and insomnia.  When one of these conditions leads to ED, usually once the condition is cured normal sexual behavior returns.  If you believe you have one of these conditions, see your doctor for an evaluation before beginning any treatment.  One side effect of antidepressants is erectile dysfunction.
Your ability to orgasm is not connected to the prostate gland, although a man who has had a radical prostatectomy will have a dry orgasm with no ejaculation. As long as you have normal skin sensation, you should be able to have an orgasm with the right sexual stimulation. This means that treating your ED should allow you to resume a normal, healthy sex life.
Alcohol is a depressant, not an aphrodisiac or a libido enhancer. Excessive consumption can interfere with the ability to achieve an erection at any age, and even occasional drinking can make erectile dysfunction worse in older men. Feloney advises using alcohol in moderation: "In small amounts, alcohol can relieve anxiety and may help with erectile dysfunction, but if you drink too much, it can cause erectile dysfunction or make the problem worse."
While self-esteem can be affected by the perceptions of others, it is largely how you feel about yourself. If you have a negative view of yourself and your abilities, it is going to color your experience and actions on a daily basis. Many people with low self-esteem get so caught up in their own perception of themselves, that they begin to project it onto others. For example, a man with low self-esteem might believe that he is not capable of satisfying a woman and, as a result, he becomes unable to perform in the bedroom. Low self-esteem can also be a sign of other psychological issues such as depression.  
If this treatment approach fails, it is useful, however frustrating, to start again from the beginning. Reassess the history to ensure that nothing was missed originally. Obtain labs and perform a PCDU. This will give the objective information that you might need in order to make a diagnosis of a known etiology for ED and to provide the patient reassurance that your evaluation has been thorough.
Poor cardiovascular health reduces your body’s ability to deliver blood needed to produce erections. In a study published in 2004, researchers followed male participants for 25 years. The researchers found that heart disease risk factors predicted which men were most at risk of future ED. Numerous studies have strongly tied four major cardiovascular risk factors to ED:
A medical history focused on risk factors, such as cigarette smoking, hypertension, alcoholism, drug abuse, trauma, and endocrine problems including hypothyroidism, low testosterone levels, and hyperprolactinemia, is very important. Commonly used drugs that disrupt male sexual function are spironolactone (Aldactone), sympathetic blockers such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, most antidepressants, ketoconazole (Nizoral), cimetidine (Tagamet), alcohol, methadone, heroin, and cocaine. Finally, assessment of psychiatric history will help identify emotional issues such as interpersonal conflict, performance anxiety, depression, or anxiety.
Drinking in moderation can be beneficial to your heart health, and therefore your sex life. A 2004 study published in the journal Seminars in Vascular Medicine found moderate alcohol consumption was associated with decreased cardiovascular mortality due to the antioxidant capacities of alcoholic beverages. The polyphenolic compounds — a group of compounds that include tannins and anthocyanins — were shown to change the lipid profiles, decrease coagulation, increase fibrinolysis, inhibition of platelets, and increase nitric oxide. This is vital since vascular diseases (those that affect the blood vessels) commonly cause erectile dysfunction.
Infection is a concern after placement of a prosthesis and is a reported complication in 8%-20% of men undergoing placement of a penile prosthesis. If a prosthesis becomes infected (redness, pain, and swelling of the penis and sometimes purulent drainage are signs of infection), the prosthesis must be removed. Depending on the timing and severity of the infection and your surgeon's preference, the area can be irrigated extensively with antibiotic solutions and a new prosthesis placed at the same time or removal of the infected prosthesis and an attempt to place a new prosthesis made at a later time when the infection is totally cleared.
If you have unstable heart disease of any kind, heart failure or unstable, what we call angina, contraindication to using the medications. All right? So if you’re in an unstable medical state, these medications are not a good idea. Now, there are relative issues. If you may be taking a blood pressure medicine or a medicine for your prostate which dilates your blood vessel a little bit– you know, the typical ones are what we call the alpha blockers– you may have an additive effect from the medication. But for the most part, the medicines are incredibly safe.

Also, even if rates of erectile difficulties are rising in young guys, we definitely can’t say why. While many like to point to increased access to online porn as the likely culprit, we need to be mindful of the fact that a ton of other things could potentially be playing a role. For example, young people today are much more likely to be using antidepressants than they were in the past, which we know can cause a number of sexual side effects. There may also have been changes in condom use patterns—we know that a lot of guys have erectile difficulties when using condoms, so if guys today are using more condoms, that could translate to more difficulties.


Once you have talked to your partner about your issues, you may want to consider taking things one step further with psychosexual therapy. This is a form of therapy in which both you and your partner see a therapist together. The therapist will help you and your partner break out of the cycle of stress and disappointment that has been coloring your sex life and contributing to your ED. Going to a therapist with your partner may also help you work out any relationship issues that have been affecting your sex life so the both of you will be more satisfied.
Erectile dysfunction (ED) is defined as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction. This definition, which has been recently endorsed by the Fourth International Consultation on Sexual Medicine (ICSM) (1), is based on a clinical principle which leaves room to the judgement of patients, being widely affected by their self-perception of normality. Furthermore, rather than focusing on possible causes of the dysfunction, it hinges on the sexual distress which it causes. This is consistent with the philosophy of Sexual Medicine, according to which, only symptoms creating despair are worthy of medical care. On the other hand, it carries the risk of over- or under-estimating a medical condition that does not have objective medical parameters of definition. This is particularly the case for young and apparently healthy men whose complaint of ED can be perceived by medical practitioners as excessive or overrated thus, minimized without even performing an adequate screening of possible associated or causing conditions. This review is aimed at summarizing the available evidence on the organic and non-organic disorders that can be associated with ED in young men, underlining the importance of recognition and assessment of a symptom, which can lead to a unique opportunity for performing a high quality preventive medicine intervention.
Erectile dysfunction isn’t just about not being able to achieve an erection. Often times men can get an erection and still suffer from some of the early symptoms of erectile dysfunction. ED is more about the inability to get and maintain an erection that’s strong enough to have “satisfactory” sex. Satisfaction is the key word in that definition. And it encompasses a lot.
Begot, I., Peixoto, T. C. A., Gonzaga, L. R. A., Bolzan, D. W., Papa, V., Carvalho, A. C. C., ... & Guizilini, S. (2015, March 1). A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction. The American Journal of Cardiology, 115(5), 5741-575. Retrieved from http://www.ajconline.org/article/S0002-9149(14)02270-X/abstract

Chlamydia and erectile dysfunction: What's the link? Some people who have chlamydia also experience erectile dysfunction (ED), which involves problems getting or maintaining an erection. Chlamydia can infect the prostate gland, leading to prostatitis, pain, and ED. In this article, learn more about the link between this common infection and ED, and treatments for both. Read now
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
Regardless of age, if a man is obese and sedentary, with poor dietary habits, he is at greater risk of developing diseases that can lead to erectile dysfunction. These include heart disease, hypertension and type 2 diabetes. Some forms of congenital heart disease may remain hidden and only cause problems in adulthood. Men of any age noticing a marked change in sexual function should contact their physicians to rule out the possibility of a more serious condition.
The initial step in evaluating ED is a thorough sexual history and physical exam. The history can help in distinguishing between the primary and psychogenic causes. It is important to explore the onset, progression, and duration of the problem. If a man gives a history of “no sexual problems until one night,” the problem is most likely related to performance anxiety, disaffection, or an emotional problem. Aside from these causes, only radical prostatectomy or other overt genital tract trauma causes a sudden loss of male sexual function.
Mental causes of sexual dysfunction include: depression, stress, anxiety and insomnia.  When one of these conditions leads to ED, usually once the condition is cured normal sexual behavior returns.  If you believe you have one of these conditions, see your doctor for an evaluation before beginning any treatment.  One side effect of antidepressants is erectile dysfunction.

Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.
The association between psychiatric conditions and sexual dysfunctions, including ED, is well known. Data from population-based studies demonstrate a cross-sectional association between depressive symptoms and ED (65-68) and, among men seeking medical care for ED, depression is significantly associated with a greater severity of the impairment in erectile function (69,70). A meta-analysis of the available prospective studies has shown the role of depression as a significant risk factor for development of ED (71). However, the relationship seems to be bidirectional, as also ED has been associated with the occurrence of depression (72). In addition, treatment with PDE5i is related with an improvement in depressive symptoms (72). Most of this evidence comes from studies not specifically designed for the assessment of this relationship in younger men. However, few studies available in younger populations seem to confirm these results. In an internet-based survey, involving more than 800 North American medical students with a mean age of 25.7 years, ED was reported by 13% of them and it showed a significant association with depressive symptoms, whose frequency got higher as a function of ED severity (73). In a population of more than 2,500 very young Swiss men, aged 18–25 years, participating to a survey on sexual function while attending the medical screening for the evaluation of military capability, ED had a prevalence of 30%. Among the possible correlated conditions, mental health showed an independent association, besides the use of medications without medical prescription, a shorter sexual lifespan and impaired physical health (74). The results from this Swiss study were then prospectively extended on a sample of 3,700 men evaluated at baseline and 15.5 months later (75). Among a number of different possible predictors, including life-style, drug abuse, perceived physical fitness and BMI, only perceived impairment in mental health and depression, either newly occurred or continuously present, were associated with both persistence and development of ED (75). In a retrospective population-based study from Finland, involving almost 3,500 men aged 18–48 years, the role of depression as a significant predictor for ED was confirmed, but this study also showed that anxiety plays a significant role and that ED is significantly less frequent in men with a longer lasting sexual life, thus underlining the positive role of sexual experience and self-confidence (76). Anxiety is often involved in the pathogenesis of ED at the beginning of sexual life. In fact, anxiety can lead to an excessive focus on quality of erection, thus providing a cognitive distraction that negatively affects the arousal and consequently the erection itself (77-79). On the other hand, anxiety can result from one or more sexual failures, with loss of sexual confidence, increasing fears and avoidance for sexual experiences that, in the end, lead to an increased probability of new failures, thus creating a vicious circle (77). Cognitive distraction could be also provided by excessive worry for physical, and in particular genital, self-image. In fact, it has been proposed that when most mental energy is focused on monitoring body, psychological resources are distracted from sex, resulting in an impaired functioning (80,81). In line with this cognitive explanation, a recent study conducted on 367 military personnel younger than 40 years showed that a deteriorated genital self-image is associated with sexual anxiety which, in turn, is associated with a higher probability of sexual dysfunction (82).
Many commonly used drugs can cause erectile dysfunction. Prescription medication and over-the-counter drugs can decrease libido, interfere with normal blood flow, or even cause absent seminal emission or retrograde ejaculation. In fact, 8 of the 12 most commonly prescribed medications list ED as a side effect. Medications that commonly cause ED include:
The second option is a prosthesis or penile implant:  a kind of hydraulic device surgically implanted in the penis. The prostheses consist of two rods that fit inside the penis, a pump that sits inside the scrotum next to the testicles, and a little reservoir that houses fluid that sits under the groin muscles.  When a person wants to be intimate, they pump up the prostheses; afterward, they can use a button to reverse it.
Oral medicines: The best known ED medications are the Big Three: Viagra (sildenafil citrate, made by Pfizer, Inc.), Levitra (vardenafil HCl, made by Bayer and GlaxoSmithKline), and Cialis (tadalafil, made by Eli Lilly). The three are chemically very similar, and all have proven very effective. Because they are effective, convenient, and relatively inexpensive (about nine dollars per pill), these medicines have become the treatment of choice for most men experiencing ED.
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