About 90 per cent of erectile dysfunction is due to physical causes, and there are often two or three different physical causes which contribute to the inability to get an erection strong enough to satisfactorily complete sex.

Getting a successful erection is the result of a long chain of linked physical changes in nerves, blood vessels and muscle cells, beginning in the brain. If any of the links in the chain fails, the strength of the erection will be affected.

The erection cycle begins when physical or mental stimulation causes the brain to send chemical messages via the nerves in the penis telling the penile blood vessels to relax so that blood can flow freely into the penis.

If anything interrupts this chain of messages from the nerves to blood vessels to smooth penile muscle cells, erectile dysfunction will result.

Most Common Physical Causes of ED

The most common physical causes of erectile dysfunction are:

  • Reduced blood flow due to cardiovascular issues
  • Diabetes-related metabolic changes affecting nerves or blood flow
  • Side effects of common medicines like arthritis pain relief or anti-depressants
  • Low testosterone


Less common physical causes include:

  • Kidney disease
  • Over 50 per cent of men with kidney failure also have ED
  • Neurological (nerve and brain) disease
  • ED is common if nerves are affected by stroke, Alzheimer’s, Parkinson’s or multiple sclerosis (MS)
  • Inflammatory diseases like cystitis or prostatitis affecting the urogenital system
  • Spinal cord injuries
  • Pelvic injuries
  • Prostate cancer surgery
  • Enlarged prostate
  • Recent research links enlarged prostate to varying degrees of ED

ED Most Common Physical Cause No 1

Reduced Blood Flow

More than half of the men suffering from erectile dysfunction are affected by poor blood flow to the penis as a result of vascular disease.  Doctors estimate inadequate blood flow is the physical cause for 50 to 70 per cent of erectile dysfunction.

The following conditions are associated with poor blood flow:

  • Coronary artery disease
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Peripheral vascular disease — this disease particularly affects blood vessels that supply blood to the lower extremities.

ED Most Common Physical Cause No 2

Diabetes-Related Metabolic Change

Diabetes can cause nerve and artery damage that can make achieving an erection difficult. Having diabetes more than doubles the risk of having erectile dysfunction. 

Diabetes seems to be particularly hard on the arteries in the penis, but it also affects nerve function, and also leaves men more likely to have low testosterone.

ED Most Common Physical Cause No 3


Side Effects of Common Medications

More than 200 commonly prescribed medications can cause erectile dysfunction, through physical side effects. Your health provider may prescribe one of them to you without explaining the possible side effects, so you are caught unaware.

The most common prescription medications to cause ED fall into four categories,

  • Vascular disease (high cholesterol, high blood pressure, and heart disease)
  • Anti depressants (particularly SSRI’s - selective serotonin-re-uptake inhibitors)
  • Arthritis joint and muscle pain relief (especially NSAIDs – Non steroidal anti-inflammatories)
  • Reflux products  (GERD) to reduce stomach acid

1) Vascular Medications That Cause ED

Vascular disease medications for high cholesterol, high blood pressure and heart conditions can all cause erectile dysfunction.

  • High cholesterol products like statins and fibrates (gemfibrozil, and clofibrate)

It is thought the high cholesterol medications interfere with the production of testosterone, estrogen and other sex hormones. A 2002 review of statins and fibrates concluded both classes of drugs may cause erectile dysfunction (ED).

And a 2009 US government-funded study found that men and women taking statins reported increased difficulty achieving orgasm. In the study, people’s levels of sexual pleasure dropped along with their levels of LDL cholesterol.

  • High blood pressure products  – particularly diuretics, beta-blockers and calcium channel blockers
  • Diuretics – or water pills - can decrease forceful blood flow to the penis, making it difficult to achieve an erection. They can also deplete the body of zinc, which is necessary to make the sex hormone testosterone.
  • Beta blockers:  can affect the nervous system reaction that causes an erection and also make it difficult for the arteries in the penis to widen (dilate) to let in enough blood flow to cause an erection.
  • Heart medications like digoxin

2) Anti-Depressants That Cause ED

Black Sabbath star Ozzy Osbourne reckons anti-depressants killed his sex life. He wouldn’t be alone.  Research suggests nearly 40 per cent of people who take anti-depressants suffer low sex drive or erectile dysfunction as a result.


Even worse, Dr Mark Hyman says anti depressants often don’t work anyway.

The anti-depressants that cause the most physical problems for your sex life are the SSRI’s selective serotonin-reuptake inhibitors the most commonly prescribed psychiatric medicine, affecting as many as 1 in 2 of the people who take them.  These types of anti-depressants disrupt neurotransmitters in the brain and also affect nitric oxide levels which are a key for good sexual response.

Some men’s health specialists believe many men with low testosterone are misdiagnosed as depressed and put on anti-depressants because the symptoms of depression and low testosterone are similar.

3) Arthritis Pain Relief and ED

Over-the-counter joint and muscle pain relief products known as non steroidal anti-inflammatories cause physical symptoms of ED.


4) Anti-Acid Products Cause ED

Reflux disorder medications, used to reduce stomach acid, such as rantidine (Zantac) and cimetidine (Tagamet), both sold in Australia, cause erectile dysfunction.


ED Most Common Physical Cause No 4

Low Testosterone

Low testosterone levels are estimated to be the physical cause of about 10 per cent of the 90 per cent of men who have erectile dysfunction because of physical causes.

Good levels of testosterone are essential for good erectile health. Even erection drugs will not work if testosterone levels are low. Studies show that men who failed to get erections with erection drugs like Viagra, and who then had their testosterone levels supplemented could then use Viagra with success.