01
Blood vessels and the heartAn erection is blood flow. Narrowed or stiff arteries (atherosclerosis) reduce it - and because the arteries of the penis are small, the problem often shows there years before it shows in the heart.
02
High blood pressureOver time it damages the lining of the blood vessels, and some blood-pressure medicines can affect erections too - never stop one without your doctor.
03
DiabetesHigh blood sugar harms both blood vessels and nerves. Men with diabetes get ED more often and earlier.
04
High cholesterolFatty deposits narrow the arteries that carry blood to the penis.
05
Weight and metabolic syndromeA large waist, high blood sugar, high blood pressure and abnormal blood fats together raise the risk.
06
SmokingNicotine and smoke damage blood vessels and restrict blood flow.
07
Alcohol and drugsHeavy drinking and recreational drugs interfere with nerves, hormones and blood flow.
08
Low testosterone and other hormonesLow testosterone mostly lowers desire; thyroid problems and high prolactin can play a part. A blood test tells.
09
SleepPoor sleep and sleep apnoea are linked with ED and with low testosterone.
10
MedicinesSome antidepressants, blood-pressure medicines, antihistamines and prostate treatments list ED as a side effect. Ask your doctor about alternatives.
11
Surgery, injury and nervesPelvic or prostate surgery, spinal injury, multiple sclerosis or Parkinson's disease can affect the nerve signals.
12
Stress, anxiety and depressionThe mind starts an erection. Worry about performance, work stress, depression and relationship problems are common causes - often together with a physical one.
// SEE A DOCTOR
ED is common and treatable - and it can be an early warning sign of heart disease, diabetes or high blood pressure. If it lasts more than a few weeks, see a doctor. Seek urgent help for chest pain or an erection lasting more than 4 hours. Never take someone else's prescription medicine.