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other risk factors for erectile dysfunction (ED)

by Janet Casperson, BS, MSN, ANP-C

Risk factors for erectile dysfunction include testosterone levels, depression, side effects of medications, stress, excessive alcohol intake, prostate diseases, neurological disorders and relationship problems—all can have an affect on ED.

In addition to the risk factors for cardiovascular disease described elsewhere—aging, smoking, obesity, diabetes, endothelial function, lipid and cholesterol levels and diet—many other internal and external factors affect men's bodies and can lead to erectile dysfunction.



These include testosterone levels, depression, side effects of medications, stress, excessive alcohol intake, prostate diseases, neurological disorders and relationship problems.

Low testosterone and ED

Hypogonadism, or low testosterone in men, is an incredibly common condition associated with diabetes and with a high body mass index (BMI) or obesity. This is discussed in detail in an article about testosterone. We also offer extensive information about low testosterone in our Andropause Center.

Medications that affect ED

We have included a table of medications that can cause sexual dysfunction elsewhere. This list of medications will include both medications known to have effects on erections and medications known to promote erectile function.

Stress and ED

The fact that stress is a risk factor for erectile dysfunction is no surprise given life in modern America. A million years ago, human stress may have been related to protecting yourself from a wild animal. The stress response is known as a sympathetic discharge—the sympathetic nervous system releases the hormone called cortisol. This is the "fight or flight" hormone, allowing humans to face the situation or run away from it. When cortisol is released, it causes an increase in blood pressure, increased blood flow to organs that are needed for rapid activity, increased mental activity, increased blood glucose and an increased rate of metabolism.

It decreases blood flow to organs not needed for rapid activity. The sex organs are not vital for rapid activity and receive less of the blood flow. One way to imagine this response is to imagine someone walking in on you when you're in the midst of sexual activity. What's the first thing that happens? Usually, a loss of an erection. This is a sympathetic event. You are startled, you have a "fight or flight" response and your body releases cortisol. Blood flow is diverted from the sex organs.

Unfortunately, today the fight of our life may be in the board room, the office or on the highway. The stress isn't met with aggressive physical activity output but the stress is real and constant. Cortisol levels become too high and glands become exhausted. The way you handle stress can dramatically affect erectile dysfunction.

Nerve damage, bicycle seats and ED

Less common risk factors for erectile dysfunction include neurological problems or damage to the nerves that supply the penis which can cause changes such as numbness in the glans or change in sensation in the penis. Neurological risk factors include spinal cord injury, non-nerve-sparing surgery within the pelvis, pelvic injury, stroke, epilepsy, Parkinson's, brain tumors, Alzheimer's and head trauma.

One of the newer risk factors for neurologic damage is bicycle seat configuration. It's been documented that certain types of bicycle seats in people who do distance riding can affect erectile dysfunction by damaging the arteries to the penis and causing a low blood flow state.

Relationships and ED

Relationship problems need no explanation. We all understand that "it takes two to tango" and without a good relationship, there is no place to use the erections. The old aphorism "use it or lose it" is as true today as it was years ago. It's important to work on your relationship at the same time you work on modifying risk factors.

Prostate problems and ED

Prostate disease can affect erectile dysfunction. It was previously thought that when men fell asleep after ejaculation and had a good night of sleep without the need to get up to urinate it was a sign of a satisfied or selfish man. This couldn't be farther from the truth. When men fall asleep after an ejaculation, it has to do with prostate activity and the activation of receptors in the prostate. Prostate disease is intimately associated with erectile dysfunction for a very specific reason.

With so many risk factors leading to erectile dysfunction, it's a wonder that any men can achieve satisfying sex lives.

References: See Bibliography

August 2006
Posted August 2008
Updated December 2011


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