Best sexologist . What causes erectile dysfunction or Impotence? There are several causes which tend to be grouped into ‘physical’ and ‘psychological’. Physical causes About 8 in 10 cases of ERECTILE DYSFUNCTION OR IMPOTENCE are due to a physical cause. If the ERECTILE DYSFUNCTION OR IMPOTENCE is due to a physical cause, you are likely to still have a normal sex drive (libido). Causes include: Reduced blood flow to the penis. Like in other parts of the body, the arteries which take blood to the penis can become narrowed. The blood flow may then not be enough to cause an erection. ‘Risk factors’ can increase your chance of ‘narrowing of the arteries’. These include: getting older; high blood pressure; high cholesterol; smoking; diabetes. Diseases which affect the nerves going to the penis. For example, multiple sclerosis, a stroke, etc. Diabetes. This is one of the commonest causes of ERECTILE DYSFUNCTION OR IMPOTENCE. Diabetes can affect blood vessels and nerves.Best sexologist . Injury to the nerves going to the penis. For example, spinal injury, following surgery to nearby structures, fractured pelvis, radiotherapy to the genital area, etc. Side-effect of certain medicines. The most common are: some antidepressants; betablockers such as propranolol, atenolol etc; some diuretics (‘water tablets’); cimetidine. Many other less commonly used tablets sometimes cause ERECTILE DYSFUNCTION OR IMPOTENCE. Alcohol and drug abuse. Cycling. ERECTILE DYSFUNCTION OR IMPOTENCE after long distance cycling is thought to be common. It is probably due to pressure on the nerves going to the penis from sitting on the saddle for long periods. This may affect the function of the nerve after the ride. Hormone causes are rare. For example, a lack of a hormone called testosterone which is made in the testes. Excessive outflow of blood from the penis through the veins (‘venous leak’). This is rare but can be caused by various conditions of the penis. In most cases due to physical causes (apart from injury or after surgery) the ERECTILE DYSFUNCTION OR IMPOTENCE tends to develop slowly. So, you may have intermittent or partial ERECTILE DYSFUNCTION OR IMPOTENCE for a while, which may gradually get worse. In some cases, ERECTILE DYSFUNCTION OR IMPOTENCE causes poor self esteem, anxiety, and even depression. These reactions to ERECTILE DYSFUNCTION OR IMPOTENCE can make the problem worse. Mental heath (‘psychological’) causes Various mental health conditions may cause you to develop ERECTILE DYSFUNCTION OR IMPOTENCE. For example: Stress. For example, due to a difficult work or home situation. Anxiety. Relationship difficulties. Depression. Best sexologist . Typically, the ERECTILE DYSFUNCTION OR IMPOTENCE develops quite suddenly if it is a symptom of a mental health problem. The ERECTILE DYSFUNCTION OR IMPOTENCE may resolve when your mental state improves. For example, if your anxiety or depression eases. However, some people become even more anxious or depressed when they develop ERECTILE DYSFUNCTION OR IMPOTENCE. They do not realise it is a reaction to their mental health problem. This can make matters worse and lead to a ‘vicious circle’ of worsening anxiety and persisting ERECTILE DYSFUNCTION OR IMPOTENCE. As a rule, a psychological cause is more likely for the ERECTILE DYSFUNCTION OR IMPOTENCE than a physical cause if there are times when you can get a good erection, even though most of the time you cannot. (For example, if you can get an erection by masturbating, or wake up in the morning with an erection.) Best sexologist .