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8 surprising causes of erectile dysfunction 

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E-cigarettes, gum disease and more: Here’s what researchers say could be hurting your ability to get an erection. 

Emily Shiffer

By Emily Shiffer

Erectile dysfunction (ED) isn’t just a bedroom problem. It can disrupt your life. It can hurt your ability to share intimate moments with the person you love. It might also make you question your health.   

Clinicians define ED as trouble getting or keeping an erection that’s firm enough for sexual intercourse. “It’s currently the most common sex problem that men report to their doctor,” says Jeffrey Dlott, MD. He’s a clinical pathologist in Reston, Virginia, and the medical director of the diagnostic insights firm QuestDirect. 

Dr. Dlott notes that ED affects as many as 30 million men. While most are over 50, it affects younger men, too. One analysis from Sexual Medicine Reviews found that ED affected 30% of men under 40. 

Regardless of your age, if you’re struggling with erectile dysfunction, it’s smart to ask why. The inability to get an erection might signal a deeper problem. Men with ED are 68% more likely to develop dementia, according to data collected by King’s College London. They’re also 43% more likely to have cardiovascular disease. 

If you need medication for ED, the Optum Store has subscription plans starting at just $25. Viagra®, Cialis® or one of their generic alternatives can be shipped to your home for free.   

But to get to the root of the problem, keep reading. Here are 8 sneaky causes of erectile dysfunction. 

You smoke e-cigarettes

Researchers have long known that cigarettes can hurt your ability to get an erection. But what’s startling is that electronic cigarettes may be no better.  

A new study from the American Journal of Preventative Medicine found that people who smoke e-cigarettes daily are more than twice as likely to suffer from erectile dysfunction.  

Related reading: What it’s really like to take Viagra. 

You skipped your COVID-19 vaccine 

Research from the University of Florida found that men who had COVID-19 were more than 3 times as likely to have ED. And this was after adjusting for conditions such as obesity and diabetes.  

As to why, a second study from the University of Miami provides a clue. Using a small sample of men with severe ED, researchers found that the virus may linger in the penis long after the symptoms pass.  

The researchers also note that severe COVID-19 infections can damage endothelial cells, which line blood vessels. Endothelial cells allow smooth muscles to relax. That’s critical for getting an erection. When they’re damaged, the odds of ED go up. 

You have low testosterone 

It might not be a complete shock to learn that low testosterone affects erectile function. Testosterone is the primary sex hormone in men, after all. It plays important roles in many functions, including sperm production and sex drive, according to Harvard Health.   

Studies have suggested that about one-quarter to one-third of men with ED also have low testosterone,” says Dr. Dlott.  

Low testosterone can also increase your risk of bone problems, such as osteoporosis, adds Dr. Dlott. So if you think your numbers are low, consider getting tested. You can do this through your doctor or a mail-order at-home testosterone test

You have gum disease 

If you don’t take care of your oral health, you could increase your risk of ED. A large study review, which included about 215,000 people ages 20 to 80, found that men with periodontitis (infected gums) were 2.6 times as likely to have ED. 

As a possible explanation, the researchers note that an infection in the gums can increase inflammation throughout the body. This can damage your cardiovascular system and possibly lower your testosterone level.   

Remember that the next time you’re tempted to skip the dentist. In the meantime, check out these 5 ways to beat gum disease.  

You eat too much junk food 

If your typical dinner is a cheeseburger and fries, you could be putting yourself at risk for ED. 

Poor diet is another cause of ED,” says Dr. Dlott. He notes that in the U.S., diabetes and obesity, 2 conditions related to poor diet, are responsible for 8 million cases of erectile dysfunction. 

Check out our newbie’s guide to the DASH diet for an eating plan that can reduce your odds of developing conditions related to ED. 

You have more than 1 or 2 alcoholic drinks a day 

Government nutritionists recommend drinking alcohol only in small amounts. For men, that means no more than 2 drinks on days that you choose to drink.  

The more you flout that limit, the more likely you are to see problems with sexual function, says Dr. Dlott. “ED is more prevalent among men who have a history of heavy drinking or those who have alcohol dependence,” he says. “This ladders back to diet and nutrition.” So it’s important to eat — and drink — for health.  

You struggle with mental health issues 

Certain mental health conditions, specifically depression and anxiety, may also contribute to ED. 

“Researchers have found that almost a quarter of men with ED also suffer from depression and/or anxiety,” says Dr. Dlott. “This can stem from stress at work or home, anxiety over finances and more.” 

You can find relief through medication and meditation, says Dr. Dlott. But he also recommends speaking to a psychologist. Some counselors focus specifically on sexual health, he says. They can help with performance anxiety by coaching you on how to stay present during sexual activity.  

You have a chronic health issue 

If it’s not already clear, your general health influences your ability to get and maintain an erection. So chronic conditions that strain your heart and other organs increase your odds of ED.  

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“Patients should begin by looking at their overall health, focusing on some known causes such as high cholesterol levels, high blood pressure and heart disease,” says Dr. Dlott. 

So make a plan with your doctor to treat the conditions behind your ED. And to save money at the pharmacy, download the Optum Perks discount card. It may help reduce the costs of your medication by up to 80%.  


Additional sources 

ED in men under 40: Sexual Medicine Reviews (2017). “Erectile dysfunction in young men—a review of the prevalence and risk factors"

ED and cardiovascular disease and dementia: BJU International (2019). “The global prevalence of erectile dysfunction: a review” 

E-cigarettes and ED: American Journal of Preventative Medicine (2021). “Association of e-cigarettes with erectile dysfunction: The population assessment of tobacco and health study” 

Covid-19 and ED: Journal of Endocrinological Investigation (2021). “Increased odds ratio for erectile dysfunction in COVID-19 patients” 

Covid-19 in the penis: The World Journal of Men’s Health (2021). “COVID-19 endothelial dysfunction can cause erectile dysfunction: Histopathological, immunohistochemical, and ultrastructural study of the human penis” 

Testosterone overview: Harvard Health 

Periodontitis and ED: American Journal of Men’s Health (2021). “The association between periodontitis and erectile dysfunction: A systematic review and meta-analysis

Alcohol recommendations: Dietary Guidelines for Americans