Table: Common Causes and Features of Erectile Dysfunction

Common Causes and Features of Erectile Dysfunction

Cause	Common Features*	Tests^†
Blood vessel disorders
Blockage of arteries ( peripheral vascular disease Overview of Peripheral Arterial Disease Peripheral arterial disease results in reduced blood flow in the arteries of the trunk, arms, and legs. Most often, doctors use the term peripheral arterial disease to describe poor circulation... read more )	Claudication (painful, aching, cramping, or tired feeling in the muscles of the legs that occurs regularly and predictably during physical activity but is relieved promptly by rest) Usually risk factors (for example, high blood pressure, diabetes, or abnormal blood levels of cholesterol and lipids)	Comparison of blood pressures measured in the ankle and arm at the same time (called the ankle-brachial index) Testing for risk factors (for example, elevated blood glucose [sugar] and blood lipid levels) Ultrasonographic measurement of blood flow in the arteries of the penis
Venous leak (when the veins in the penis cannot prevent blood from leaving the penis during an erection, as they normally do)	Erections that occur but cannot be sustained	Ultrasonographic testing of the arteries of the penis
Nerve disorders
Nerve damage caused by diabetes (diabetic neuropathy)	Known diabetes Sometimes numbness, burning, or other pains of the feet Sometimes urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting about 30% of older women... read more	A doctor's examination Sometimes electromyography and nerve conduction studies
Multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more	Intermittent episodes of weakness or numbness in different parts of the body at different times	MRI Sometimes spinal tap (lumbar puncture) and tests of spinal fluid
Nerve injury during pelvic surgery or radiation therapy	Known surgery (such as radical prostatectomy) or radiation therapy	Only a doctor's examination
Spinal cord disorders (such as tumors or injuries)	Numbness in the area between the penis and anus Usually other symptoms of spinal cord disorder (for example, numbness and weakness of legs and incontinence)	MRI
Prolonged pressure in the buttocks and genital area (the so-called saddle area), as occurs when riding a bicycle or a horse	Usually competitive athletes who bicycle for long periods Symptoms occur shortly after riding	Only a doctor's examination
Prostatitis Prostatitis Prostatitis is pain and swelling, inflammation, or both of the prostate gland. The cause is sometimes a bacterial infection. Pain can occur in the area between the scrotum and anus or in the... read more (inflammation of the prostate)	Pain in the pelvic or groin area and bothersome urinary symptoms, such as pain, a burning sensation, blood in the urine, having to urinate frequently, or having difficulty starting to urinate	Urine testing
Stroke	Known stroke	Only a doctor's examination
Hormonal disorders
Hypogonadism (testosterone deficiency)	Loss of sex drive, sleep disturbances, and depression or mood changes Eventually, decreases in the size of muscles and testes, bone density, and body hair Eventually, an increase in body fat and breast size	Measurement of the testosterone level in the blood
Cushing syndrome Cushing Syndrome In Cushing syndrome, the level of corticosteroids is excessive, usually due to taking corticosteroid drugs or overproduction by the adrenal glands. Cushing syndrome usually results from taking... read more	Round face, increased body fat in the trunk, purple streaks on the abdomen, high blood pressure, and mood changes	Measurement of levels of cortisol in the urine Sometimes blood tests
Severe hyperthyroidism Hyperthyroidism Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more (thyroid hormone excess)	Restlessness, increased heart rate and blood pressure, tremor, weight loss, and inability to tolerate heat	Measurement of levels of thyroid hormone in the blood
Severe hypothyroidism Hypothyroidism Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice... read more (thyroid hormone deficiency)	Sluggishness, decreased heart rate and blood pressure, thickened skin, decreased appetite, weight gain, and inability to tolerate cold	Measurement of levels of thyroid hormone in the blood
Structural disorders
Peyronie disease Peyronie Disease Peyronie disease is a fibrous thickening that contracts and deforms the penis, distorting the shape of an erection. Many men have a small degree of curvature of their erect penis. Peyronie disease... read more (formation of scar tissue in the erectile tissue of the penis)	Firm tissue in the penis Often severe curving of the penis during erection Often pain during intercourse	Only a doctor's examination Usually ultrasonography of the penis to detect scar tissue
Hypospadias Urethra in the wrong place (a birth defect)	Urethra located on the underside of the penis	Only a doctor's examination
Microphallus (a birth defect)	Abnormally small penis	Only a doctor's examination
Psychologic disorders
Depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more	Sadness, helplessness, hopelessness, loss of appetite, and problems sleeping	Only a doctor's examination
Performance anxiety or stress	Full erections during sleep and when masturbating Concern about sexual performance Sometimes ED occurring only with certain partners or in certain situations	Only a doctor's examination
Other
Drugs (see table Some Commonly Used Drugs That Can Cause Erectile Dysfunction )	History of taking a drug known to cause ED	Only a doctor's examination
Hypoxemia (chronically low blood oxygen levels)	Usually a chronic lung disorder (for example, chronic obstructive pulmonary disease Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette... read more )	Pulse oximetry (measurement of the level of oxygen in the blood)
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.
† Testosterone level is usually measured. If the level is low, doctors measure levels of other hormones.
ED = erectile dysfunction; MRI = magnetic resonance imaging.