What causes erectile dysfunction?

An erection needs healthy arteries, working nerves, enough hormones and a calm mind. This page walks through what can interrupt each one, then looks at the causes that matter most for men in the Philippines. For the basics of what ED is and how it is treated, start with what is erectile dysfunction.

What are the main causes of erectile dysfunction?

The causes fall into four groups: physical, psychological, medicines and lifestyle. Physical causes account for most ED in men over 40, while anxiety and lifestyle play a larger part in younger men.

In practice the groups overlap. A man with diabetes may also worry about performance, and that worry makes the physical problem worse. That is why doctors look at the whole picture rather than searching for a single cause.

What physical problems cause ED?

Blood vessel disease is the leading physical cause, followed by diabetes, nerve damage and hormone problems. These often build slowly over years.

High blood pressure and narrowed arteries

High blood pressure damages the inner lining of the arteries, making them stiffer and less able to relax. High cholesterol adds fatty plaque (atherosclerosis). Because the arteries in the penis are small, they show the effect early, which is why ED can be a warning sign of heart disease years before chest pain.

This matters in the Philippines. The World Health Organization estimated that 33% of Filipino adults aged 30 to 79, about 14.5 million people, had high blood pressure in 2019, and many do not know it. Free blood pressure checks are available at barangay health centres.

Diabetes

Diabetes is one of the strongest single causes of ED. High blood sugar damages both the small blood vessels and the nerves that start an erection.

A 2017 meta-analysis of 145 studies covering over 88,000 men found ED in about 52.5% of men with diabetes, and men with diabetes had roughly three and a half times the odds of ED compared with men without it. ED is also often one of the first signs of diabetes, which is why a doctor will check your blood sugar.

The International Diabetes Federation estimates that about 7.5% of Filipino adults aged 20 to 79, around 4.7 million people, had diabetes in 2024, and that about half of them had not been diagnosed. If you have ED and have never had a fasting blood sugar or HbA1c test, ask for one.

Obesity and fatty liver

Fat around the waist releases substances that inflame blood vessels and lowers testosterone. It often comes with high blood sugar, high cholesterol and fatty liver, which together are called metabolic syndrome. Losing weight and exercising can improve erections in a meaningful share of men.

Nerve damage

The nerves that carry signals from the brain to the penis can be damaged by diabetes, a spinal injury, multiple sclerosis, a stroke, or surgery in the pelvis, including surgery for prostate or bowel cancer. Nerve-related ED often needs a urologist's assessment.

Hormones

Low testosterone mainly lowers desire, but it can contribute to ED, and it makes PDE5 medicines work less well. Thyroid problems and a high prolactin level can also play a part. Our page on ED and low testosterone explains when a hormone test makes sense.

Structural problems

Peyronie's disease, in which scar tissue causes a curve, and injuries to the penis can also make erections difficult.

What psychological factors cause ED?

Stress, anxiety, depression and relationship problems can all cause ED on their own or make a physical cause worse. They work because fear and stress release adrenaline, which narrows blood vessels.

• Performance anxiety. One difficult night leads to worry about the next one, and the worry makes it more likely to happen again. This loop is common and very treatable. See ED in your 20s and 30s for more.
• Stress. Money worries, work pressure and family responsibilities take a toll. Many Filipino men carry the role of main provider for an extended family, and that weight is real.
• Depression. Low mood dampens desire and arousal, and some antidepressants affect erections too.
• Relationship strain. Conflict, distance or pressure make every other cause worse.
• Lack of privacy. Living in a shared home with parents, children or relatives can make it hard to relax, and that tension matters more than many men expect.

A clue that the cause is mainly psychological: the problem started suddenly, happens in some situations but not others, and morning erections are still normal. Even so, doctors still check for physical causes, because the two often coexist.

Which medicines can cause erectile dysfunction?

Several common medicines can affect erections as a side effect. The main ones are some blood pressure medicines, antidepressants, and medicines for the prostate.

Medicines that have been linked to ED include:

• Some older blood pressure medicines, such as certain beta blockers and thiazide diuretics.
• Antidepressants, especially SSRIs.
• Some medicines for an enlarged prostate or hair loss (5-alpha reductase inhibitors) in a minority of men.
• Some medicines for epilepsy, psychosis and stomach acid.
• Opioid painkillers used long term.
• Recreational drugs, including methamphetamine (shabu), and anabolic steroids.

If you think a medicine is involved, do not stop it on your own. Stopping a blood pressure medicine suddenly can be dangerous. Ask your doctor whether a switch is possible: there are often alternatives that are kinder to erections.

How does lifestyle affect erectile function?

Smoking, heavy drinking, little exercise and poor sleep all damage the blood vessels and hormones that erections rely on. The good news is that each of these can be changed.

Smoking and vaping

Nicotine narrows blood vessels immediately and damages their lining over time. Across many studies, smokers are more likely to have ED than non-smokers, and the risk rises with the number of cigarettes. In the Philippines, the 2021 Global Adult Tobacco Survey found that about a third of men smoked tobacco, far higher than among women. Vaping is not risk-free either: a large US study linked daily e-cigarette use with higher odds of ED. The DOH Quitline (1558) offers free help to stop.

Alcohol

A drink or two is unlikely to cause problems for most men, but heavy drinking blunts erections in the short term and can damage nerves, the liver and hormone levels in the long term. Inuman sessions that run late add short sleep to the mix.

Sleep and night-shift work

Short or broken sleep lowers testosterone and energy. Night work, common in the Philippines' BPO industry, disrupts the body clock. In a US study of 754 men, those who worked night shifts scored notably lower on a standard erectile function questionnaire than men who worked days, and men with shift work sleep disorder also scored lower.

If you work nights, a fixed sleep window, a dark and cool room (blackout curtains and an electric fan or air-conditioning help in the heat), and avoiding caffeine late in your shift all protect your sleep.

Exercise and heat

Regular aerobic exercise improves blood vessel health and erections. The Philippine heat makes exercise harder, so walk early in the morning, swim, or use an air-conditioned gym or mall. Dehydration on hot days can also leave you tired and less responsive, so drink water.

Why are diabetes and blood pressure such big causes in the Philippines?

Both are common here, often undiagnosed, and both damage the small arteries that erections depend on. A large share of Filipino adults have one or both, and many only find out when complications appear.

Rice-heavy diets, sweet drinks, long commutes with little time for exercise, and family history all contribute. ED can be the first sign that pushes a man to get checked, and that check can protect his heart, kidneys and eyes for decades. If ED is your reason for seeing a doctor, that is a good outcome, not an embarrassing one.

How does a doctor work out which cause applies to you?

A doctor pieces it together from your story, a short examination and a few blood tests. The pattern of the problem, how it started and whether morning erections still happen, gives the first clues.

ED that crept in over months or years, with fewer morning erections, points towards blood vessels, diabetes or hormones. ED that began suddenly, happens with a partner but not alone, and leaves morning erections intact points more towards stress or anxiety. ED that started soon after a new medicine points towards that medicine.

The European Association of Urology recommends a basic set of checks for most men: blood pressure, weight and waist, a fasting blood sugar or HbA1c, a cholesterol test, and a morning testosterone level. Depending on your history, your doctor may add thyroid, kidney or liver tests. These are routine at hospital labs and diagnostic centres across the Philippines, and many can be arranged after a teleconsultation.

Be open about smoking, vaping, alcohol, sleep and any tablets or supplements you take, including products bought online. Doctors ask because these details change the advice, not to judge. If the first treatment does not help, a urologist may suggest specialist tests such as a penile Doppler ultrasound, which measures blood flow.

What should you do if you recognise these causes?

Start with a check-up that covers blood pressure, blood sugar and cholesterol, and an honest look at smoking, alcohol and sleep. Then talk to a doctor about treatment, which often includes a prescription medicine alongside lifestyle changes.

Medicines such as sildenafil (Viagra) and tadalafil (Cialis) need a prescription in the Philippines, and generics cost much less than the original brands. You can compare checked prices on our ED medicine prices page. Your doctor decides which medicine and strength suits you.

Frequently asked questions

What is the most common cause of erectile dysfunction?+

Reduced blood flow from narrowed or stiffened arteries is the most common cause, usually linked to high blood pressure, diabetes, high cholesterol, smoking or age. Most men have more than one contributing cause.

How does diabetes cause erectile dysfunction?+

Years of high blood sugar damage both the small blood vessels and the nerves that control erections. A large review found ED in about half of men with diabetes, and men with diabetes tend to develop it earlier than men without.

Can stress alone cause ED?+

Yes. Stress and anxiety release adrenaline, which narrows blood vessels and works against an erection. Stress-related ED often comes on suddenly and leaves morning erections normal, but a doctor should still check for physical causes.

Can my medicines cause erection problems?+

Some can, including certain older blood pressure medicines, antidepressants and medicines for an enlarged prostate. Do not stop a prescribed medicine on your own; ask your doctor whether a different one would suit you.

Does working night shifts cause ED?+

It can contribute. In one US study, men who worked night shifts scored worse on erectile function than day workers, and those with shift work sleep disorder scored worse still. Protecting your sleep helps.