Other antidepressants such as venlafaxine and mirtazapine have variable negative effects on all aspects of sexual function. Initial reports on agomelatine in both male and female patients with major depressive disorder suggested significant antidepressant efficacy without significant sexual adverse effects. However, more recent reviews of the sexual effects are conflicting.26,27


Do you have a couple of hours, or longer? The list of medications that cause erectile dysfunction (ED), or problems getting and maintaining an erection during sex, are long and varied. While there's no way to mention all the chemical culprits, let's start with a few of the common ones: Over-the-counter antihistamines for allergies and other conditions. Tranquilizers and antidepressants can also cause a bout of ED, which is why guys should take them only for a short time. Meds that treat high blood pressure and heart disease may help save your life but will compromise or kill your sex life. Radiation and chemotherapy medications for prostate, colon, and similar cancers also cause problems in the bedroom. And illicit drugs such as marijuana, cocaine, and heroin, which might make their users feel good for a while, will only cause them to crash in the bedroom.
Problems with the veins that drain the penis can also contribute to erectile dysfunction. If the veins are not adequately compressed, blood can drain out of the penis while blood is coming into the penis and this prevents a fully rigid erection and maintaining an erection. Venous problems can occur as a result of conditions that affect the tissue that the veins are compressed against, the tunica albuginea. Such conditions include Peyronie's disease (a condition of the penis associated with scarring [plaques] in the tunica albuginea that may be associated with penile curvature, pain with erections, and ED), older age, diabetes mellitus, and penile trauma (penile fracture).

In most healthy men, some of the drug will remain in the body for more than two days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, doctors have to lower the dose and frequency of tadalafil in the following examples:
"There are times when couples recognize that the problem is more about their relationship or individual issues that get in the way of relaxing and enjoying physical intimacy," Connolly adds. In this instance, an individual or couple should look for a qualified therapist, preferably a member of the American Association for Marriage and Family Therapy, who will have experience in dealing with issues regarding relationships and erectile dysfunction.
Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife. Exercise as a treatment is under investigation.[23]:6, 18–19 For tobacco smokers, cessation often results in a significant improvement.[24] Oral pharmacotherapy and vacuum erection devices are first-line treatments,[23]:20, 24 followed by injections of drugs into the penis, as well as penile implants.[23]:25–26 Vascular reconstructive surgeries are beneficial in certain groups.[25]
When you become aroused, your brain sends chemical messages to the blood vessels in the penis, causing them to dilate or open, allowing blood to flow into the penis. As the pressure builds, the blood becomes trapped in the corpora cavernosa, keeping the penis erect. If blood flow to the penis is insufficient or if it fails to stay inside the penis, it can lead to erectile dysfunction.
But don’t panic. ED can be caused by a number of factors, from depression and medication side effects to high blood pressure, high cholesterol, low testosterone levels, Peyronie’s disease, nerve damage, performance anxiety, heart disease, diabetes, and more. Even better, many of these ED causes are treatable with medication and simple lifestyle changes. It’s important to know the root cause of your erectile dysfunction in order to treat it in the fastest, most effective way possible. Here are the 5 most common causes of erectile dysfunction.
These commonly prescribed medications affect sexual function in different ways depending on the specific type of drug and how it works. “Central regulation of erections relies on dopamine and serotonin, so any impact on these processes can worsen erectile function,” says Trost. He notes that Wellbutrin (buproprion) and Remeron (mirtazipine) are the antidepressants that likely have the least impact on erectile function.
Options: If you’re among the many millions of older Americans without known coronary disease who are taking these drugs, ask your doctor or other health care provider about treating your slightly elevated cholesterol with a combination of sublingual (under-the-tongue) vitamin B12 (1000mcg daily), folic acid (800mcg daily) and vitamin B6 (200mg daily).

Epidemiological studies consistently show that prevalence of erectile dysfunction (ED) increases with ageing. Nonetheless, complaints of ED even in younger men are becoming more and more frequent. Healthcare professionals working in Sexual Medicine but even those operating in different clinical contexts might be adequately prepared to answer this increasing requirement. ED in younger men is likely to be overlooked and dismissed without performing any medical assessment, even the most basic ones, such as collection of medical history and physical exam. This is due to the widespread assumption that ED in younger individuals is a self-limiting condition, which does not deserve any clinical evaluation or therapy and can be managed only with patient reassurance. However, evidence shows that, in younger subjects, organic, psychological and relational conditions can contribute to the pathogenesis of ED and all these conditions might be evaluated and treated, whenever necessary. Among the organic conditions contributing to the onset of ED, metabolic and cardiovascular (CV) risk factors are surprisingly of particular relevance in this age group. In fact, in younger men with ED, even more than in older ones, recognizing CV risk factors or conditions suggestive of cardio-metabolic derangements can help identifying men who, although at low absolute risk due to young age, carry a high relative risk for development of CV events. In this view, the assessment of a possible organic component of ED even in younger individuals acquires a pivotal importance, because it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.
The lab testing obtained for the evaluation of erectile dysfunction may vary with the information obtained on the health history, physical examination, and recent lab testing. A testosterone level is not necessary in all men; however, a physician will order labs to determine a patient's testosterone level if other signs and symptoms of hypogonadism (low testosterone) such as decreased libido, loss of body hair, muscle loss, breast enlargement, osteoporosis, infertility, and decreased penile/testicular size are present.
While each of these medications alone can affect erectile function, “the greater the number of medications a patient is taking, the greater the impact on sexual function,” says Trost. “In addition to eliminating as many of these as possible, changing to an alternative where possible, and optimizing health through lifestyle choices, we can typically treat the ED directly through other therapies.”
Reduced hormone production: Elevated pressure in the circulatory system affect the production of certain hormones, including those that regulate sexual drive and erection response. There also is some evidence that men with high blood pressure have lower sperm counts and testosterone levels than men with normal blood pressure, which in turn may lower the hormonal response to sexual stimulation. 
Thinking about sex creates a burst of dopamine, which is a brain chemical that’s linked to excitement, motivation and pleasure. It also plays a crucial role in helping you to get an erection! In a man who is bored with or indifferent about sex, thinking about the act is unlikely to be accompanied by that dopamine burst, making it likely that the man will experience erectile dysfunction.

myDr myDr provides comprehensive Australian health and medical information, images and tools covering symptoms, diseases, tests, medicines and treatments, and nutrition and fitness.Related ArticlesGum disease linked to erectile dysfunctionAdvanced gum disease (periodontitis) has been linked to an increased risk of erectile dysfunction, wAdvertisement
Many men who suffer from erectile dysfunction feel guilty about being unable to please their partner. If the problem persists, the guilt becomes more than just a side effect – it can contribute to the ongoing cycle of ED as well. Guilt is often paired with low self-esteem, and not just in men with erectile dysfunction. Guilt and shame are feelings that are commonly linked to mental health issues such as depression. In fact, feelings of worthlessness and inappropriate guilt is one of the clinical criteria for major depressive disorder, according to the DSM-5.
Countless men suffer from psychological erectile dysfunction (or ED) – an inability to get or maintain an erection. While many drugs, such as Viagra and Cialis, are available to mask the symptoms, they do not deal with the underlying causes of ED. This means that for many men, these drugs are not an effective solution – and particularly for those who have medical conditions that prohibit the use of performance-enhancing drugs. Also, there are some men wanting to fix ED, but simply do not want to be reliant on a drug.
We are offering a short series of articles, explaining each of the causes of erectile dysfunction and how to deal with them. It is possible you are dealing with two or all three of the underlying causes at once. We believe you are the expert on your own life and sexual health – but we hope these articles will help you determine which underlying causes of ED feel like they most apply to you.
First, medical conditions need to be ruled out. Let’s assume that you have never been diagnosed with a medical condition that is physically linked to erectile dysfunction, such as type 2 diabetes, obesity or heart disease. In this case you’re probably looking at a case of psychological impotence, given that there are no physical explanations for your difficulties.
Erectile dysfunction may be an unpleasant condition that no one really wants to talk about, failing to acknowledge it won’t make the problem go away. Your best defense against health problems like this is to learn everything you can about it so you can tackle the problem at the root. If you’re ready to stop living in embarrassment about your sexual function, become an advocate for yourself and your own health and talk to your doctor.
Research has even found possible links to frequent ejaculation and a lower risk of prostate cancer. In one study of 32,000 men published in 2016 in the journal European Urology, for example, men who ejaculated at least 21 times per month while in their 20s were less likely to be diagnosed with prostate cancer than those who ejaculated four to seven times per month. And men who ejaculated more often in their 40s were 22 percent less likely to get a prostate cancer diagnosis.
Not enough info for you? No problem. Nerd out on erectile dysfunction with these studies and research from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you on the way to a healthier manhood.
If you are having problems achieving or maintaining an erection you may want to take a look at your medicine cabinet first. There are a number of prescription and over-the-counter drugs that may cause erectile dysfunction. While these drugs may treat a disease or condition, they can also affect a man's hormones, nerves, or blood circulation, resulting in ED or increase the risk of ED.
“Anything that depresses nerves, such as Xanax, Ativan, Valium, alcohol, Neurontin (gabapentin), Lyrica (pregabalin), and any of the sleep aids often impact erectile function,” says Trost. The effect is reversible and is most likely caused by direct suppression of nerve signals or possibly by changes in hormonal signaling. Mills adds that “narcotic use causes suppression of testosterone which can alter blood flow to the penis.”

For one thing, most studies that have found a link between bicycle riding and ED have focused on men who spend long hours astride a bike, such as policemen who spend as many as 24 hours a week riding, and those who do long bike tours as amateurs or professionals. In fact, according to the Massachusetts Male Aging Study (MMAS), a survey of more than 1,700 men between the ages of 40 and 70, "at least three hours of cycling per week were more likely to cause artery blockage and long-term damage." That's more riding than the average person tends to clock, but the results are something to think about if you ride for longer.

ED is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD, and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two different clinical manifestations of the same systemic disease.19
Same.. I've been living with my gf for 8 months and recently I had a bad experience, it's happened before but recently I've developed a serious anxiety problem, I get extremely scared and it just goes down.. What's worse, I tried being open with her about it and she just got so sad and anti-supportive.. I tell her about things that make it worse so she understands, and she does them anyway, she puts WAY too much pressure on me and the anxiety has just skyrocketted.. With her lack of support I don't see this issue getting solved..

Diabetes is an example of an endocrine disease that can cause a person to experience impotence. Diabetes affects the body’s ability to utilize the hormone insulin. One of the side effects associated with chronic diabetes is nerve damage. This affects penis sensations. Other complications associated with diabetes are impaired blood flow and hormone levels. Both of these factors can contribute to impotence.
Erectile dysfunction, or ED, is the inability to achieve or sustain an erection suitable for sexual activity. Causes vary and include: adverse side effects to certain medications, chronic illnesses such as diabetes and heart disease, poor blood flow to the penis, low testosterone, physical trauma, mental health issues, alcohol and/or drug abuse or misuse, and fatigue.
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ED is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD, and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two different clinical manifestations of the same systemic disease.19

Poor lifestyle habits, such as a terrible diet and lack of exercise, may result in having to take medication. Some of these can interfere with how your penis works. For example, blood pressure medication reduces blood flow to the penis, which can cause erectile dysfunction. This results in a lower sexual arousal and poor sexual performance, says the National Library of Medicine.

The longer a man has had diabetes, the more likely it is that he'll develop ED, especially if his blood glucose levels have not been well controlled. Complications of accompanying heart diseases such as high blood pressure and high cholesterol also can play a role in impotence. A man with diabetes who also smokes increases his risk of developing ED.
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin [an antibiotic], ketoconazole [Nizoral, a medication for fungal/yeast infections], and protease inhibitors [medications used to treat AIDS]). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over 65 years of age with liver disease, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example,
The prostaglandin E1 is contained in a small suppository located at the tip of an applicator. You should urinate first as this lubricates the urethra and makes it easier to insert the applicator into the tip of the urethra (urethral meatus, the opening at the tip of the penis that urine passes through). A patient can release the suppository into urethra by gently wiggling the applicator and pressing the button at the end. Rubbing the penis allows the suppository to dissolve, and the prostaglandin is absorbed through the tissue of the urethra into the penis. It takes 15 to 30 minutes for this occur. Once into the penis, the prostaglandin causes increased blood flow into the penis. The prostaglandin can be present in the ejaculate, and thus doctors recommend that men use a condom when having intercourse with a pregnant partner. Men may need to use a condom if vaginal irritation occurs in female partner.

"Stress and anxiety can adversely affect sexual performance and are common causes of erectile dysfunction,” warns Feloney. “Feelings of stress and anxiety can also lead to depression and a loss of interest in sex." It's important to get these feelings out in the open where you can deal with them. Issues that can lead to erectile dysfunction include fear from previous bad experiences with sex, family or work related stress, poor communication with your partner, and unrealistic goals and expectations.


Of course, this is easier for some people than others – it’s important to remember that there’s no such thing as a ‘normal’ sex drive. Libido varies from person to person so some people have low libido compared to others. If there is a drastic difference between the sex drive levels of you and your partner(s), this can lead to problems in your relationship, but it doesn’t have to.

Once you have talked to your partner about your issues, you may want to consider taking things one step further with psychosexual therapy. This is a form of therapy in which both you and your partner see a therapist together. The therapist will help you and your partner break out of the cycle of stress and disappointment that has been coloring your sex life and contributing to your ED. Going to a therapist with your partner may also help you work out any relationship issues that have been affecting your sex life so the both of you will be more satisfied.


Sexual dysfunction is more common as men age. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70. And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years. erectile dysfunction can be treated at any age.
Although scientists don't understand exactly how this condition can lead to ED, one theory is that high arterial pressure in the small vessels of the penis may cause microscopic tears to the vessel walls. In the process of repairing these tears, the arteries become thicker and less able to supply needed blood to the spongy, erectile tissues of the penis.
Drugs causing your erectile dysfunction can be checked during your assessment – during your medical assessment, your doctor will assess your full medical history including any drugs you are currently taking. This is to work out whether your ED is a side effect of a medication, and also to work out which types of ED treatment are safe for you to use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is sage, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Psychotherapy sessions can help you learn to deal with anxiety, both in and out of the bedroom. Sometimes, therapy sessions are "as simple as helping couples understand what happens in typical couples’ sex lives. Couples therapy can also include learning to talk about sex in ways that help them let down their defenses and openly discuss their needs, wants, and desires," says Connolly.
Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.
Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise also contribute to ED.  Studies indicate that men who exercise regularly have a lower risk of ED.
“No question these impact erectile function,” says Landon Trost, MD, head of andrology and male infertility at the Mayo Clinic in Rochester, Minn. It is not clear why these blood pressure lowering medications can cause ED, but it reverses if a patient quits taking the drug. Unfortunately, however, “people usually can’t get off of these, but if the medication can be switched for another blood pressure drug, angiotensin receptor blockers or ACE nhibitors are preferred,” adds Trost.
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In many ways, performance anxiety becomes a self-fulfilling prophecy wherein you become nervous about being able to satisfy your partner and the nerves lead to sexual dysfunction. In many cases, performance anxiety is triggered by negative self-talk – worries about being able to achieve an erection, pleasing a partner, or ejaculating too early. If you have had erectile issues in the past, those experiences will add to the weight of performance anxiety.

These prescription drugs increase the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in your penis. More blood in your penis makes it much easier for you to get and maintain an erection when you are sexually aroused.


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^ Latini, DM; Penson, DF; Colwell, HH; Lubeck, DP; Mehta, SS; Henning, JM; Lue, TF (Nov 2002). "Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction". Journal of Urology. 168 (168(5)): 2086–91. doi:10.1097/01.ju.0000034365.57110.b7 (inactive 2019-02-16). PMID 12394715.
Obesity and metabolic syndrome can cause changes in blood pressure, body composition, and cholesterol which may lead to ED. Other conditions that may contribute to erectile dysfunction include Parkinson’s, multiple sclerosis, Peyronie’s disease, sleep disorders, alcoholism, and drug abuse. Taking certain medications can also increase your risk for ED.
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