ERECTIONS ∙ 3 minutes read

The 4 different types of erectile dysfunction

By Kirsty Mason | Medically reviewed by Dr Jaskirt Matharu

Erectile dysfunction (ED) is when a man has persistent trouble getting hard enough, long enough, for sex. While it’s extremely common, it’s not always easy to diagnose as it can be a symptom of underlying physical and psychological health conditions.

There are several known risk factors - such as age, lifestyle, medication and medical conditions - which make ED more likely to occur. Any one of these conditions can compromise the physiological response of the body, meaning you’re more at risk of experiencing ED.

An erection is made up of a complex chain of events, with each response vital for a healthy erection. Broadly speaking, there are four main components that must function properly in order to attain a successful erection. The dysfunction of one of these components lends a common explanation as to why ED occurs. 

We take a look at each of these four functions and break down the scientific reasons behind why they might be harming your erections.

1. Psychological issues

An erection starts in the mind. Sexual arousal triggers nerve cells in the brain, which informs the body how to respond. Sometimes, ED occurs when the mind doesn’t set off this trigger. This could be down to relationship problems or psychological trauma.

It’s well established that stress, depression and anxiety can interfere with a man’s ability to achieve and maintain an erection. Even antidepressant medications themselves can cause ED.

There is strong evidence to show that you’re more likely to have ED if you have symptoms of depression and that more severe depression is associated with more severe ED. It can work the other way around too - men who report having ED are at higher risk of developing depression than men who don’t.

There are several different ways to overcome the psychological barriers that cause ED and the best treatment largely depends on individual circumstances. If you’re suffering from stress, anxiety, or depression, you should visit your local GP where they can recommend the best treatment. Sometimes, sexual trauma or religious beliefs cause ED and you may need therapy to overcome the problem.

For men who suffer from performance anxiety or lack confidence in a new relationship, you may be recommended ED medication. ED treatment doesn’t necessarily have to be taken regularly but helps some men to gain back lost confidence in the bedroom.

If psychological issues aren’t causing your ED, then it may be physiological. This brings us on to the next critical function for an erection…

2. Nerve signalling

The second important function for an erection to occur is nerve signalling. This function is controlled by the central nervous system in the brain, which signals the body to relax the arteries, allowing more blood to flow to the penis. 

Because the signals that lead to an erection are mediated by the nerves, problems with this function can result in ED. Nerve damage may be caused by injury, surgery, multiple sclerosis, Parkinson’s disease, or diabetes (which can affect blood vessel health as well as nerve health).

If your nerves are perfectly intact, you may have an issue with blood flow.

3. Blood flow

Blood flow is critical for strong erectile function. When a man is sexually aroused, the central nervous system triggers an involuntary physiological response in the body. Nerves signal the arteries to relax and widen, increasing blood flow to the penis. This results in an erection.

Most ED medications, such as sildenafil, Viagra, and tadalafil are PDE5 inhibitors. PDE5 is an enzyme that breaks down the molecule responsible for relaxing the arteries. Essentially, this means that the medication prevents the arteries from narrowing, encouraging longer, more satisfying erections.

One of the most common causes of ED is an underlying problem with reduced blood flow, arterial insufficiency or arterial blockage. Poor arterial flow can stem from diabetes, high lipid (cholesterol) levels in the blood, or cigarette smoking.

4. Hormonal imbalances

Sometimes, hormonal imbalances are to blame for ED. For example, low levels of testosterone are associated with erectile dysfunction, as testosterone plays an important role in libido. Abnormal thyroid hormone levels can also cause ED.   

The bottom line

Broadly speaking, erectile dysfunction is often caused by a malfunction in four main categories: psychological issues, nerve signalling, blood flow, and hormonal imbalances.

The surest way to get to the bottom of what might be causing your ED is with an Erectile Dysfunction Test Kit: a simple, at-home blood test that can identify if you have any underlying health conditions that could be contributing to your ED.

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