Health & Wellness

What Causes ED?

A look at the mental and physical conditions at play in any ED diagnosis — and the key steps to perking up again.

Photo credit: daizuoxin/

Sean Evans


Sean Evans,   

Jan 16, 2020 • 4 min read

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There’s a big difference between having a low sex drive (or low libido) which means you’ve got a decreased interest in sexual activity, and erectile dysfunction (ED). If you’re unable to produce or sustain a substantial erection for sexual activity, that’s considered to be ED. While both low libido and erectile dysfunction can sporadically occur from time to time, repeated or regular instances are a sign of a larger medical issue that you should address with your doctor. 

 “Your libido is interconnected to erections,” says James Kashanian, MD, a urologist and assistant professor at Weill Cornell in New York City. “Your libido could be affected by sleep, testosterone, depression, or other medications but it’s not necessarily the same as ED.” However, if you have ED, the psychological impact from it can in turn lower your sex drive. “When ED is treated, confidence comes back, as does the sexual satisfaction, and the sex drive will again increase,” Dr. Kashanian says.

ED can be caused by underlying physical or psychological health conditions. “Men don’t typically see a doctor until something is wrong,” says Dr. Kashanian. “Often the ED is presenting as a side symptom of a separate medical condition. Vascular disease is the number one cause of ED, followed by diabetes.” Men with ED are often at a higher risk for a heart attack, heart disease, or a stroke, as a result of vascular or coronary issues they may have, and this can often make ED a double-header in the diagnosis department when it comes to the state of their health.  “Especially for patients in their forties or fifties, I’m usually the one diagnosing them with heart disease or diabetes,” says Dr. Kashanian.

Other medical conditions that can play a factor include high cholesterol, low testosterone, certain injuries, or damage from cancer or surgery. Medications treating other illnesses or conditions can play a factor in causing ED, too, including medications for blood pressure, antidepressants, anti-hormone, or chemotherapy drugs.

If the ED is related to an existing medical condition, treating that condition can mitigate or vanquish the ED. Simple lifestyle changes, including losing excess weight, increasing physical activity and exercise, and other options to bolster overall health, can go a long way in the fight against ED. Smoking, drug use, and alcohol abuse can also hinder erections, so eliminating those elements may have an immediate impact on your ED.

Psychological issues can wreak havoc below the belt as well. “Any man who has erection problems is going to have a psychological issue as a result,” says Dr. Kashanian. “Some men present with anxiety, stress, and/or depression to begin with, and the first bad ED experience snowballs into future bad experiences. Every time those men are sexually active, they replay their most recent sexual failure and that worsens the ED.”

If emotional or relationship issues are the culprit of your ED, therapy or counseling may help alleviate the issue. Otherwise, drugs like sildenafil (generic Viagra) or tadalafil (generic Cialis) are effective at helping you return to your standard sexual activity. “If a young guy without underlying medical conditions or issues is having ED problems, it’s typically psychogenic,” says Dr. Kashanian. “I’ll put him on a daily low dose of tadalafil, so he has the meds on board at all times. That’ll help with spontaneous erections, masturbation, and more.” The cumulative effect of achieving erections when desired helps patients feel more normal, putting to rest psychological fears and easing ED. Dr. Kashanian says he will typically keep this course of treatment for about three months before discussing how and if the patient should be weaned off the medication.

If you think you might benefit from an ED med or a change in your current Rx, Blink offers online doctor consults for $5. You can get your ED drug prescribed or refilled from the privacy and comfort of home. 

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This article is not medical advice. It is intended for general informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.

Blink Health is not insurance. The discount prescription drug provider is Blink Health Administration, LLC, 1407 Broadway, Suite 2100, New York, NY 10018, 1 (844) 265-6444,

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