Lots of things! Stress, depression, anxiety, relationship problems, diet, exercise, heart disease, diabetes, hormone issues, nervous system disorders, injuries, and side effects from medications… just to name a few.
Alcohol and recreational drugs can also play a big role for guys having difficulty achieving an erection. If you can’t get an erection when you’re drunk or high, consider cutting back on the amount of alcohol and drugs you consume before sex.
Basically, erectile dysfunction happens when the nerves or blood vessels in the penis aren’t working properly. If you are experiencing hardening of the arteries (arteriosclerosis), ED might be a warning sign of a more serious problem; for some guys, erectile dysfunction precedes a heart attack or stroke. Smoking is often a big contributor to erectile dysfunction, as it restricts the function of blood vessels in the penis. Guys who aren’t in good physical shape also experience higher rates of ED (as if you needed another excuse to dust off your running shoes!).
ED is experienced more frequently in guys over 40, but can occur at any age.
Erectile dysfunction is also common among guys living with HIV. Be careful when mixing ED drugs with HIV meds – and always make sure that your doctor and pharmacist know about all of the medications you’re taking, including any ED drugs.
Some guys find it difficult to stay hard while wearing a condom, so they engage in risky sex – that is, anal sex without a condom. Talk to your doctor; there are techniques and medications that can make it easier to stay hard while wearing a condom.