Am I at risk of erectile dysfunction?

We hope that this post will help you identify whether you, or your partner, has any of these erectile dysfunction risk factors, and how to address them.

In the 1980s, researchers concluded that erectile dysfunction (ED) was not just a condition with a psychological cause (psychogenic). Investigative techniques uncovered that certain organic factors contribute to the etiology of ED in approximately 80% of men (Sullivan, Keoghane, & Miller, 2001).

ED, or erection difficulties are widespread and a difficult disorder among middle-aged and aging men.

Many studies show an association between ED and heart disease, peripheral vascular disease, and stroke, suggesting that ED may be a sentinel event for underlying atherosclerosis (Derby, 2000).

Other common erectile dysfunction risk factors are diabetes mellitus, cardiovascular disease, psychiatric disorders, genitourinary conditions, and other chronic diseases.

In 2004, researcher Dr. Lewis and associates studied ED to provide recommendations and guidelines concerning the epidemiology and erectile dysfunction risk factors, as well as sexual dysfunction risk factors for women. The study involved international collaboration of major urology and sexual medicine agencies and over 200 multidisciplinary experts from 60 countries. Over a two-year period, these researchers found that the incidence rate of ED was 25-30 cases per 1,000 people – a rate that increased with age.

Erectile dysfunction risk factors

Advancing age

A meta-analysis conducted by Sullivan and associates (2001) showed advancing age was the strongest variable associated with developing ED. Unfortunately, advancing age is one erectile dysfunction risk factor that you can’t change. However, other risk factors are modifiable.

Coronary heart disease and atherosclerosis

If you have coronary heart disease (CHD) you have an increased risk of developing ED. Atherosclerosis causes vasculogenic ED by obstructing the arterial inflow to the corporal bodies by atherosclerotic plaques.

This means the vessels that supply blood to the penile tissue are blocked. When the vessels narrow, they prevent an adequate supply of blood to the penile carvernosal tissue (Sullivan, Keoghane, & Miller, 2001).

Dr. Feldman et al conducted a study with a random group of subjects, seeking to investigate the relationship between baseline risk factors and ED. In the study, 513 men aged 40-70 years provided blood samples along with completed questionnaires.

The researchers found that cigarette smoking almost doubled the likelihood of moderate or complete ED at follow-up, and there was also an association between hypertension (high blood pressure) and ED. They concluded ED and coronary heart disease were definitely associated.

If you have, or think you may have, heart disease, speak to your doctor, as treating and managing cardiovascular disease is one of the modifiable erectile dysfunction risk factors.

Diabetes mellitus

Sullivan and associates (2001) studied 541 men with diabetes, and found 190 of the participants had ED – a 35% prevalence rate.

Other diabetes-associated factors that further increased the risk of ED were retinopathy, autonomic neuropathy, peripheral neuropathy, and use of insulin or oral hypoglycaemic agents. To prevent ED, those with diabetes can lose some weight and ensure they control their blood sugar.

High cholesterol

Hyperlipidemia is the medical term for high cholesterol and high triglycerides. In a study of 3,250 men, researchers found those who developed ED had high total cholesterol.

Each 1mmol/L increase in total cholesterol was associated with a 1.32-fold greater risk of ED, and a low concentration of high-density lipoprotein (HDL) was associated with a 2.6-fold greater risk.

When a man has hyperlipidemia, there is a hypogastric-cavernosal arterial bed, which causes a deficiency in penile arterial inflow. Impairment of this structure leads to endothelium-dependent relaxation of the vascular bed, or in other words the blood is unable to flow into the penis and remains in the carvernosal tissue.

The good news is that lipid-lowering therapies reverse this condition.

While the physical changes associated with hyperlipidemia are not the primary cause of ED, they contribute to more complex atherosclerotic lesions. Large clinical trials found that a reduction of serum lipids seriously reduced cardiac events, restored coronary artery function, and slowed or revered plaque formation.

To modify this risk factor, lower your cholesterol with exercise, proper diet, and medication compliance.

High blood pressure

Sullivan and associates (2001) found many studies showed a correlation between ED and hypertension. One report found severe ED was the higher among hypertensive men than in the general population.

The vascular compromise hypertension causes affects the vascular erectile mechanism, with ED being seen in as many as 10% of men with untreated hypertension.

Animal studies have shown changes in cavernosal tissue, increases in vascular smooth muscle proliferation, and carvernosal fibrosis in hypertensive subjects. Penile tissue is affected by high blood pressure (i.e. it compromises blood flowing to the necessary tissues).

To modify this risk factor, control your blood pressure with medication, lose weight, and eat right.

Lifestyle and habits

Dr. Derby and colleagues researched ED in 2000 to examine whether changes in heavy alcohol consumption, sedentary lifestyle, smoking, and obesity were linked with the risk of ED.

In a study of 1,709 men aged 40-70 years old, 593 did not have ED at baseline. The researchers found that obesity and physical inactivity were associated with ED, but changes in smoking and alcohol consumption weren’t.

Smoking has systemic effects on the body, including hypercoagulability, imbalanced thromboxane and prostacyclin concentrations, increased platelet aggregation, and toxic effects on the vascular endothelium. It also has damaging effects on the vascular endothelium and peripheral nerves.

Nicotine increases sympathetic muscle tone in the penis by smoothing (or relaxing) muscle contraction.

Several studies have found young men with ED who smoked had atherosclerosis in the internal pudendal artery of the penis. This risk increased for every 10 years of heavy smoking. Chronic smokers also have ultrastructural damage to the penile vascular tissue.

Derby et al concluded that midlife changes may be too late to reverse the effects of lifestyle issues on ED. They recommend adopting a healthy lifestyle by avoiding smoking and excessive alcohol consumption, and exercising more and eating a low-cholesterol diet.


Erectile dysfunction risk factors include cardiovascular disease and atherosclerosis, advancing age, smoking, obesity, sedentary lifestyle, alcohol consumption, diabetes, hypertension and hyperlipidemia.

If you think, or know, you have erectile dysfunction risk factors, see your doctor today and learn about the many preventive measures you can take to reduce, or even eliminate, your risk.


  • Derby, C.A. et al. (2000). Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk? Adult Urology, 56(2), 302 – 306.
  • Feldman, H.A., et al. (2000). Erectile dysfunction and coronary risk factors. Preventive Medicine, 30(4): 328 0 338. DOI: 10.1006/pmed.2000.064
  • Lewis, R.W. et al. (2004). Epidemiology/risk factors of sexual dysfunction. The Journal of Sexual Medicine, 1 (1): 35 – 39. DOI: 10.1111/j.1743-6109.2004.10106.x
  • Sullivan, M.E., Keoghane, S.R., Miller, M.A (2001). Vascular risk factors and erectile dysfunction. BJU International, 87 (9): 838 – 845. DOI: 10.1046/j.1464-410x.2001.02211.x

Last reviewed 24/Feb/2017


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