The Top Four Causes of Erectile Dysfunction (ED)

Written by | Wellness

By Michael A. Werner, MD, FACS / Medical Director, Maze Men’s Health

At Maze, we know that how you have sex and who you have sex with matters when it comes to treating erectile dysfunction. We prioritize treating you as a whole person because we know that gay and bisexual men face additional stressors that extend beyond sexual functioning. No matter the cause or the context, medical intervention can always manage a man’s ED, and sometimes solve the problem too.

Our first step is to evaluate the cause(s) of your ED, which will help determine your optimal treatments. Treatments may include:

  • Oral Medications (which are dramatically cheaper from a few local pharmacies than by mail order)
  • Low Intensity Extracorporeal Shock Wave Therapy
  • Penile Injections (with an autoinjector so they are barely felt)
  • Vacuum Erection Device
  • Surgery

Here are the top four causes of ED: 

Vascular. Blood must be able to flow rapidly into the penis through the arteries (and then be trapped there). Any process that damages the arteries will affect a man’s erections. Thus, conceptually, anything that would make a man more likely to have a heart attack or stroke will make him more likely to have ED. This includes smoking, diabetes, hypertension, high cholesterol and sub-optimal exercise and diet.  Sometimes, treating these underlying conditions can improve a man’s erections.

Potential Treatments: Oral Medications; Low Intensity Extracorporeal Shock Wave Therapy; Penile Injections; Vacuum Erection Device; MUSE Pellet

Neurological. The neurological system must be intact to achieve an erection. The most common cause of neurologic ED is diabetes, which usually affects both nerves and blood flow. Other causes include previous surgeries, spinal cord injury, strokes, multiple sclerosis, or other systemic neurological diseases.

Potential Treatments: Penile Injection; Surgery

Hormonal. Significantly low testosterone and thyroid hormones, or a very high prolactin (another pituitary hormone) may cause problems with erections.

Potential Treatments: Hormonal Therapy (usually combined with other therapy to get a man up and running quickly)

Psychological. ED can often occur for primarily psychological reasons. However, even when the underlying cause is a mild physical one, once a man’s erections are inconsistent, anxiety almost invariably intrudes.  We will perform an evaluation and treat you aggressively and quickly to get you back functioning.

Potential Treatments: Oral Medications, Injections, Behavioral Therapy 


Sexual Dysfunction in Gay and Bisexual Men

Our Maze Men’s Health team is knowledgeable about the diverse sexual experiences of the men who seek out our care. Maximizing your sexual satisfaction requires understanding the relationship between your physical and emotional health. Like many men who are not exclusively heterosexual, you may have been labeled as “other” or “less than,” and that is an aspect of your sexual life that can’t be ignored.  Many men also have consensual sexual and romantic relationships with more than one partner. While you may have struggled with coming out to your medical provider or therapist in the past, you don’t need to worry about coming out to the Maze team.

Since founding Maze in 1994, I have been committed to being inclusive and welcoming to men of all sexual orientations, behaviors, and relationship models. With our new program focusing on the needs of gay and bisexual men, we now offer even more services with gay men (our nurse practitioner, therapist, and pelvic floor specialist) as the primary providers. In addition to treating ED, Low Testosterone, Pelvic Floor Dysfunction and Premature Ejaculation, we also offer pelvic floor and anus assessment, and PrEP maintenance. If you are a gay or bisexual man you have unique needs, and you will receive respectful, professional care at Maze Men’s Health.

Visit for more information, to submit any questions or to schedule a free phone consultation with one of our specialists.


Last modified: June 26, 2021