Answer:
Erectile dysfunction (ED) can develop from either physical or psychological factors, and in many cases, both play a role. Below is a detailed breakdown of common causes:

Physical Causes

Conditions that impair blood flow, nerve function, or muscle activity in the penis can lead to erectile dysfunction. These include:

• Heart disease

• Atherosclerosis (blocked blood vessels)

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Metabolic syndrome (a cluster of conditions such as high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels)

• Parkinson’s disease

• Multiple sclerosis

• Side effects of certain medications

• Smoking or tobacco use

• Peyronie’s disease (scar tissue inside the penis)

• Alcoholism or substance abuse

• Sleep disorders

• Prostate cancer or treatments for an enlarged prostate

• Pelvic or spinal cord surgery and injuries

Psychological Causes

Mental health and emotional well-being are just as important for sexual function. Psychological issues may directly cause ED or worsen physical factors over time. Common psychological causes include:

• Depression

• Stress

• Relationship conflicts

• Performance anxiety

The diagnosis of erectile dysfunction (ED) usually begins with a detailed medical history and physical examination conducted by an andrology specialist. During this evaluation, the doctor reviews possible contributing factors such as psychological issues, medications, underlying medical conditions, and any history of surgery. A thorough genital examination is also performed.

After this initial assessment, laboratory tests may be ordered:

• Blood tests to measure cholesterol and blood sugar levels, which help evaluate cardiovascular risk.

• Hormone tests (such as testosterone and prolactin) if hormone-related ED is suspected, since treatment may differ depending on hormone balance.

In cases where vascular problems are suspected, a penile Doppler ultrasound may be performed to assess blood flow. For cases linked to psychological causes, referral to a sexual therapist can be beneficial.

It is also important to note that men over the age of 40 with ED face a higher risk of heart attack within the next five years. For this reason, a comprehensive cardiovascular evaluation is recommended.

Yes, in many cases erectile dysfunction (ED) can be reduced or prevented by avoiding risk factors and adopting healthy lifestyle habits. Helpful strategies include:

• Avoiding smoking and limiting alcohol use

• Following a Mediterranean-style diet

• Managing chronic conditions such as diabetes, high blood pressure, and high cholesterol

• Reviewing and, if necessary, adjusting medications that may contribute to ED (under medical supervision)

• Exercising regularly and maintaining a healthy weight

• Reducing stress and supporting mental well-being

Despite these preventive measures, some individuals may still experience erectile difficulties. In such cases, it is important to undergo a thorough evaluation by an andrology specialist and follow the treatment plan recommended by the physician.

The treatment of erectile dysfunction (ED) depends on its underlying cause, and several options are available:

• Vascular-related ED: First-line treatments include medications that improve blood vessel dilation and regeneration, as well as shockwave therapy (ESWT). If these are not sufficient, advanced therapies such as PRP (platelet-rich plasma), SVF (stromal vascular fraction), and exosome treatments may be added to support tissue and nerve repair.

• Injection therapies: These can provide immediate erections and may be useful when oral or regenerative treatments are ineffective.

• Surgical options: For patients who do not respond to other treatments, penile prosthesis (implant) surgery offers a permanent solution to erectile dysfunction.

• Venous insufficiency-related ED: In such cases, treatment often combines deep venous ligation surgery, shockwave therapy (ESWT), and stem cell–based approaches (SVF).

Each treatment plan should be tailored to the patient’s condition and determined after a thorough evaluation by a specialist.