Impotence, aka erectile dysfunction, aka ED, is not often the easiest topic to discuss but it effects more men than we likely realize.  As many as 50 million men in the US and Europe suffer from impotence, or erectile dysfunction.  Statistically, this number includes only about 5% of men less than 40 years old and up to 25% of men by the time they reach 65 years of age. By definition, impotence is the inability to get or keep an erection firm enough for sexual intercourse.

There are plenty of risk factors for erectile dysfunction, but one of the most prominent is chronic disease. Chronic disease includes long term illnesses like diabetes, hypertension, obesity, high cholesterol, and cardiovascular disease. Lifestyle habits like smoking, drug/medication use, nicotine and alcohol use can also contribute to problems with potency.  For still others mental health, neurological, or neurophysiological disorders are the problem. These include depression, stress, stroke, spinal cord injury, multiple sclerosis, dementia, or neurologic disease. In a smaller subset of men hormonal abnormalities, or depleted testosterone levels typically due to aging are to blame.

Here is a detailed look at how some chronic disease effect sexual function and can lead to impotence:

High Blood Pressure

This can directly lead to erectile dysfunction, as can the medicines used to treat it.  These medications act by lowering the pressure inside blood vessels, in order to decrease the strain on the heart.  In men, this decreased blood flow can interfere with erections, ejaculation and sexual desire.

High Cholesterol

Statins and other drugs used to treat high cholesterol, act by restricting the amount of cholesterol.  Cholesterol is an essential building block of hormones, including sex hormones like testosterone.  You can probably guess where this is going. A reduction in cholesterol can lead to reduced production of these hormones, and effect a man’s ability to maintain an erection.

Diabetes

This condition can damage blood vessels and nerves, two big components of sexual function.  As with high blood pressure, the reduced blood flow resulting from damaged vessels can contribute to erectile dysfunction.

Depression/Anxiety

Antidepressants act by blocking chemicals in the brain, particularly chemicals that relay signals between nerve cells: serotonin, norepinephrine and acetylcholine.  It is well documented that decreased libido, diminished ability to orgasm, impotence and ejaculation are associated with antidepressant usage.  Similarly, the mental aspect of sexual function is not to be overshadowed.  Performance anxiety, or work related stress can also hinder erectile function.

Aside from chronic disease, recreational drugs are also a common cause of impotence.  Let’s take a look at how certain drugs can contribute to ED:

Alcohol

Alcohol is a depressant, and using it heavily can dampen mood, decrease sexual desire, and make it difficult for a man to achieve erections or reach an orgasm while under the influence. Overdoing it on the booze can inhibit erectile functioning by causing a restriction in blood flow to the penis and can affect production of the male hormone testosterone, affecting sex drive and erections.

Cocaine

Although cocaine has a reputation as an aphrodisiac, it actually may make you less able to finish what you start. Chronic cocaine use can impair sexual function in men and women. In men, cocaine can cause delayed or impaired ejaculation.  Furthermore, cocaine is a vasoconstrictor, meaning that it causes blood vessels to constrict, and blood vessels in the penis need to be dilated in order for an erection to occur.

Marijuana

Smoking increases the risk of atherosclerosis, or hardening of the arteries.  This can reduce blood flow throughout the body, including to the penis, impairing a man's ability to get erection. Quitting smoking can help some men partly or fully restore erectile function.  There are also some studies that show marijuana impairs smooth muscle function, which can be a problem when the penis is 70-80% smooth muscle.