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In 70 percent of cases, physical causes are responsible for erectile dysfunction. Most often, penile blood circulation is disturbed and / or the penile gland itself, which is very similar to the vascular wall musculature, falls ill. Either too little blood in the penis arrives because the supplying arteries are “calcified” (arteriosclerosis). Or the blood drains off too quickly through the veins. Or both. In any case, the amount of blood in the erectile tissue of the penis is no longer sufficient for a satisfactory erection.

Circulatory disorders causing erectile dysfunction

Various diseases that promote circulatory disorders also increase the risk of erectile dysfunction: Diabetes mellitus (diabetes), hypertension, lipid metabolism disorders. The lifestyle also has a decisive influence: Smoking, obesity, physical inactivity and a one-sided and unhealthy diet increase the blood vessels and thus increase the probability of potency problems. Conversely, a healthy lifestyle helps to prevent potency disorders. It has also been shown repeatedly that a healthy lifestyle and regular exercise exercise a favorable influence on an erectile dysfunction.

Erectile dysfunction is often the first warning sign of vascular disease and thus a possible harbinger from heart attack or stroke. If atherosclerosis is detected and treated early, Often bad consequences can be avoided. Not least for this reason, it is advisable to clarify a potency problems medically.

Testosterone deficiency

The male sex hormone testosterone seems to have a significantly greater impact on the love life as long suspected. This is shown by recent research results. So is a sufficiently high hormone level apparently a very important condition for a satisfactory erection. With the years of life, testosterone levels in the blood usually fall off in men. A testosterone deficiency (hypogonadism) does not have, but may well lead to impotence. Therefore, if men have erection problems, they should necessarily also have low testosterone levels as a possible cause be considered.

Drug side effects

Important to know: Many medications can cause impotence as a side effect, including beta-blockers for high blood pressure, dehydrating medications, lipid-lowering drugs or depression medications. If there is an indication in the instruction leaflet and there is a suspicion that the remedy might be a cause of erectile dysfunction, patients should consult their physician. Maybe he can prescribe another drug. Caution: Do not discontinue or change medication on your own!

Other causes of erectile dysfunction

For an erection to come, not only the penis circulation must be right. All involved nerve tracts – from the penis to the spinal cord to the brain – must be intact. Herniated discs, injuries, radiation or pelvic or spinal cord surgery can cause erectile dysfunction. Also, diseases that can cause damage to peripheral nerves (a neuropathy) – such as diabetes mellitus (diabetes) or chronic alcohol abuse. Other possible causes of erectile dysfunction include diseases affecting the central nervous system, such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease or stroke. Serious diseases – such as cancer, severe kidney or liver disease – can always affect the potency with.

Psychic triggers

Physical and emotional triggers can be mixed in erectile dysfunction. If men suffer from physical problems with potency, they easily develop additional psychological problems. Purely psychologically caused causes can be found especially in younger men. In addition to conflicts in the partnership, stress, problems or anxiety disorders, depression is very often with associated with erectile dysfunction. In erectile dysfunction, the man can not get or maintain an erection sufficient for intercourse. The penis does not get hard enough and / or recovers quickly. The problems last for at least six months and occur in more than two-thirds of the cases. Often, erectile dysfunction (commonly called “impotence”) gradually develops and occurs both in intercourse with the partner and in masturbation.

This constellation indicates physical causes such as vascular changes (see chapter Causes). In every healthy man, erections occur in certain phases of sleep. If they stay out, this is another indication of physical causes. Does it only in very specific situations to erectile dysfunction and they are very sudden – almost from one day to the other – are the possible (but not proving) signs of psychic trigger.

Balance testosterone deficiency

With increasing age, the testosterone level in the blood drops slightly in almost all men. This is nothing unusual and no reason for a therapy. However, if a man suffers from erectile problems, a testosterone deficiency (hypogonadism) could play a decisive role. In this case, the doctor will advise to balance the hormone deficiency. Maybe this will already improve the potency problems. Often, erectile dysfunction medications (PDE-5 inhibitors, see below) are better or first in combination with hormone therapy. Some men with erectile dysfunction even benefit from testosterone supplements, although her blood levels are actually in a near normal range. When does the hormone supplement make sense? It should therefore be decided individually – jointly by doctor and patient. The testosterone is applied in the form of a gel on the skin or sprayed at greater intervals in the muscle.

At first, research seemed to indicate that That a testosterone therapy could possibly increase the risk for prostate cancer or a heart attack. However, according to current knowledge such fears are unfounded, say experts – a professional medical treatment provided. Mostly, however, only the symptoms, not the actual triggers of erectile dysfunction can be treated. There are various options, from medication to mechanical aids. What helps best in an individual case is an individual decision the after extensive consultation on possible side effects and risks together with the doctor – and ideally, of course, together with the partner – should be taken. Patients themselves can help to maintain or even improve their potency for a long time. What keeps the blood vessels fit also prevents erectile dysfunction. In detail this means: Do not smoke, eat well, drink little alcohol, move a lot, lose weight, blood pressure, Check blood sugar and blood lipids regularly and treat them with bad results.


In Germany, various phosphodiesterase 5 inhibitors (PDE-5 inhibitors) are approved for the treatment of erectile dysfunction: the first was sildenafil, which was launched in 1998. Tadalafil, Vardenafil and Avanafil followed. All are prescription. Effect and side effects are roughly comparable. The tablets help about 70 to 80 percent of “impotent” men and differ mainly in dosage and duration of action. Sildenafil, vardenafil and avanafil work after about 15 to 60 minutes (the onset of effect may be delayed after high-fat meals). Their effect lasts around four to twelve hours. Tadalafil works after about 30 minutes for about 24 to 36 hours. This medication can also be prescribed as a permanent medication with one tablet a day. As the name suggests, the drugs inhibit phosphodiesterase-5 (PDE-5), which is an endogenous enzyme. This enzyme normally breaks down a certain messenger substance, which increases in sexual arousal and increases blood circulation in the penis. If the enzyme phosphodiesterase-5 is now obstructed in its work by the drugs, there is more messenger left. Consequently, penile blood flow increases, an erection develops or persists longer.

A second effect is that the blood pressure in the pulmonary circulation drops. Phosphodiesterase 5 inhibitors are therefore also used to treat pulmonary hypertension. PDE-5 inhibitors only work if the man is sexually aroused. So you do not increase the desire. The erection ends – as without medication – with orgasm or ejaculation. Within the duration of action, however, further erections are possible. Possible side effects include headache, facial flushing, heartburn, stuffy nose, Transient changes in color vision in sildenafil and vardenafil, in Tadalafil also muscle and back pain. Exact information can be found in the leaflet. Not suitable are PDE-5 inhibitors for patients prescribed by the doctor nitrates or molsidomine, because it can lead to a dangerous drop in blood pressure here. Nitrates or molsidomine, for example, in the treatment of angina pectoris in coronary Heart disease used. Some diseases (for example, severe liver disease, Heart disease or a stroke in the past) may speak against taking PDE-5 inhibitors. The PDE-5 inhibitors are good for a prescription. Before the first application, patients should consult the doctor extensively on side effects and inform possible individual risks. Another drug for the treatment of erectile dysfunction is yohimbine, which acts in the brain and especially for psychically induced potency disorders is used.

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