Many different causes

One possible distinction between psychological and physical causes of ED is the extent of nocturnal erections. They are part of a man's physiological repertoire and are already evident in infancy, so they have nothing to do with sexual behaviour. These REM sleep-dependent erections often lead to the morning erection that men notice when they wake up. If they notice that this erection no longer occurs at all or only very rarely, then this indicates an organic rather than a psychological event. 

In addition to arteriosclerosis as an important cause of ED, other possible causes include diabetes, Parkinson's disease and dementia. Problems with erections can also occur alongside neurological diseases such as multiple sclerosis (MS), be associated with benign enlargement of the prostate and be the result of certain operations. Medications that can impair erectile function include antidepressants, some medications for high blood pressure, antipsychotics and anticonvulsants as well as opioids.

If a man feels like having sex but cannot achieve an erection, phosphodiesterase inhibitors (PDE-5 inhibitors) can help, regardless of whether the cause is psychological or physical. The drugs sildenafil, tadalafil and vardenafil relax the smooth muscle cells in the erectile tissue, allowing blood to flow in and induce an erection. Possible but temporary side effects include headaches and stomach pains, facial flushing, nasal congestion and visual disturbances.

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