What Biopsychosocial Factors Influence Erectile Dysfunction?

What Biopsychosocial Factors Influence Erectile Dysfunction?

Erectile dysfunction (ED) is a complex medical condition that is often related to several different biopsychosocial factors. The following are some biopsychosocial factors that are frequently associated with ED.


As a patient’s age increases, so does their likelihood of experiencing ED. One study of 3,548 Portuguese men between the ages of 40 to 69 years found that the prevalence of ED increased from 29% in men aged 40 to 49 years, to 50% in men aged 50 to 59 years, to 74% in men aged 60 to 69 years.  


Men with hypertension may be almost twice as likely to suffer from insufficient blood flow to the penis and erectile difficulties than men with normal blood pressure. This is likely due to the damage that high blood pressure causes to the artery walls and the endothelium that impairs the blood flow that is necessary to support firm erections. As such, hypertension is undoubtedly associated with ED, and many health care providers even consider ED to be an early marker of cardiovascular disease.


Smoking is a significant risk factor for ED. It worsens erectile function by damaging the body’s vascular system. Multiple studies have demonstrated that smokers are between 1.4 to 3.1 times more likely to develop ED over time than their nonsmoking counterparts.

Endocrine Disorders

Endocrine disorders occur when a gland produces too much or too little of an endocrine hormone, resulting in a hormonal imbalance. Disruptions in the body’s hormone production processes such as thyroid dysfunction or hypogonadism can negatively impact a person’s erectile function since these hormones are necessary for healthy sexual functioning.

Medication Usage

Certain medications such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics, immunosuppressants, anti-androgens, recreational drugs, and more are associated with sexual dysfunction (including ED) in men.

Psychological or Relationship Issues

Lastly, psychological and/or relationship issues are frequently associated with psychogenic ED. If an individual is anxious, depressed, or experiences performance anxiety during sex, it may be more difficult for him to get and maintain and erection. Additionally, if that person has feelings of guilt, shame, distrust, or has other unresolved issues in their relationship, it may impact their sexual performance.


  • Antipolis, S. (2020, August 28). How to treat high blood pressure without ruining your sex life. https://www.escardio.org/The-ESC/Press-Office/Press-releases/how-to-treat-high-blood-pressure-without-ruining-your-sex-life

  • Javaroni, V., & Neves, M.F. (2012). Erectile dysfunction and hypertension: impact on cardiovascular risk and treatment. International Journal of Hypertension2012. 1155/2012/627278

  • Kovac, J.R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L.I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia47(10), 1087–1092. https://doi.org/10.1111/and.12393

  • Martin, S., Atlantis, E., Wilson, D., Lange, K., Haren, M.T., Taylor, A., & Wittert, G. (2012). Clinical and biopsychosocial determinants of sexual dysfunction in middle-aged and older Australian men. The Journal of Sexual Medicine9(8), 2093-2103. https://doi.org/10.1111/j.1743-6109.2012.02805.x

  • Teles, A.G., Carreira, M., Alarcão, V., Sociol, D., Aragüés, J.M., Lopes, L., Mascarenhas, M., & Costa, J.G.E. (2008). Prevalence, severity, and risk factors for erectile dysfunction in a representative sample of 3,548 Portuguese men aged 40 to 69 years attending primary healthcare centers: results of the Portuguese erectile dysfunction study. The journal of sexual medicine5(6), 1317-1324. https://doi.org/10.1111/j.1743-6109.2007.00745.x

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