The most common cause of erectile dysfunction is damage to arteries, smooth muscles and fibrous tissues.

• Problems with the blood vessels (vascular problems) make up 48% of erection problems.
• Problems with the nerves (neurological problems): 14%
• Problems with the structure of the penis or surrounding tissues: 3%

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These problems can in turn be caused by a variety of factors:

• Disease: illnesses account for 70% of erectile dysfunction. These may include diabetes, kidney disease, and multiple sclerosis. Atherosclerosis or "hardening of the arteries" can prevent adequate blood from entering the penis.
• Injury to the penis, spinal cord, prostate, bladder or pelvis: such injury can be the result of sports or car accidents, or even riding on hard bicycle seats.
• Complications of surgery or radiation (e.g. for prostate cancer): these can interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, you cannot have an erection.
• Side effects of common medication: these include drugs taken for high blood pressure, anti-depressants, anti-histamines, tranquillisers, appetite suppressants, and the ulcer drug cimetidine.
• Substance abuse: chronic use of alcohol, marijuana or other drugs often causes impotence, which may be aggravated by decreased sexual drive. Excessive tobacco use can also block penile arteries.
• Hormonal factors, such as low testosterone levels.
• Zinc deficiency.
• Erection problems in men over 50 are more likely to have physical causes.

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