There are several lifestyle factors that are known to cause or contribute to ED. The most common cause of ED in men younger than forty is excessive alcohol consumption. By forty years of age, most men have had at least one episode of ED, often the result of alcohol misuse. In spite of the subjective feelings of lowered inhibitions, alcohol is technically a central nervous system depressant, which means that it restricts the functioning of the neurological system.
Up to 50% to 80% of alcoholics experience erectile dysfunction.
Where alcohol use is concerned, as the saying goes, “Too much of a good thing is bad.” Alcohol is thought of as a relaxant, and its use will take away one’s inhibitions. Yet alcohol abuse – regular drinking to excess – can cause erectile dysfunction; occasional use does not. Liver failure as a result of alcohol abuse may also affect erectile function.
Long-term smoking or passive exposure to smoke may cause ED by harming the penile vascular system. Smoking may be an independent risk factor for erectile dysfunction, particularly erectile dysfunction caused by vascular disease, and it may also contribute to other causes of erectile dysfunction. In the Massachusetts Male Aging Study, neither the number of cigarettes smoked nor the duration of time smoking had an effect on the incidence of erectile dysfunction. However, the study did show a significant relationship between smoking and erectile dysfunction for certain categories of men. In men who were being treated for heart disease, complete erectile dysfunction was 56% for current smokers, compared with 21% for nonsmokers, after correction for differences in age. Similar results were noted for men with high blood pressure (20% incidence of erectile dysfunction in current smokers versus 8.5% in nonsmokers), those with arthritis (20% in current smokers versus 9.4% in nonsmokers), those taking heart medications (41% in current smokers versus 14% in nonsmokers), and those taking medications for high blood pressure (21% for current smokers versus 7.5% in nonsmokers).
Recreational drugs, including alcohol, cocaine, marijuana, and heroin, may also have a negative effect on erectile function. The erectile dysfunction may resolve with prolonged abstinence, but in some men it may persist. Marijuana decreases testosterone levels, and long-term marijuana use may affect erectile function.
Obesity’ or a sedentary lifestyle with poor physical conditioning may limit the physiologic responses of arousal (for example, respiration and cardiovascular efficiency). Erectile dysfunction occurs to different degrees in different medical conditions. In men with hypertension, for example, erectile dysfunction occurs in about 27%. The Massachusetts Male Aging Study found an association between low concentration of high-density lipoproteins (HDL – the “good” cholesterol) and erectile dysfunction, even though there was no correlation between erectile dysfunction and total cholesterol levels. (Cholesterol is a fat-like substance that is important to certain body functions but, when present in excessive amounts, contributes to unhealthy fatty deposits in the arteries, which may interfere with blood flow.) In men between the ages of 40 and 55, the risk of moderate erectile dysfunction increased from 6.7% to 25% when the HDL level decreased from 90 to 30 mg/dL. This study also found a similar effect of the HDL level on erectile function in the older male population. Another study did find a relationship between the total cholesterol and erectile function; according to this study, the risk of erectile dysfunction increased as total cholesterol level increased. This study also found a negative correlation between HDL level and risk of erectile dysfunction – meaning that the higher the HDL level, the lower the risk of erectile dysfunction. This increased risk of erectile dysfunction with low HDL levels and elevated cholesterol levels is not surprising, because these are the factors that increase one’s risk of cardiovascular disease.