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There are many underlying psychological and physical causes of erectile dysfunction. Reduced blood flows to the penis and nerve damage are the most common physical causes. The following Underlying condition associated with erectile dysfunction includes:

• Diabetes
• Cadio-Vascular disease
• Excess usage of Drugs
• Hormone (Testosterone) deficiency
• Neurologic conditions ( Nerve or spinal cord damage)
• Radiation therapy, Pelvic trauma, Surgery
• Peyronie’s disease
• Venous leak
• Psychological conditions (Depression and anxiety)
• Smoking
• Medications and substance abuse
• Low testosterone levels

Diabetes 
Chronic high blood sugar levels associated with diabetes mellitus often damages small blood vessels and nerves throughout the body, which can impair blood flow and nerve impulses essential for sustain erection. More than 60% of men with diabetes experience impotence world wide.

Cardio-Vascular Disease
The hardening and narrowing of the arteries or Arteriosclerosis, causes a reduction in blood flow throughout the body and can lead to impotence. More than 60 % men experience erectile dysfunction and impotency is associated with age and vascular disease around the World.
Risk factors for arteriosclerosis include:

• Diabetes mellitus
• High cholesterol
• High blood pressure

Smoking, which can lead to any of the above risk factors, is possibly the most important risk factor for impotence related to arteriosclerosis.

Excess Usage of Drugs
Commonly prescribed drugs are known to contribute or cause to impotence, including drugs for antidepressants, tranquilizers, high blood pressure, heart medications and sedatives. Long-term use of alcohol and drugs may affect the nervous and vascular systems are associated with erectile dysfunction problems.

Hormone (Testosterone) deficiency

Testosterone is the primary sex hormone in men. Testosterone is not only key necessary for sex drive or libido but also necessary for maintaining nitric oxide levels in the penis. Deficiency of testosterone can result in a loss of person’s instinctive drives (sexual desire or libido) and loss of erection. Hormone instability can also result from liver or kidney disease.

Neurologic Conditions (Nerve or spinal cord damage)

Brain injuries (e.g., Stroke, Paralysis of the lower half of the body or paraplegia) and Spinal cord damage can cause impotence. Other nerve disorders, such as Parkinson’s disease, Alzheimer’s and disease with multiple sclerosis (MS) may also lead to impotence.

• Pelvic trauma, Radiation therapy, Surgery

  Sudden and severe physical injury to the pelvic region or spinal cord can damage nerves and veins which plays important role conducting signal to the brain and needed for erection. Surgery of the prostate, bladder, colon or rectum may damage the nerves and blood vessels involved in erection. Cancer surgery of the Prostate and bladder often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.

• Radiation therapy for prostate or bladder cancer also can constantly damage the nerves. Cystectomy (surgical removal of a cyst in the urinary bladder cancer) and prostatectomy (surgical removal of the prostate cancer) require removing or cutting nerves that control penile (of the penis) blood flow. These almost dead nerves are not responsible for orgasms and do not restrain sensation in the penis often erection is affected by these procedures.
• Nerve-sparing techniques such as Retroperitoneal Lymph Node Dissection (RPLND) aimed at lymph nodes surrounding the aorta on the back wall of the abdomen are removed in order to determine whether cancer has spread outside of the testicle and to remove the primary metastatic sites. The RPLND is a major operation involving an incision from the sternum to the pubic bone lowering the incidence of impotence to 50% to 60%. Temporary impotence is also associated with these procedures, even those in which nerve-sparing techniques were used.

Peyronie’s Disease:
Peyronie’s disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1-4% of men cause painful erections.
Peyronies Disease is also formally known as “penile induration” or “Induratio Penis Plastica (IPP)” and colloquially as “bent nail syndrome”.

Venous Leak:
Venous leakage - An erection is produced when blood to the penis press together the veins in the corpora cavernosa so the blood cannot leave. Venous leak can be a result of injury, disease, or damage to the veins in the penis, Leakage of the Corpus cavernosum venous result inability to maintain or sustain erection.

Psychological Conditions (Depression and anxiety):
Depression, sadness, guilt, worry, stress, anxiety and low spirits all contribute to loss of libido, sexual instinct; person’s instinctive drives and energies and erectile dysfunction. If a man experiences loss of erection, he may mentally and emotional worry that it will happen again. This can produce anxiety associated with performance and may lead to chronic problems during sex. If the cycle is inevitable, incapable of being avoided or ignored, cannot be escaped, it can result in impotence. Psychological factors in impotence are often secondary to physical causes, and they magnify their significance.Cigarette Smoking make worse or exacerbate or aggravate atherosclerosis (disease characterized by cholesterol deposits in the arteries) and thereby increases the risk for erectile dysfunction over a period of time.

Smoking

Medications and substance abuse:
Common medicines cause erectile dysfunction as a side effect. Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants.

• Examples of common medicines that can cause erectile dysfunction include beta-blockers such as propranolol (Inderal), hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin), lithium (Eskalith; Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), and gemfibrozil (Lopid). For more, please visit the Medications Index.
• Marijuana, heroin, cocaine, and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy of the testicles and lower testosterone levels.