11 Surprising Erectile Dysfunction Causes

Why? “Men don’t like to talk about anything that’s stressful, such as ED,” says Salvatore J. Giorgianni, Jr., PharmD, the science advisor for TheNetwork and American Public Health Association Men’s Health Caucus. “Tons of studies show men will wait a very long time before seeking medical help, even with something that causes physical pain.” Making matters worse, ignoring ED often means ignoring the reasons for ED—physiological, psychological, or a mix of the two, he says.

Erectile dysfunction—defined as experiencing problems achieving an erection at least 50% of the time—is something you absolutely should see your doctor about. Consider the following 11 surprising causes of ED all the more reason to make an appointment ASAP. Help is out there—you just have to speak up.

In a survey for ErectileDoctor.com, an online clinical directory of dysfunction-focused medical services, men who work in an environment prone to depression and anxiety (think food service staff, health care workers, firefighters, and police officers) are more likely to cope by smoking, drinking, and taking antidepressants, which have all been linked to upping the risk of ED.

In fact, anxiety and depression are the leading psychological causes for dysfunction, says Justin Sitron, PhD, CSE, a professor in the Center for Human Sexuality Studies at Widener University in Chester, PA. “Erections require the nervous system to trigger them, and if the system is depressed or distracted, then it won’t happen,” he says.

Natural solution: Make relaxation a priority, and, while easier said than done, try not to obsess over the disorder, says Sitron. “Sometimes a man’s dysfunction feeds itself and only makes matters worse,” he says. A relaxation exercise, such as meditation or massage, can help ease your worries.

In the same ErectileDoctor.com survey, men who lived in Pennsylvania, Arizona, Missouri, and Wisconsin were more affected by ED than men living in Colorado, Washington, North Carolina, and Virginia. The highly-affected states have the highest proportion of men over 60, while the lower-affected states have a higher proportion of people in their 20s. True, older men experience the disorder more often, but their younger counterparts shouldn’t breathe a sigh of relief just yet: Research published in the Journal of Sexual Medicine finds that ED rates in young men are on the rise.

Natural solution: Move. (Just kidding—wanted to make sure you were paying attention.) In this case, your best defense is a good offense; be aware of the specific health challenges your state faces, such as a high obesity rate, to take steps to protect your own well-being.

The adult site PornHub revealed they had more than 14 billion visitors in 2013, averaging 1.7 million visits an hour. Excessively watching porn can lead to psychological problems, says Muhammad A. Mirza, MD, the board certified internist behind ErectileDoctor.com. “Porn is often skewed from reality, and there’s research suggesting that the human brain organically changes when you watch too much of it,” he says. “It becomes almost like an addiction and could make it so you can’t get aroused without that kind of stimulation.”

Natural solution: Are you watching too much porn—or are you just embarrassed about it? “If a man feels guilty or badly about the porn he’s watching, or thinks he could get caught, then his ED symptoms may be triggered by the worry or concern,” says Sitron. Assuage your fears by talking to your partner about what you’ve been watching and see if it isn’t something you two both fantasize about—threesomes, bondage, voyeurism, and exhibitionism are the most popular fantasies among both sexes, according to London-based psychotherapist Brett Kahr, author of Sex and the Psyche: The Truth About Our Most Secret Fantasies.

If it’s not just embarrassment putting a strain on your offline relationships, consider seeing a counselor or sex therapist about a potential addiction to pornography.

Forget to floss? You might also have to forget a healthy erection. Israeli researchers found that more than 15% of men with ED also suffer from periodontitis—a severe form of gum disease—compared to only 2% of men without ED. In addition, a study published in The Journal of Sexual Medicine suggests that oral inflammation can lead to a decrease in eNOS, an enzyme that produces the nitric acid that works to regulate blood flow. Without proper flow, a man will struggle to get aroused.

Natural solution: It’s time to make friends with your dentist—or at least be less of a stranger. And when he tells you to floss, just do it already. Added incentive: Poor oral hygiene has also been linked to heart attacks and diabetes, as well as other major health problems.

Speaking of dysfunction-causing diseases, cardiovascular disease is a common culprit. One in four men in the U.S. will die from the disease each year, and the average middle-age man has a 60% risk of developing heart disease in his lifetime, finds a 2012 JAMA study.

The breakdown: High blood pressure and cholesterol—symptomatic of heart disease—restrict blood flow and harden your arteries, allowing plaque to build up. These two conditions can cause a stroke, which can then damage the nerves running through your body, including the ones to your penis.

Natural solution: Exercise, exercise, exercise. For your heart and your erections. People who work out have better overall health and flow to their genitals, says sex therapist Ian Kerner. Research from Queens University in Kingston, Ontario, and the Cooper Institute in Dallas found that found physically fit men are less likely to die from cardiovascular disease. And a Boston University School of Medicine study shows that burning at least 200 calories a day through exercise significantly reduces the risk for ED.

You’re stressed and it shows: Stress hormones cortisol and adrenaline constrict the blood vessels that allow you to get an erection, as well as increase blood pressure—a risk factor for cardiovascular disease. And while job worries are the typical stress culprit, it keeps good company: A 2012 study shows that of the 2,000 adult men surveyed, 34% stress most about their finances, 17% stress about their family and relationships, and 8% stress about their health.

Natural solution: Stress is a commonly overlooked cause for ED, says Stephen Williams, MD, a Harvard-trained urologic specialist and surgeon from St. Joseph Hospital in Orange, CA. “When addressed, it helps dysfunction and improves a person’s overall quality of life.” You know the drill: yoga, meditation, and socializing are all excellent stress-busters.

Improving your diet is an easy way to reduce your ED risk. But research shows that the Mediterranean diet specifically is the healthiest for men with erection problems, says Marianne Brandon, PhD, a clinical psychologist and sex therapist in Annapolis, MD. “The focus on natural foods with healthy fats, such as nuts and olive oil, helps clear blood vessels of dangerous plaque and boosts production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis,” she says.

Additionally, a slew of studies have found eating like the Greeks keeps you mentally sharp and reduces risk of heart attack, stroke, age-related frailty, and early death.

Bicycling, spinning, and even horseback riding, have all been associated with ED. “The pelvic floor is a relatively vulnerable neurological system in which nerves can experience desensitization,” says Sitron. If blood vessels are damaged—like from a hard, narrow bike seat—that can cause a problem, he says.

Natural solution: Scale back on the amount of miles you ride each week, says Sitron. If you’re still having a problem after decreasing your riding time, schedule a pelvic floor examination with your doctor.

SHUTTERSTOCK

All that snoring your bedmate complains about? It could be a symptom of sleep apnea, a disorder that causes people to stop breathing for 10 to 30-second increments. The link to ED: The less oxygen in the blood, the worse your body’s overall function will be, including sexual function, says Sitron. Of the 18 million Americans are affected by sleep apnea, 63% experience relationship problems, 69% experience reduced sexual desire, and 46% experience reduced arousal, finds a study in the Journal of Clinical Sleep Medicine.

Natural solution: The right treatment can reverse the disorder, according to the International Journal of Clinical Practice. If you’d rather not go the CPAP option—you know, the one that looks like you’re wearing a fighter pilot mask to bed, which research shows more than 50% of patients don’t use properly in the first place—you can consider oral appliance therapy (OAT). It’s a mouth guard-like appliance that works to prevent airways from collapsing. Find a dentist your area who offers OAT at LocalSleepDentist.com.

Many religions incorporate a lot of guilt around sexual behaviors, says Sitron. And while this is a less common trigger, sexual guilt can in fact cause ED.

Natural solution: If this is an issue for you and your spouse, taking the guilt out of sex will take some work, as it’s likely a deeply rooted problem. To find a therapist near you, visit The National Association of Cognitive Behavioral Therapists.

If you go right for the prescription without acknowledging any of the underlying issues, it probably won’t get the job done. “You can take all the Viagra you want, but if you have poor circulation because of diabetes, it’s going to be difficult to work,” says Dr. Giorgianni.

Williams agrees. “Everyone wants to walk out with a Viagra sample, but medications weren’t developed to treat underlying causes—just symptoms,” he says. “It’s more important to figure out why you’ve developed the dysfunction in the first place.”

Natural solution: Work with your doctor or therapist to find the right treatment instead of focusing on a pill. The key here, of course, is actually talking to your doctor. “Men just need to understand it’s not something to be ashamed of,” says Sitron. “It’s a common problem, and if treated the right way, ED can easily be solved.”

This article originally appeared on Prevention.