Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.Psychological causes of erectile dysfunctionDepression, anxiety or other mental health conditionsStressPerformance anxietyFear of failureSmall penis syndromeRelationship problems due to poor communication or other concernsPartner’s sexual dysfunction Physical causes of erectile dysfunctionVascular: patients with diabetes mellitus, hypertension, hypercholesterolemia and hyperlipidaemia, heart problems, smokers' vascular problems, obesity, intense sedentary life, heavy alcohol drinkers, cigarette and substance use (mainly cannabis). Studies have shown that men with "sudden" loss of their erection may have undiagnosed coronary artery disease. It has now been shown that 1 in every 5 men (mainly middle-aged) who lose their erection, already suffer from “silent” coronary artery disease, with erectile dysfunction being the only symptom. Neurogenic: patients with multiple sclerosis, Parkinson's disease, stroke, pelvic surgery such as radical prostatectomy, radical cystectomy, diabetic neuropathy, neurogenic bladder and other degenerative neurological conditions, are associated with erection and ejaculation problems that time aggravates.Hormones: patients with thyroid disorders, hypogonadism and reduced testosterone disorder exhibit erectile dysfunction. Prolactin, another hormone, is also involve in erectile dysfunction as it competes with testosterone - when elevated, prolactin causes a drop-in testosterone level.Peyronie's disease: development of scar tissue inside the penis. As a result, the penis morphology changes (shape and size), causing painful erections and making penetration difficult or even impossible. 1 out of 2 men suffering from Peyronie disease will develop angiogenic erectile dysfunction at some point.Certain prescription medications:antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions and many others. One should not interrupt the prescript medication against doctor’s orders, as the consequences can be far greater than the erectile dysfunction itself, putting patient’s life at risk.