Men with a healthy lifestyle and no chronic disease had the lowest risk for erectile dysfunction; the greatest difference was seen for men aged 65-79. For instance, men who exercised at least three hours per week had a 30% lower risk for ED than those who exercised little. Obesity, smoking, and excessive TV watching were also associated with having a greater risk of erectile dysfunction.
Performance anxiety: Perhaps the most common cause of erectile problems among younger guys is performance anxiety. Many cultures place pressure on men to be the "experts" when it comes to sex, which can make men feel like they have to be responsible for sex or know how to please their partner every time. This pressure can be stressful and make it more difficult to get or maintain an erection.
UW Health urologists with advanced training offer medical and surgical treatment options for men and their partners affected by erectile dysfunction. There are several different ways that erectile dysfunction can be treated. For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition. 

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If the problem is physical, there are numerous treatments available, such as penile injections or penile revascularization surgery, which increases blood flow to the cavernosal artery of the penis. There are also medications like Viagra, Cialis and Levitra, but Lehmiller cautioned men with erectile difficulties not to self-medicate without seeing a doctor beforehand due to the potential negative side effects associated with such medications (such as chest pain or shortness of breath).
In an article on Men’s Health about things that wreck your erection, some examples of threats to an erection are sugar, lack of sleep, sleeping near a newborn baby, and lack of vitamin D. The common theme in the article is that reduced testosterone impacts your erection. Not all scientists agree with that. But there are definitely links between testosterone and erectile problems.
"We used to think that ED in young men was 90 percent psychological, but we now know that most cases are caused by a combination of risk factors. Erectile function depends on hormones, blood supply, nerve function, and psychological health,” said Run Wang, MD, professor of urology at The University of Texas Health Science Center in Houston and director of sexual medicine at MD Anderson Cancer Center.

There can be both an indirect and direct way to achieve this. The reflex erection is the direct way, achieved by touching your penis to trigger the nerves in the lower part of your spinal cord and your peripheral nervous system. The psychogenic erection is the indirect way, via non-mechanical sexual stimulation (visual, for example) and sexual arousal. This activates the limbic system in your brain, sending electrical signals down to your erectile nerve centres via the lower regions of your spinal cord. The latter is why you can get both nocturnal or "morning glory" erections, rather non-erotically referred to as nocturnal penile tumescence. How romantic.
There are a lot of explanations for these high ED rates, some of which are psychological. “A lot of men may have an off night, and then that sticks in their head and hurts their performance for a few weeks or months,” Dr. Köhler explains. He says anxiety stokes hormones like the fight-or-flight chemical adrenaline, which is a serious boner killer. (In evolutionary terms, it would be tough to run away from a predator with an erection.)

"This triggers the release of a neurotransmitter called dopamine, and it sends a chemical message from the brain to the penis, causing an increase of blood flow to the penis. The blood vessels leading to the reproductive system then relax and this allows increased circulation in the genital area. When you aren't aroused, the blood vessels in your penis are only partially open. But when your brain sends messages to your penis that you are ready for sex, the vessels open and allow more blood to enter the area. Because of the increased blood flow, blood gets trapped in the penis, which makes the penis expand and causes an erection."


"One of the reasons erectile dysfunction increases with age is that the diseases that lead to it also increase with age," notes Dr. Feloney. Evaluating the causes of erectile dysfunction starts with your doctor taking a good health history and giving you a physical exam. Common medical issues that can lead to erectile dysfunction include diabetes, high blood pressure, hardening of the arteries, low testosterone, and neurological disease. Talk to your doctor about better managing these health conditions.
Use penile injection therapy. An alternative method that you may be advised on by a doctor is penile injection therapy. For this you will be trained by the doctor how to inject your penis with medicine that relaxes the blood vessels and promotes the blood flow that causes an erection. This treatment has been shown to be effective at treating a range of issues both physical and psychological.
"It definitely was a blow to my masculinity," Francis told Mic. "It didn't help that my wife at the time would say that I must be gay if I couldn't keep it up for her." Compounding the issue, if an erection doesn't happen during a given sexual encounter, the man can obsess over it, inevitably creating pressure and making it difficult for him to become fully aroused during future encounters. 
Remember that he is in his 40's, and that's a huge factor too. Around the age of 30, testosterone, androgen, and other hormone levels gradually begin to drop at about a rate of 1 percent. and as a direct result, by the time a man reaches 40, hormone drops cause loss of muscle mass and increased body fat. As a man reaches 45 these gradual hormone drops cause brain capacity and function to slowly regress. This, mixed with risks of genetic diseases like diabetes and high blood pressure, all take a toll on the body, especially the sex organs. Those who are physically active are at a huge advantage, as working out inhibits hormone levels, the neuromuscular system, and protein synthesis to maintain.
"This triggers the release of a neurotransmitter called dopamine, and it sends a chemical message from the brain to the penis, causing an increase of blood flow to the penis. The blood vessels leading to the reproductive system then relax and this allows increased circulation in the genital area. When you aren't aroused, the blood vessels in your penis are only partially open. But when your brain sends messages to your penis that you are ready for sex, the vessels open and allow more blood to enter the area. Because of the increased blood flow, blood gets trapped in the penis, which makes the penis expand and causes an erection."
Most men may not openly talk about their erection problems, but erectile dysfunction — when a man cannot achieve or maintain an erection well enough or long enough to have satisfying sex — is very common. According to the National Institutes of Health, 5 percent of 40-year-olds and 15 to 25 percent of 65-years old have ED. But while ED is more likely to occur as a man gets older, it doesn’t come automatically with age.
"It definitely was a blow to my masculinity," Francis told Mic. "It didn't help that my wife at the time would say that I must be gay if I couldn't keep it up for her." Compounding the issue, if an erection doesn't happen during a given sexual encounter, the man can obsess over it, inevitably creating pressure and making it difficult for him to become fully aroused during future encounters. 
"If any of these physiological factors don't work properly, a man can experience weak erections," says Axe. "Problems maintaining an erection can be due to a number of issues, from hormone imbalances, to neurological issues, cardiovascular conditions, stress and issues with your mental health. There is not one clear way to explain erectile dysfunction — it depends on the man and his specific health condition."
Condom troubles. Can the simple act of putting on a condom cause so much stress that it actually leads to erectile dysfunction? Sure it can — in fact, one recent survey of 234 young men conducted by the Children's Memorial Hospital in Chicago found that 25 percent had lost an erection while putting on a condom. “Putting on a condom requires a break from stimulation, and when it is on, it can reduce sensation,” says Dr. Montague.
So there you have it. Three relatively easy lifestyle changes that can improve erectile function. Eat better, exercise more, and keep the drinking to a minimum. Erectile dysfunction can signal a major health problem, so if you’re experiencing ED, get checked out. However, it’s worth looking into your diet and lifestyle before you start taking medication.
Alcohol: A couple of drinks can loosen your inhibitions and help you relax. But alcohol can also impair sexual functioning. Alcohol works on the nervous system by slowing down brain function, breathing, and pulse. Initially, the effect is often psychologically stimulating, since emotions and desires flow more freely. However, while alcohol may boost sexual desire by helping a person to relax, it can decrease performance, especially where erections are concerned. For this reason, it's best for guys to limit their alcohol intake to one to two drinks (or none at all) for optimal sexual function.

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