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Erectile Dysfunction from Nerve Damage

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Geoffrey C. Whittaker

Published 06/24/2021

Updated 05/19/2024

Erectile dysfunction, or ED, is a common form of sexual dysfunction that affects about 30 million men in the United States, and a variety of factors can cause ED — from your cardiovascular health to psychological issues such as sexual performance anxiety

Sometimes, problems in your nervous system can affect your sexual function and either cause or worsen erectile dysfunction. This type of erectile dysfunction is referred to as neurogenic, or neurological ED.

Worried you might have this condition? Below, we’ve discussed how ED develops, as well as how neurological factors like nerve damage may affect your erectile function and sexual performance.

We’ve also explored the treatment options that are currently available for erectile dysfunction, including ED that’s caused by or linked to neurological factors.

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Neurological erectile dysfunction, or neurological ED, is any form of erectile dysfunction caused by impairment to your nervous system. 

Not following where the nervous system comes in? We’ll break it down: Erections start with stimulation and arousal. 

When you feel aroused due to physical contact or sexual imagery, signals from your brain and nerves in your pelvic area send impulses to the erectile tissue inside your penis.

These impulses cause the blood vessels that supply your erectile tissue to expand, increasing the amount of blood that flows into your penis.

This process depends on a few things. Most importantly: 

  • Sexual arousal 

  • Consistent blood flow

  • A functional nervous system

When your nervous system is impaired, this process may be interrupted, preventing you from being able to get and/or sustain an erection.

Several issues can cause neurological erectile dysfunction, including nerve problems related to multiple sclerosis, spinal cord and nerve injury, diabetes, and even epilepsy.

Other potential causes of neurological ED include heavy metal poisoning and alcoholism, both of which can affect the nerve tissue throughout your body.

Research shows that neurological ED causes can overlap, meaning more than one factor may contribute to  symptoms.

Here’s a more comprehensive list of common causes:

  • Traumatic Injuries that affect your nervous system. Injuries that cause nervous system damage, such as spinal cord injuries, often lead to sexual issues like erectile dysfunction and anejaculation (inability to ejaculate). These issues are often temporary. For example, research has found that most men with spinal cord injury recover some erectile function after two years.

  • Surgery to the prostate or bladder. Some surgical procedures for prostate or bladder cancer can damage the nerves and blood vessels around the penis, which may lead to erectile dysfunction. Many men find that their erection quality and sexual performance improves over time as they recover from this type of surgery.

  • Diabetic neuropathy (nerve damage due to diabetes). Diabetes can cause a form of damage to your nerves known as diabetic neuropathy, especially when it’s uncontrolled or inconsistently treated. Research has found a clear link between poorly controlled diabetes and severe erectile dysfunction. In fact, approximately 40 percent to 50 percent of men with diabetes are affected by neuropathy-induced erectile dysfunction.

  • Multiple sclerosis. Multiple sclerosis, or MS, damages the central nervous system and eventually causes permanent nerve damage. This nerve damage can cause erectile dysfunction. In certain cases, medications used to treat the symptoms of MS may also contribute to ED.

  • Parkinson’s disease. Erectile dysfunction is a known symptom of Parkinson’s disease, a progressive nervous system disorder. Men with Parkinson’s disease also often face other sexual issues, including reduced sexual feeling and difficulty reaching orgasm.

  • Epilepsy. Some men with epilepsy develop erectile dysfunction. Experts believe that this may be caused by epileptic discharges that affect the levels of sex hormones, such as testosterone and prolactin, which are involved in sex drive and penile erection.

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Although neurological issues can cause or worsen erectile dysfunction, they aren’t always the only factor. Other common causes of ED include:

  • Cardiovascular health issues. ED is often linked to atherosclerosis (clogged arteries), high blood pressure, heart and blood vessel disease, cholesterol, heart disease, and other common vascular health issues.

  • Physical urology injuries and/or scarring. ED can often occur after physical injuries that affect the penis or pelvis, including priapism (a prolonged painful erection), pelvic surgery, surgery for prostate cancer, and during the installation of penile implants and prostheses. Scarring conditions, such as Peyronie’s disease, can also cause or worsen erectile dysfunction.

  • Psychological issues. ED often occurs as a result of mental health issues, such as fear or anxiety regarding sexual contact, depression, chronic stress, and persistent feelings of guilt or low self-esteem.

  • Medication side effects. Some medications, such as medications for depression, anxiety, difficulty sleeping, high blood pressure, and androgen-related health issues, can cause or worsen erectile dysfunction.

  • Habits and lifestyle factors. You may have a higher risk of developing ED if you drink a large amount of alcohol on a regular basis, smoke, are overweight or physically inactive, or if you use illicit drugs. Using vacuum erection devices and other devices for the treatment of ED incorrectly can also result in injuries.

Just like ED caused by poor cardiovascular health or psychological issues, neurological erectile dysfunction can vary in severity.

If you have neurological erectile dysfunction, you may:

  • Find it difficult or impossible to get an erection at any time

  • Be able to get an erection, but find it difficult to sustain it for long enough to have sex

  • Be able to get an erection, but not consistently enough to have sex when you want to

The symptoms of neurological ED mirror the symptoms of cardiovascular ED. 

Choose your chew

Treatment for ED can vary based on its cause. If you have erectile dysfunction, it’s important to talk to your healthcare provider to learn what could be causing it, as well as what options you have for treating your symptoms and improving your sexual performance. 

Most neurological ED cases related to treatable health conditions or cavernous nerve (hint: the ones that facilitate erectile function) injuries improve with treatment. Unfortunately,  some cases — particularly those that involve complex, major injuries — can be challenging to treat. 

Many cases of neurological ED can be treated with medication. Common ED medications like sildenafil (the active ingredient in Viagra®, AKA generic Viagra) and tadalafil (Cialis®) are often prescribed for men with ED caused by multiple sclerosis, Parkinson’s disease, and other conditions.

These medications, which are called PDE5 inhibitors, work by increasing the level of blood flow to the erectile tissue inside your penis.

In some cases, neurological ED may be treated using injectable medications, such as Trimix®, which contains alprostadil papaverine and phentolamine.

We’ve discussed these medications and their effectiveness in more detail in our full guide to ED injections

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If you have erectile dysfunction, you may find it difficult to develop or maintain an erection that’s firm enough for a fun and healthy sex life. 

If you’re concerned that it may be neurological, here’s what to consider:

  • Erectile dysfunction often occurs as a result of damage to your nervous system, whether due to an injury, surgery, or a medical condition that affects your nerve function.

  • While some forms of neurological ED improve with the passage of time, others require ongoing treatment and management. 

  • There are several treatment options for neurological ED, including medications, devices, and surgical procedures. 

  • Although these aren’t effective for everyone, many men find that they can produce real, noticeable improvements in their erections and sexual performance after treatment.

Hims offers a selection of ED treatments online, including medications such as sildenafil, tadalafil, and avanafil (sold under the brand name Stendra®).

These medications require an online consultation with a licensed healthcare provider, who will determine if a prescription is appropriate.

15 Sources

  1. Anwar, Z., et al. (2017). Erectile Dysfunction: An Underestimated Presentation in Patients with Diabetes Mellitus.
  2. Calabrò, R. S., et. al (2016). Erectile Dysfunction in Individuals with Neurologic Disability: A Hospital-based Cross-sectional Study.
  3. Cavayero CT, McIntosh GV (2021) Penile Prosthesis Implantation.
  4. Fulbright, Y.K. (n.d.). Sexual Effects of Parkinson’s Disease.
  5. Hess, M.J. & Hough, S. (2012). Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application.
  6. Hopkins Medicine (n.d.) Erectile Dysfunction After Prostate Cancer.
  7. International Society for Sexual Medicine (n.d.). What are common sexual problems for men with spinal cord injury? ‘
  8. Landtblom, A.-M. (2006). Treatment of erectile dysfunction in multiple sclerosis. Expert Review of Neurotherapeutics.
  9. Modh, R.A., Mulhall, J.P. & Gilbert, S.M. (2014). Sexual Dysfunction Following Cystectomy and Urinary Diversion. Nature Reviews Urology.
  10. My Cleveland Clinic. (2020) Erection Ejaculation: How It Occurs.
  11. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Definition & Facts for Erectile Dysfunction.
  12. Neurology Today (2003, August). Erectile Dysfunction, Often Overlooked in Neurological Disorders, is Treatable.
  13. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Symptoms & Causes of Erectile Dysfunction.
  14. Yuan, J., et al. (2010). Vacuum therapy in erectile dysfunction—science and clinical evidence. International Journal of Impotence Research.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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