Erectile dysfunction, or ED, is the inability to achieve and maintain an erection firm enough for sexual intercourse. While it’s a common issue as men age, there are underlying medical and psychological conditions that can cause ED at any age.

Here are six surprising causes of erectile dysfunction that you may not have considered.

1. Gum Disease

Gum disease, also known as periodontitis, is a chronic bacterial infection of the gums and bones that support the teeth. Studies have shown that men with gum disease are more likely to have ED than those without.

The inflammation caused by gum disease is believed to damage blood vessels and interfere with blood flow to the penis, resulting in ED.

2. Sleep Apnea

Sleep apnea is a disorder that causes a person to stop breathing briefly while sleeping. It’s estimated that about half of all men with ED also have sleep apnea.

The lack of oxygen during apnea episodes can damage blood vessels and decrease blood flow, leading to ED. Treating sleep apnea with a continuous positive airway pressure (CPAP) machine may improve symptoms of ED.

3. Peyronie’s Disease

Peyronie’s disease is a condition that causes scar tissue to form inside the penis, resulting in a curved and often painful erection.

It’s estimated that up to 10% of men experience Peyronie’s disease, and it can lead to ED by making it difficult to achieve and maintain an erection. Treatment options include oral medications, injections, and surgery.

4. Medications

Many medications can cause or contribute to ED. These include antidepressants, antihistamines, blood pressure medications, and cholesterol-lowering drugs.

If you’re experiencing ED and currently taking medication, talk to your doctor about the possibility of switching to a different medication or adjusting your dosage.

5. Cycling

Cycling is a popular form of exercise, but prolonged pressure on the perineum (the area between the scrotum and anus) can damage nerves and blood vessels. This can lead to ED, as well as other issues such as numbness and pain.

To reduce the risk of ED from cycling, use a seat that’s designed for your anatomy and take breaks to stand and stretch periodically.

6. Stress and Anxiety

Stress, anxiety, and other mental health conditions can contribute to ED. When you’re stressed or anxious, your body releases hormones that can interfere with the physiological processes required for an erection.

Relaxation techniques such as meditation and deep breathing exercises can help reduce stress and improve ED symptoms.

While ED can be a frustrating and embarrassing issue to deal with, it’s important to remember that it’s a common condition that can often be treated with lifestyle changes or medical intervention.

If you’re experiencing ED, talk to your doctor to determine the underlying cause and develop a treatment plan.