In a recent online survey, a sample of 1,500 men were asked to identify the most common causes of erectile dysfunction (ED). Results indicated that 1 out of 3 guys pointed to wearing skinny jeans and 1 out of 10 guys pointed to “excessive” masturbation as the primary culprits. Is there any truth to the idea that wearing tight pants or “overusing” your genitals can affect your ability to achieve erections in the future? No. There is simply no research to suggest wearing slimmer pants or underwear will cause ED (incidentally, the often cited claim that tight undies impairs sperm production appears to be exaggerated too [1]). And scientists have found no association between frequency of masturbation and reports of erectile problems [2]. So let’s talk about the actual causes of ED and what you can do to maintain erectile health.

First, it is important to note that ED can be caused by physical or psychological factors. Thus, there is not always an underlying medical condition—sometimes the mechanics of the penis work just fine, but the brain won’t allow it to operate. Some of the more common psychological causes of ED include stress, distraction, relationship conflict, and performance anxiety. In addition, guys who have previously experienced an erectile failure with a partner and constantly fear that it will happen again can lay the basis for a self-fulfilling prophecy, which occurs when the problem is so strongly anticipated that it ultimately becomes a reality.

In terms of physical causes, scientists have identified a ton of them. For one thing, obesity and the chronic illnesses associated with it can make erections more difficult to achieve. In particular, ED has a strong linkage to illness that impair blood flow or damage blood vessels, such as heart disease and diabetes. ED also has a link to the use of several prescription and over-the-counter drugs, including certain antidepressants, allergy medications, and high blood pressure medicines. Antidepressants of the selective serotonin reuptake variety (SSRI), such as Prozac, are especially prone to this sexual side effect [3].

Furthermore, substance use and abuse can cause both temporary and chronic cases of ED. For instance an episode of binge drinking can make it more difficult to achieve an erection in a given situation, whereas chronic alcoholism can lead to persistent erectile difficulties. In fact, in one study of men aged 20-50 suffering from alcohol dependence, fully one-third reported symptoms of ED [4]. Long-term tobacco usage can cause similar problems, with smoking doubling one’s risk of facing future erectile difficulties [5].

As you can see, some of the most common causes of ED are things that are under our control, which means that men can reduce their risk of developing erectile problems through a series of lifestyle changes. This means taking care of yourself by watching what you eat and getting the right amount of exercise in order to lower your risk of obesity, heart disease, and diabetes. It also means watching your alcohol and tobacco intake and learning about the side effect profiles of the medications you are on. Finally, it’s important to relax during sex and to recognize that your body will not always function the way you want it to. Most guys will have at least one “failure to launch” experience during their lives; however, being unable to get it up once is not a sign that there is something wrong with your penis, so avoid jumping to that conclusion if it happens.

In short, maintaining erectile health means taking care of both your mind and body. Your wardrobe choices couldn’t have less to do with it.

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[1] Munkelwitz, R., & Gilbert, B. R. (1998). Are boxer shorts really better? A critical analysis of the role of underwear type in male subfertility. The Journal of Urology, 160, 1329-1333.

[2] Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States. The Journal of the American Medical Association, 281, 537-544.

[3] Csoka, A., Bahrick, A., & Mehtonen, O. P. (2007). Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. The Journal of Sexual Medicine, 5, 227-233.

[4] Arackal, B. S., & Benegal, V. (2007). Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian Journal of Psychiatry, 49, 109.

[5] McVary, K. T., Carrier, S., & Wessells, H. (2001). Smoking and erectile dysfunction: Evidence based analysis. The Journal of Urology, 166, 1624-1632.

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