Physical erectile dysfunction often stems from diseases like diabetes, kidney disease and vascular disease. Men with these conditions can have poor blood flow to the penis, resulting in decreased erections. Sometimes, an injury to the penis or pelvis area, or an invasive surgery, can cause ED, although these effects are often temporary. Finally, abuse of recreational drugs like alcohol, illegal opiates and tobacco, can also damage blood vessels and restrict blood flow to the penis. No matter the cause, for men who have difficulty sustaining an erection, a once enjoyable act can be anything but! While erectile dysfunction can be incredibly frustrating, there are treatments that can help, so talk to your doctor about ED.