If you watch any football games, you probably think erectile dysfunction is America’s number-one disease. That’s because every other commercial is for the magic pills that have helped many men regain their lost abilities.

Erectile dysfunction, often abbreviated to just its initials, ED, is said to affect as many as 30 million American men. It is clinically determined by its frequency – while most, if not all, men have problem getting or maintaining an erection from time to time, a clinical diagnosis of erectile dysfunction occurs when it happens more than 50 percent of the time.

There are as many causes of erectile dysfunction as there are commercials for the product, and pinpointing what’s causing it in any particular man requires health forensics of the highest order. The problem can stem from physical problems or emotional upsets, and it’s often a harbinger of serious underlying illnesses, such as high blood pressure, diabetes or heart disease. It also can be caused by aging or anxiety in a particular situation.

Whatever the cause, it’s disturbing when it happens and can lead to future stage fright (technically called “performance anxiety”) about it happening again. That leads to low self-esteem, depression and stress, which can be a self-fulfilling prophecy that inhibits future performance.

Erections: How They Happen

Sexual arousal in men occurs when signals from the brain release certain chemicals that stimulate blood flow to the penis. The blood enters two specific erection chambers in the penis filled with spongy tissue known as the corpus cavernous. When the blood fills the tissue, it produces the erection. When the male experiences an orgasm, the process reverses, with the blood flowing out of the chambers and deflating the penis.