ED and Fertility

​​While erectile dysfunction (ED) does not directly cause infertility, it significantly affects a couple’s ability to conceive by preventing sexual intercourse.

Background

Although erectile dysfunction has traditionally been viewed as a condition affecting older men, recent studies suggest that its prevalence in men under 40 may be as high as 35%. This new information is especially important when we consider how the average age of new fathers has changed over the past four decades. A study published in Fertility and Sterility, found that the number of fathers younger than 30 has dropped by more than 27%, while the number of fathers aged 30–34 has increased by 15%, and the number aged 35–49 has risen by 52%–63%.

Introduction

Despite the trend of men fathering children at older ages, data indicate that one in four men seeking treatment for newly onset erectile dysfunction is younger than 40. While traditionally the medical establishment has categorized ED into 3 groups: organic, psychological, and lifestyle - blaming those conditions for ED, recent data is changing this paradigm and proposing that ED is a symptom of something more serious than erection. This new way of looking at ED aligns with principles long held in Traditional Chinese Medicine, which teaches that when a person’s lifestyle becomes imbalanced, the body eventually follows, leading to various symptoms of dysfunction.

Lifestyle

Traditional Chinese Medicine views erectile dysfunction as a direct consequence of an unhealthy lifestyle. When we look at the three categories used in allopathic medicine—organic, psychological, and lifestyle-related—we can see that all of them may stem from lifestyle imbalance. For instance, the organic category includes conditions such as cardiovascular disease, diabetes, and hormonal disturbances, all of which are strongly influenced by diet, activity level, and overall daily habits. With healthy eating and regular exercise, many of these conditions can be prevented or significantly reduced. The psychological category includes conditions such as anxiety, depression, and stress. Several studies show that these issues often arise as a consequence of experiencing ED rather than as its primary cause. The lifestyle category is more straightforward: factors such as smoking, excessive alcohol use, physical inactivity, obesity, certain medications (including antidepressants, antihypertensives, and antipsychotics), and recreational drugs all fit naturally within this group. 

In addition to the factors listed under lifestyle, recent research has also identified a potential link between pornography use and erectile dysfunction. A study in Belgium examined men aged 18 to 35 and found that higher levels of pornography consumption were associated with an increased risk of ED.

ED and CVD

Erectile dysfunction is now recognized as a potential predictor of cardiovascular disease (CVD). A 2024 study investigating whether ED can indicate cardiovascular risk concluded that:

“ ED severity and the time from ED to CVD onset may be predictive of coronary heart disease severity”

A systematic review describing the association between erectile dysfunction and cardiovascular disease concluded that:

“ ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD”

Eating for Health

A diet centered on whole plant foods — such as vegetables, fruits, whole grains, legumes, nuts and seeds — has been associated with a significantly reduced risk of cardiovascular disease (CVD) and heart-related mortality. For example, a 2021 meta-analysis of 13 prospective studies found that people adhering to a mostly plant-based diet had about a 10% lower risk of developing CVD, and a slightly lower risk of CVD-related death. A broader meta-analysis of nearly 700,000 adults showed that the highest adherence to plant-based diets was linked with roughly a 16% lower risk of CVD or coronary heart disease compared to those with the lowest adherence. In July 2025, the Journal of the American Medical Association (JAMA) published a meta-analysis examining whether vegetarian diets improve the cardiometabolic profile of individuals with, or at high risk for, cardiovascular disease. The analysis included 20 randomized clinical trials involving 1,878 participants and an average intervention duration of six months. The study concluded that vegetarian diets were associated with significant improvements in cardiometabolic health.

There is also a growing body of research suggesting that diets rich in whole plant foods may reduce the risk of erectile dysfunction by improving vascular, metabolic, and endothelial health. For instance, a large analysis of 2,549 men from the National Health and Nutrition Examination Survey (NHANES) found that men with higher scores on a “healthy plant-based diet index” had a significantly lower chance of ED. A 2021 Chinese study similarly found that greater consumption of plant-based foods correlated with fewer ED symptoms and better erectile function scores. A 2025 narrative review proposed plausible biological mechanisms: whole-food plant diets help improve endothelial function and increase nitric oxide availability — both essential for healthy erections — while lowering inflammation, “bad” cholesterol, arterial stiffness, and other cardiovascular risk factors.

Acupuncture and ED

By improving blood circulation and reducing anxiety, acupuncture has shown to improve erectile dysfunction. A 2023 randomized controlled trial reported that 18 acupuncture sessions over 6+ weeks significantly improved erectile hardness and quality of sexual life compared to sham acupuncture, with benefits lasting up to four weeks.

Conclusion

Erectile dysfunction is more than a disorder that negatively impacts fertility; it is now recognized as an early warning sign of cardiovascular disease. As research continues to show that diets rich in whole plant foods can reduce the risk of ED—and consequently decrease the risk of heart disease—it becomes clear that nutrition plays a critical role in men's overall reproductive and heart health. Adopting a plant-based diet may therefore offer a powerful and accessible approach to both preventing ED and supporting long-term cardiovascular wellness.