Also known as ED or impotence, erectile dysfunction occurs when a man is unable to get or keep an erection firm enough to engage in sexual intercourse. While these commercials spur jokes and laughs among most, erectile dysfunction could indicate a serious health issue.

The likelihood of erectile dysfunction does increase with age (22 percent of men over the age of 60 and 30 percent of men over the age of 70 suffer from impotence), but it’s not an inevitable part of growing older. Instead, the cause is more likely related to an underlying physical or psychological condition.

1. Medical Conditions

Serious medical conditions, such as heart disease, could be the origin of your erectile dysfunction. In fact, causes of heart disease and erectile dysfunction are very similar. ED symptoms may occur earlier than those of heart disease due to cardiovascular issues like atherosclerosis. Atherosclerosis, the narrowing of blood vessels throughout parts of the body, is believed to be the most common cause of erectile dysfunction and a warning sign of a future heart attack or stroke. Other medical conditions that put men at risk for erectile dysfunction are diabetes, chronic kidney disease, multiple sclerosis and Peyronie’s disease.

2. Medications

Are you taking any prescribed or over-the-counter drugs on a regular basis? Certain medications may make it difficult for you to get or keep an erection, like antidepressants, antihistamines or blood pressure medications. While these drugs may treat a condition, they can also affect hormones, nerves, or blood circulation, which can all increase the risk of erectile dysfunction. If you think your ED may be the result of a medication, it’s best to consult your physician.

3. Emotional Distress

Have you been fighting with your partner? Relationship problems causing stress can lead to struggling in the bedroom. Depression, anxiety, low self-esteem, guilt, and fear of sexual failure are other contributing factors.

4. Lifestyle Choices

Making poor health decisions on a daily basis may affect your ability to get an erection. Men who are overweight, habitual smokers, alcoholics, or substance abusers are more prone to experiencing erectile dysfunction. Eating foods high in flavonoids, like blueberries, help reduce the risk of erectile dysfunction. Increased flavonoid intake also helped men smoke less, drink less and exercise more.

5. Physical Injury

While exercise is great for your health, be cautious of any physical activity that could injure your lower half, as injuries to these areas of the body can cause erectile dysfunction. With the increasing popularity of cycling, men have expressed concern about whether this exercise contributes to ED. A recent study published in the Journal of Men’s Health concluded that there was no relationship between prolonged cycling and erectile dysfunction.

With 30 million Americans currently suffering from erectile dysfunction, a number estimated to rise to 320 million worldwide by 2025, it’s important to be active in your health care. Talk to your health care provider if you’re experiencing impotence and share your concerns about any underlying causes.