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Physical causes include: Cardiovascular disease reduced blood flow to the penis due to atherosclerosis or hypertension Diabetes mellitus nerve damage and vascular complications affecting erectile function Hormonal imbalances particularly low testosterone levels Neurological conditions such as multiple sclerosis, Parkinson's disease, or spinal cord injury Pelvic surgery or trauma including prostate surgery Medication side effects various medicines can contribute to ED (discussed in detail later) Psychological factors such as anxiety, depression, stress, and relationship difficulties can also contribute significantly to ED, either independently or in combination with physical causes

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As side effects mounted, so did lawsuits