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Cite as: Archiv EuroMedica. 2025. 15; 6. DOI 10.35630/2025/15/Iss.6.617
,
Justyna Krawczak2 , ,
Magdalena Dobraniecka 2 , ,
Rafał Sochacki3 Background: Sleep disturbances and unhealthy dietary patterns are major modifiable contributors to endocrine instability, metabolic stress, and endothelial dysfunction. These lifestyle related mechanisms remain underestimated in the diagnostic evaluation of erectile dysfunction despite their growing epidemiological significance.
Aims: The aim of this review is to synthesize the endocrine, metabolic, and vascular mechanisms through which insufficient sleep and poor diet impair erectile function and to justify lifestyle modification as a fundamental component of erectile dysfunction therapy.
Methods: A narrative synthesis of publications from 2023 to 2025 indexed in PubMed, Scopus, Google Scholar, and Web of Science was performed. Fifty seven peer reviewed studies addressing sleep disturbances, dietary patterns, hormonal regulation, endothelial function, diagnostic classifications, and clinical management of erectile dysfunction were analyzed.
Results: The evidence shows that sleep restriction and unhealthy diet lead to parallel disruptions of neurohormonal homeostasis including decreased testosterone and increased cortisol and to endothelial dysfunction through chronic inflammation, insulin resistance, and reduced nitric oxide bioavailability. These mechanisms converge to impair vasodilation and penile blood flow and form the physiological basis of organic erectile dysfunction.
Conclusions: Early identification of modifiable lifestyle factors is essential for accurate diagnosis and effective management of erectile dysfunction. Dietary correction, weight reduction, and restoration of normal sleep patterns should serve as central therapeutic measures integrated into standard clinical practice.
KEYWORDS: erectile dysfunction, sexual health, sleep disorders, diet quality, endocrine regulation
Modern lifestyles lead to numerous disruptions in the balance between mental and physical health. As a result, a growing number of patients are presenting to doctors' offices with symptoms such as hypertension, diabetes, and feelings of depression [1]. The causes of these conditions are complex and multifactorial, and each chronic disease, like long-term emotional stress, negatively impacts the third type of health – sexual health. A holistic approach to patient health problems is increasingly being promoted, unfortunately, too often neglecting one of its key aspects: sexual health. It should be emphasized that analyzing problems in this area is impossible without simultaneously assessing the patient's mental and physical condition, as sexual health is directly influenced by mental health, physical health, and environmental factors [2].
The current lifestyle, demanding high commitment and featuring chronic stress from social media, poor diet, and pressure for social advancement, contributes to sleep disorders. These disorders, along with poor sleep hygiene, chronic fatigue, and emotional tension, significantly impact sexual health, resulting in decreased sexual satisfaction, often manifesting as erectile dysfunction and reduced libido [3]. Current research indicates that insufficient sleep quantity and quality affect approximately one-third of the population, particularly shift workers and those with obstructive sleep apnea. Furthermore, poor dietary habits, including the consumption of highly processed foods, are a significant health concern, contributing to 14.1% of all deaths in 2019, primarily due to cardiovascular disease. Ultimately, an unhealthy diet, chronic stress, and sleep disorders are key predisposing factors for the development of chronic diseases, which negatively correlate with sexual dysfunction.
The ICD-11 classification of diseases lists erectile dysfunction as a medical condition, but to determine the underlying cause, it is crucial to conduct a detailed interview regarding the patient's mental health and reported symptoms. Only such an examination will enable an appropriate differential diagnosis and implementation of the appropriate therapeutic option for the patient, thus improving erectile function. The aim of this article is to draw the attention of physicians of all specialties and increase public awareness of the impact of poor diet and poor sleep hygiene on sexual health.
The relevance of this topic arises from the growing evidence that lifestyle related mechanisms affecting sexual function remain underestimated in everyday clinical practice, despite their significant contribution to endocrine instability, metabolic stress, and endothelial injury. Although numerous publications describe individual factors such as sleep restriction or unhealthy diet, their combined effect on neurohormonal balance and vascular function has not been adequately synthesized. The novelty of this review lies in the integration of sleep related and diet related influences into a single pathophysiological framework that explains how environmental factors impair erectile function. This perspective seeks to highlight the importance of early recognition of modifiable lifestyle components in order to improve diagnostic accuracy and therapeutic effectiveness.
The aim of this study is to synthesize the pathophysiological mechanisms through which poor sleep hygiene and poor eating habits affect sexual function. Furthermore, the work aims to emphasize the need to incorporate lifestyle modification as a fundamental element of ED therapy.
Research objectives:
This narrative review is based on an analysis and synthesis of 57 scientific sources concerning the relationship between sleep disorders, dietary patterns, and erectile dysfunction. A structured literature search was conducted in PubMed, Scopus, Google Scholar, and Web of Science to identify publications relevant to sexual health, endocrine regulation, vascular physiology, sleep disturbances, dietary risk factors, and clinical management of erectile dysfunction. The search was performed using predefined keyword combinations including sexual health, erectile dysfunction, sleep disorders, sleep quality, circadian rhythm, diet quality, unhealthy diet, metabolic syndrome, endothelial dysfunction, diagnosis, and treatment.
Inclusion criteria were defined as follows.
Exclusion criteria were as follows.
All eligible full text articles were examined and the extracted material was synthesized narratively. The synthesis focused on 5 thematic domains represented in the included literature.
The reference base includes normative diagnostic documents and international clinical guidelines, as well as recent meta analyses and reviews published between 2023 and 2025. No formal quality assessment tool was applied, which is consistent with the methodological framework of a narrative review.
When discussing sexual health, in addition to the mental and physical aspects, it's important to remember the external factors that influence it. These factors primarily include diet, sleep, physical activity, and substance use. Each of these factors influences neurohormonal homeostasis and vascular function [4]. When the body's internal balance is maintained, sexual function functions properly. Unfortunately, disruptions can lead to impaired functioning of the endocrine or vascular systems.
Sleep disorders and poor diet first affect the endocrine system, which is most susceptible to changes. Possible consequences of dysregulation of this system include decreased testosterone and estrogen levels, increased cortisol levels, and impaired insulin and leptin secretion [5]. All of these hormonal changes negatively impact sexual function, leading to erectile dysfunction, decreased libido, and even fertility problems [6]. Hormonal balance is closely linked to the circadian rhythm and regulated by sleep. Therefore, sleep disorders can significantly impair hormone metabolism and predispose to the development of endocrine diseases, impacting overall health [7]. For example, sleep disorders activate the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated cortisol levels. Cortisol not only perpetuates further activation of the HPA axis but also contributes to increased arousal, which can exacerbate insomnia [8].
Chronic hypercortisolemia is associated with decreased libido, and some studies have shown that elevated cortisol levels negatively correlate with sexual function in men [9]. However, the role of cortisol in erectile dysfunction is not straightforward, as some studies indicate a positive correlation with erectile function, and its significance may depend on overall metabolic status [10]. However, numerous studies have shown that the hypothalamic-pituitary-gonadal (HPG) axis is inhibited by chronic stress and the associated high cortisol levels, which can lead to impaired fertility and reproductive function [11]. Inhibition of the HPG axis causes a decrease in testosterone secretion, a potential cause of erectile dysfunction [12]. Furthermore, sleep disorders disrupt the circadian rhythm of testosterone secretion, resulting in low blood levels [1]. The impact of sleep disorders on testosterone levels is significant because it is one of the most important hormones responsible for erectile function in men. Testosterone itself does not directly induce an erection, but rather acts by maintaining the normal structure and function of penile tissues and regulating the neurochemical mechanisms necessary for initiating an erection [13].
Not only do sleep disorders negatively impact the body's homeostasis; unhealthy eating patterns have a similar impact [14]. The long-term consequences of a poor diet, characterized by the consumption of large amounts of simple sugars, saturated animal fats, and trans fats, include obesity, atherosclerosis, hypertension, and hypercholesterolemia [15]. Each of these diseases directly and indirectly contributes to damage to the vascular endothelium, which in turn can cause erectile dysfunction [16]. Damaged endothelium is characterized by reduced activity of the enzyme nitric oxide synthase (eNOS), necessary for the synthesis of nitric oxide (NO)—a key signaling molecule for vasodilation. As a result of NO deficiency, smooth muscle remains constricted, and penile vessels cannot dilate sufficiently to induce and maintain adequate blood inflow [17]. Endothelial dysfunction is believed to be the first stage of atherosclerosis. Since the penile arteries are much narrower (approx. 1–2 mm) than the coronary arteries, even minor damage and atherosclerotic plaque deposition can lead to significant reduction of blood flow to the corpora cavernosa (arterial insufficiency) [18].
Currently, the ICD-10 classification (chapter F52.2) is used to diagnose diseases and disorders, including sexual dysfunctions (such as erectile dysfunction, ED). According to the ICD-10, to be diagnosed, sexual dysfunction must persist for at least six months, recur frequently, and involve the inability to achieve or maintain an erection sufficient for satisfactory intercourse [19]. The ICD-11 criteria are similar, requiring persistent or recurrent symptoms for at least several months, and characterize ED as the inability or significant impairment of the ability to achieve or maintain a penile erection of sufficient rigidity to permit sexual activity, despite desire and adequate stimulation. Both the ICD-11 and the DSM-V classify sexual disorders, including erectile dysfunction, according to the time and circumstances of their occurrence. ICD-11 distinguishes primary generalized disorders (from the onset of activity, in all situations), primary situational disorders (from the onset, in specific situations), acquired generalized disorders (from a certain point in time, in all situations), and acquired situational disorders (from a certain point in time, in specific situations) [20]. In contrast, DSM-V requires that symptoms occur during all or almost all (75–100%) sexual activities and persist for at least 6 months, causing clinically significant distress; this classification divides ED into generalized or situational, lifetime or acquired, and mild, moderate, or severe [21]. Both classifications exclude situations in which the dysfunction is caused by other mental disorders, relational factors, stress, substances (including medications), or a health condition. Table 1 (Comparison of Diagnostic Criteria for Erectile Dysfunction (ED)) summarizes and compares the classifications discussed above and their diagnostic differences.
After diagnosing ED, it is crucial to select the appropriate therapeutic method based on a thorough medical history. Treatment largely depends on the underlying cause, so the primary form of therapy is treating the underlying condition [22]. If the history excludes a psychogenic cause, the focus should be on organic causes. Considering the impact of diet and sleep on sexual function, it is crucial to focus on modifying these factors. If the patient reports chronic fatigue, frequent naps, and difficulty sleeping at night, after ruling out other pathologies, focus should be on sleep hygiene [23]. Patient education should be provided, recommending maintaining a consistent sleep-wake rhythm (waking and going to bed at the same time), limiting blue light (from screens) 1–2 hours before bedtime (it inhibits melatonin secretion), and avoiding stimulants, especially caffeine, 6–8 hours before bedtime [24]. However, if the history indicates poor eating habits or obesity, the priority is weight loss by limiting sugars and saturated fats (fast food, processed foods) and introducing a diet rich in vegetables, fruits, whole grains, and lean protein. Regular physical activity is also important (e.g., 150 minutes of moderate exercise per week) [25]. In patients with obesity, hypertension and diabetes should be excluded, as they are often causes of erectile dysfunction and require immediate treatment [26]. Table 1 summarizes how ICD10, ICD11 and DSM5 differ in their diagnostic criteria for erectile dysfunction regarding conceptual focus, required duration and frequency of symptoms, the role of distress and the categorization of symptom patterns.
Table 1. Comparison of Erectile Dysfunction (ED) Diagnostic Criteria
| Feature / Classification | ICD-10 | ICD-11 | DSM-5 |
| Category Focus | F52.2 – Genital response absence (Psychogenic focus; excludes organic cause). | HA01.1 – Erectile Dysfunction (Holistic focus on function and distress). | Erectile Disorder (Focus on Frequency and distress). |
| Required Duration | Minimum 6 months | Minimum several months | Minimum 6 months |
| Required Frequency | Occurrence is frequent | Persistent/Recurrent | Every or almost everyactivity (75-100%) |
| Distress Criterion | Requires inability to engage in desired relationships | Associated with clinically significant distress | Must cause markeddistress |
| Pattern Subtypes | Four descriptive forms. | 4 patterns (Primary/Acquired & Generalized/Situational). | 3 axes(Generalized/Situational, Lifelong/Acquired, Severity). |
The analysis of the presented data indicates that sexual health is shaped by a wide range of psychological, physical, and environmental factors [27]. Psychosocial attitudes, cultural norms, and family upbringing, including religious beliefs and parental views on sexuality, exert a marked influence on sexual behavior and sexual satisfaction [27,28]. Among the modifiable determinants, diet and sleep should be considered central because they determine the state of the endocrine system and the vascular endothelium, which represent the core mechanisms of organic erectile dysfunction [2,4,29].
The collected evidence confirms that sleep disturbances and unhealthy dietary patterns act in a coordinated manner and amplify one another, creating a unified cascade of pathophysiological changes [3,14,30]. Current research shows that diets high in simple sugars, saturated fats, and ultra processed foods lead to obesity, insulin resistance, and chronic inflammation [15,29,31]. These processes reduce endothelial nitric oxide synthase activity and nitric oxide bioavailability, which impairs vasodilation and forms the basis of endothelial dysfunction [16,17,32,33]. Comparable alterations are observed in sleep disorders, particularly in chronic sleep restriction and obstructive sleep apnea, which activate the hypothalamic pituitary adrenal axis, increase cortisol levels, and further exacerbate metabolic instability and vascular impairment [8,30,34].
The combination of endocrine and vascular disturbances forms the foundation of most organic forms of erectile dysfunction [13,16,17,18]. These disturbances rarely occur in isolation. The simultaneous influence of metabolic disorders, symptoms of depression and anxiety, negative attitudes toward sexuality, and social barriers creates a multilayered clinical picture in which a single primary cause is rarely identifiable [2,4,26]. Stigma and the taboo surrounding sexual issues further reduce the willingness of patients to disclose problems and lead to incomplete or distorted sexual history reporting. Therefore, diagnosis must rely on a comprehensive clinical approach supported by a detailed, multilevel medical history that specifically considers diet and sleep as modifiable risk components [22,23,25].
The substantial variation between studies described in the literature is explained by differences in methodological design, assessment instruments, cultural contexts, and age distribution of participants [3,26]. This underscores the need for validated diagnostic tools and greater methodological standardization. Without the unification of research instruments, it is not possible to ensure comparability of findings, accurately assess the prevalence of sexual dysfunction, or reliably estimate the contribution of sleep and diet to erectile impairment [23].
The available data demonstrate that diet and sleep form a shared pathophysiological continuum that influences testosterone secretion, cortisol regulation, endothelial function, and inflammatory pathways [5,9,13,14,30,31,32,33]. This unified mechanism explains the coordinated impact of lifestyle on sexual health and highlights the need for early detection of modifiable factors and targeted adjustments of diet and sleep hygiene within a comprehensive management strategy for erectile dysfunction. Such an approach improves diagnostic accuracy, enhances therapeutic outcomes, and forms the basis for prevention strategies in populations of men at elevated risk of erectile dysfunction [2,22,35,36].
The analysis of the available literature reveals several important limitations that must be considered when interpreting the findings of this review. Existing studies differ substantially in methodological design, including the instruments used to assess sexual function, inclusion criteria, characteristics of study populations, and cultural context. These discrepancies make direct comparison of results difficult and limit the possibility of generating unified quantitative conclusions. An additional complication arises from differences in age groups, which affect sexual activity levels, endocrine regulation, and the prevalence of comorbid conditions.
Many studies rely on patient self reports, which introduces the risk of underestimating symptom severity due to embarrassment, cultural stigmatization, and the tendency to conceal sexual health problems. This reduces the reliability of individual data points and increases the likelihood of systematic bias.
Research examining the influence of diet and sleep on sexual function uses various methods to assess dietary patterns, sleep hygiene, and endocrine parameters. The lack of standardized assessment tools restricts the comparability of findings. Moreover, the limited number of longitudinal observations makes it difficult to determine causal relationships between sleep disturbances, dietary factors, and erectile function.
This review includes publications with varying levels of methodological rigor. Since no formal quality assessment was performed, the heterogeneity of sources may limit the precision of the synthesized pathophysiological mechanisms.
The synthesis of the available evidence shows that sleep disturbances and unhealthy dietary patterns jointly form a unified pathophysiological framework that substantially affects male sexual function. This conclusion directly follows from the aim of the review, which was to integrate the endocrine, metabolic, and vascular mechanisms linking diet and sleep with erectile dysfunction, and from the research objectives focused on epidemiology, hormonal regulation, endothelial health, diagnostic implications, clinical consequences, and therapeutic relevance.
Epidemiological data confirm that sleep disorders, poor diet, and erectile dysfunction frequently coexist and share common metabolic and vascular determinants. The analysis of endocrine pathways demonstrates that both insufficient sleep and unhealthy nutrition contribute to hormonal instability, including reduced testosterone levels and elevated cortisol, which directly impairs sexual functioning. The review also shows that diet related metabolic disturbances and endothelial dysfunction converge with sleep related vascular changes, together reducing nitric oxide bioavailability, which is essential for normal vasodilation and erection.
The examination of diagnostic classifications indicates that consideration of lifestyle factors is necessary for accurate identification of the mechanisms underlying erectile dysfunction. This reinforces the need for clinicians to integrate sleep quality and dietary patterns into the diagnostic interview. The evaluation of clinical consequences confirms that the combined influence of metabolic stress, vascular impairment, and endocrine dysregulation explains the high prevalence of erectile dysfunction in populations with unhealthy lifestyle patterns.
The therapeutic implications of the reviewed data underline the importance of including lifestyle modification as a central component of erectile dysfunction management. Improvement of dietary habits and restoration of healthy sleep patterns should be considered foundational elements of treatment, complementing other clinical interventions. The obtained synthesis supports the conclusion that early identification and correction of modifiable lifestyle factors increases diagnostic accuracy and enhances therapeutic effectiveness.
Limited quantity and quality of sleep negatively impacts health and well-being, leading to metabolic diseases [35] and limiting the effectiveness of daily activities [36]. A key factor in the deterioration of quality of life, besides sleep, is an inappropriate diet, which causes inflammation, insulin resistance, and vascular endothelial dysfunction, directly contributing to erectile dysfunction and other sexual dysfunctions [37][38]. At the psychosocial level, obesity causes low self-esteem and shame, which in turn leads to avoidance of intimacy and worsening sexual dysfunctions [39]. Sleep and circadian rhythm disorders are also directly linked to erectile dysfunction, as seen, for example, in patients with obstructive sleep apnea [40][41]. It is essential for medical specialists to consider both sleep disorders and dietary factors when diagnosing patients with symptoms of sexual dysfunction, which can facilitate diagnosis and recommend the best treatment [42].
Further research relying on validated assessment tools and standardized methodologies is essential to refine the understanding of these mechanisms and to strengthen the evidence base for clinical practice.
Conceptualization: Kamil Czerwiak;
Methodology: Justyna Krawczak
Validation: Rafał Sochacki
Formal analysis: Borys Dobraniecki;
Investigation: Magdalena Dobraniecka;
Data curation: Beata Majewska
Writing – Original draft preparation: Kamil Czerwiak
Writing – Review and editing: Kamil Czerwiak, Rafał Sochacki, Beata Majewska
Visualization: Rafał Sochacki
AI-based software was applied only for grammar checking and language editing, with all
modifications reviewed and approved by the authors
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