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Common Causes Identified in Clinical Evaluation Cardiovascular disease and high blood pressure reducing penile blood flow Diabetes, particularly long-standing or poorly controlled cases Venous leakage, where blood enters the penis but is not retained effectively Hormonal imbalance, including low testosterone or elevated prolactin Peyronie’s disease and structural scar tissue Nerve injury following prostate cancer surgery Psychological factors such as anxiety, depression, or performance pressure More than one factor may be present

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