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Common causes of erectile dysfunction include: Vascular conditions atherosclerosis, hypertension, and diabetes can impair blood flow Neurological disorders multiple sclerosis, Parkinson's disease, or spinal injuries Hormonal imbalances low testosterone, thyroid disorders Psychological factors anxiety, depression, stress, relationship difficulties Medications certain antihypertensives (e.g., thiazide diuretics, some beta-blockers), antidepressants (particularly SSRIs), antipsychotics, and 5-alpha-reductase inhibitors Lifestyle factors smoking, excessive alcohol, obesity, sedentary behaviour According to NICE Clinical Knowledge Summary guidance, ED is often an early marker of cardiovascular disease, as the penile arteries are smaller than coronary vessels and may show atherosclerotic changes earlier

Ethics declarations Ethics approval and consent to participate Not applicable, Ethical approval was not provided for this study on human participants because NHANES is a publicly available dataset

To further assess the long-term impact of maternal SD on offspring fertility, the follicular development and oocyte developmental competence in offspring at PD21 were examined (Fig

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