Erectile dysfunction (ED) is a prevalent condition affecting adult men globally, characterized by the inability to achieve or maintain an erection sufficient for sexual intercourse. Neurological causes, including multiple sclerosis, Parkinson's disease, ischemic stroke, congenital spinal abnormalities, and spinal cord injuries, disrupt neural pathways essential for erectile function. Additionally, chronic conditions such as diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular diseases, along with lifestyle factors like smoking and alcohol consumption, exacerbate ED by compromising vascular health. Psychological stressors further complicate the etiology of ED. Pelvic surgeries, cavernous nerve injuries, and certain medications, including antihypertensives and antidepressants, contribute to ED progression. Effective management requires addressing these neurological, vascular, hormonal, and psychological factors, necessitating a multidisciplinary approach involving specialists such as neurologists, urologists, endocrinologists, and mental health professionals. This review highlights the complex interplay between neurological disorders, systemic conditions, and lifestyle factors in the pathophysiology of ED, emphasizing the need for tailored treatment strategies targeting the underlying contributors to improve patient outcomes.