Not being able to get or keep an erection during sex can be embarrassing and stressful for many people with penises. Erection difficulties (ED) can have a direct impact on sexual confidence and enjoyment, and cause a huge amount of distress both for individuals and their partners. This booklet offers information and strategies that might help reduce the occurrence of erection difficulties, and explains how to seek help if you need it.
How common are erection problems?
Very common.
In fact it has been estimated that over 80% of people with penises have had occasional difficulties in getting or maintaining erections at some point in their lives. This is usually caused by stress, tiredness or excessive alcohol. This is very normal. A temporary loss of erections (although often a source of anxiety) is nothing to worry about.
For some, erection difficulties can occur more frequently. Recent studies suggest that around 13% of men aged 16-54 have experienced ED for more than three months over the last year. Erection problems can affect us at any age, but the rates of erection difficulties do rise with age (up to 50% of 55-70 year olds report persistent ED).
What do we mean by Erection Difficulties?
ED can mean different things to different people at different times. For some, it will mean getting a partial erection or a ‘semi’ which is sufficient for some types of sex but is often problematic when attempting penetration with a partner. For others ED may mean getting no erection at all.
Some people find that they are able to get erections at certain times, for instance on their own or in the morning. Others are able to get an erection in particular situations, for instance on holiday or with a trusted partner, but not at other times. It can also be the case that we notice that erections are difficult to get in all situations, regardless of the context.
What can cause ED?
There are lots of possible factors that can contribute to erection difficulties. These can be physical, psychological or a combination of both.
Physical Factors
Physical causes of ED are more common as men get older.
The most common physical cause of ED is reduced blood flow into the penis. This is due to a build-up of fatty deposits (atheroma) in these arteries, which cause the arteries to narrow and harden. This is the same process that affects the arteries of the heart in heart disease, and can happen more quickly in men with diabetes and high blood pressure.
Lifestyle factors can play a big part in the narrowing and hardening of the arteries, and associated ED. These include:
· Smoking
· Being overweight
· Fatty and high calorie foods which cause high cholesterol
· Lack of regular exercise
Alcohol and recreational drugs can also prevent men getting erections, especially when consumed excessively.
Talking with your doctor about ways of changing your lifestyle can have a significant effect on your ability to gain and maintain erections. Other physical factors that can contribute to ED include:
· Surgery (e.g. for prostate cancer)
· Radiation therapy
· Certain medications (prescribed to treat depression, heart disease and cancer)
· Neurological conditions (such as multiple sclerosis or stroke) which can affect the way the brain sends messages around the body during arousal
If there is a physical cause, then the ED tends to develop slowly. So, you may have intermittent ED for a while, which may gradually become worse over time. If the ED is due to a physical cause, you are likely to have a normal sex drive, but will notice it is becoming harder and harder to get and maintain erections over time.
Psychological Factors
If you notice that your ED has started suddenly it might be a sign that there are psychological factors influencing this. Men who experience ED with psychological causes are typically able to get erections when they sleep or when they wake up in the morning, and some are able to get an erection when masturbating alone, but will often struggle in and around sexual contact with others.
Common psychological causes for ED can include:
· Not being aroused by the sexual situation
· Feeling stressed, tired or bored
· Worry about sexual performance or about getting an erection
· Concerns about using condoms, sexually transmitted infections or pregnancy
· Relationship difficulties
· Feelings of guilt or shame around sex
· Anxiety or worry about any aspect of your life (even if it has nothing to do with sex!)
What can I do to help?
It is always worth speaking with your GP. Your GP might check your blood pressure or your cholesterol (on a blood test). Your GP can look at any medication you take to see if that might be causing ED. Your GP can also give you medication to treat ED.
It is important however to note that for the vast majority of those experiencing difficulties with erections, there will not be a physical cause. Experiencing stress, worry and anxiety around sex is by the far the most common cause for erection difficulties for most people.
Find out more about how anxiety effects sexual function here
Find out more about how to manage anxiety in sex here
