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Why Can't I Get or Keep an Erection?


Many men can tell you about the embarrassment of having an unwanted erection — puberty is a rough time — but the embarrassment of NOT getting an erection when you want to is not something many men are comfortable talking about. Failure to perform sexually can be quite a blow to one’s confidence and has the potential to ruin intimate relationships. Erectile dysfunction (ED), difficulty getting or maintaining an erection, is the most common type of sexual dysfunction in men. If you (or your partner) have ED or simply worry about it, then here is everything you need to know about how erections happen and why they sometimes don’t.

How Do Erections Work?

In a healthy male body, getting sexually excited includes getting an erection, but sometimes it can be difficult to achieve and/or maintain an erection either before or during intercourse. This is completely normal every once in a while, everybody has bad days. However, if you regularly have difficulty getting or maintaining an erection that is firm enough for sex, then you have erectile dysfunction (ED), also called impotence. Not to worry, however, you are not alone. ED affects about one-third of all adult men at some point during their lives and about 10% of men have long-term problems with ED.

Physiologically speaking, erections are complicated. Signals from the brain release hormones (chemical messengers) that tell the smooth muscle cells in the penis to relax, allowing increased blood flow. Blood then engorges the corpus cavernosum, the erectile tissue that makes up most of the shaft of the penis. This, in turn, puts pressure on veins along the outside of the penis, maintaining it in an engorged, erect state. Normally, an erection remains firm enough to enjoy sexual intercourse and goes away after an orgasm. The brain, nerves, blood vessels, and blood flow to the penis must be in good working order for a strong erection to occur; anything that affects any of these can interfere with having a good erection.

What Causes Erectile Dysfunction?

There are many potential causes of ED, including psychological or psychiatric issues, certain medications, and underlying medical problems. The psychological state can play a major role in sexual function. Your mind has to be in the right place for your body to function properly. Stress, distracted thinking, relationship problems, and even worrying about ED can cause ED or make it worse. Other psychological and psychiatric issues, such as anxiety and depression, can also affect your sexual function.

Medical Conditions

A wide range of medical conditions can contribute to ED, including any condition that affects blood flow or nerve function in the groin. The most common medical cause of ED is a cardiovascular disease which affects blood flow to the penis. According to the Mayo Clinic, some common medical causes of ED include:

  • Heart disease
  • Atherosclerosis (blocked arteries)
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome (a combination of high levels of blood sugar, insulin, cholesterol, and body fat)
  • Tobacco use
  • Alcohol or drug abuse
  • Sleep disorders
  • Low testosterone (male hypogonadism)
  • Peyronie’s disease (internal scarring of the penis)
  • Parkinson’s disease
  • Multiple sclerosis
  • Surgery or injury involving the penis, groin, or spinal cord
Medications

Finally, certain medications can cause or worsen ED. A surprising number of prescription and over-the-counter medications can cause or contribute to ED (an extensive list of medications can be found here).

Many psychiatric medications can cause ED, including drugs that treat anxiety, depression, bipolar disorder, and schizophrenia. There are too many drugs to list here, but commonly used drugs such as fluoxetine (Prozac), sertraline (Zoloft), lorazepam (Ativan), and diazepam (Valium) can all contribute to ED. Antihistamines can cause ED, including common drugs used to treat allergies, gastric reflux, and nausea, such as diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), cimetidine (Tagamet), and others. Many different heart and blood pressure medications can cause ED. Beta-blockers and thiazide diuretics are the two drug classes in this group that are the main culprits for causing ED, but other drugs can cause it as well, such as alpha blockers, ACE inhibitors, digoxin (Lanoxin), antiarrhythmic drugs, and other diuretics. Other medications for Parkinson’s disease, chemotherapy, migraines, and high cholesterol as well as muscle relaxants, opioid painkillers, and illicit drugs can all contribute to ED. While one or more medications that you take may contribute to ED, do not stop taking any medication without first talking to your healthcare provider. Just because a medication you take MAY cause ED, it is not necessarily responsible for YOUR erectile dysfunction. The risk of serious complications and death from stopping life saving medications far outweighs the risk of ED.

What Should I Do about Erectile Dysfunction?

First of all, if you are having any problems with your sexual health, including ED, you should discuss it with your doctor or another healthcare provider. To properly diagnose ED and its cause, your doctor should perform a physical exam and may order additional tests including blood and urine tests or an ultrasound to examine blood flow.

If there is an underlying medical reason for your ED, then it may need to be addressed before trying to treat ED. Additionally, if medication is contributing to your ED, then you may want to discuss alternative medications or treatments with your doctor. A variety of treatment options are available for ED, including medication, vacuum-assisted devices, and penile implants. One of the best things that you can do for ED, your sexual health, and overall health is to get more exercise. Physical activity is important for overall health and can improve ED in men with obesity, high blood pressure, metabolic syndrome, and cardiovascular disease. In other words, exercise can help prevent and treat ED. Better health can lead to better sex. If you’ve been looking for motivation to get off the couch and get in better shape, you’ve found it. But remember, you should talk to your doctor or another healthcare provider before making major lifestyle changes to find out what types of exercise are appropriate for you based on your health.

Key takeaways

Erectile dysfunction (ED) is the most common type of male sexual dysfunction, affecting one-third of adult men.

Erectile dysfunction can harm your self-esteem, sexual confidence, and intimate relationships.

Sex is both physical and mental. Physical health, mental health, and emotional health can all affect ED.

Effective ED treatments exist. Talk to your doctor about ED and what treatment is best for you.

References

Urology Care Foundation. Erectile Dysfunction (ED).

Sexual Medicine. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies.

Cleveland Clinic. Erectile Dysfunction.

Urologic Clinics of North America. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction.

Mayo Clinic. Erectile Dysfunction: Symptoms & Causes.

U.S. National Library of Medicine. Drugs That May Cause Erection Problems.

Mayo Clinic. Erectile Dysfunction: Diagnosis & Treatment.

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