An erection problem can leave you worrying about the next time before anything has happened. An occasional difficulty is common, especially when you are tired, stressed or have had too much alcohol. If it keeps happening, finding the cause matters more than trying to ignore it.
What counts as erectile dysfunction?
Erectile dysfunction (ED) means recurring difficulty getting or keeping an erection firm enough for sexual activity. You may still have erections at other times, including when you wake up.
It can affect younger men too. Age alone cannot tell you whether the cause is physical, psychological or a mixture of both.
What could be causing it?
Erections depend on blood flow, nerves, hormones and arousal working together. Common contributors include:
- Stress, anxiety, relationship difficulties or poor sleep.
- Diabetes, high blood pressure or high cholesterol.
- Smoking, excess alcohol and other lifestyle factors.
- Certain medicines or hormonal problems.
Persistent ED can sometimes be an early sign of cardiovascular disease. That does not mean every erection problem is a heart problem, but it is a good reason to arrange an assessment. Do not stop prescribed medicines without advice if you suspect a side effect.
What happens at an assessment?
A clinician will ask about your symptoms, general health and medicines. They may check blood pressure, request blood tests or arrange an examination where needed.
It helps to mention whether the problem happens every time, whether your sex drive has changed and whether you still get spontaneous erections. These are useful clinical details, not questions to feel embarrassed about.
Can treatment help?
Treatment depends on the cause. Exercise, stopping smoking, reducing excess alcohol and addressing underlying conditions may help. Psychosexual therapy or counselling can be useful when anxiety or relationship concerns contribute.
Medicines such as sildenafil and tadalafil improve blood flow during sexual stimulation. They do not increase desire or produce an automatic erection. Their duration and prescribing arrangements differ; neither is the best choice for everyone.
These medicines must not be taken with nitrates, recreational nitrites known as “poppers”, or riociguat. A clinician needs to check your medical history and other medicines before recommending treatment.
Common side effects include headache, flushing, indigestion and a blocked nose. Other effects vary by medicine. Do not combine ED medicines or increase the dose without advice.
When do you need urgent help?
Seek emergency medical attention for an erection lasting more than four hours or sudden loss of vision or hearing. If you develop chest pain during or after sex, seek urgent help and tell the healthcare team about any ED medicine you have taken. Do not take nitrates unless an appropriate clinician has assessed the situation.
Key takeaways
- Repeated erection problems deserve a health assessment.
- Physical and psychological factors can occur together.
- Treatment should address your wider health as well as the symptom.
Frequently asked questions
Can stress alone cause erection problems?
Yes, but persistent symptoms should still be assessed rather than assumed to be anxiety.
Can ED be assessed online?
Sometimes. A prescriber may still need blood pressure readings, tests or an in-person assessment before deciding what is suitable.
This article is general information and does not replace individual medical advice.