Trouble with erections?

Originally Published: November 1, 1994 - Last Updated / Reviewed On: September 10, 2012
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Dear Alice,

To put it very simply, I am having trouble having erections for a while now. I used to be able to. I can't have them at all, during intimate encounters or during masturbation. I get a little "hard" but cannot get completely hard. Could you please help me? Thank you!!

—Mr. Softie

Dear Mr. Softie,

Almost all men have had one or more experiences when they wanted an erection and didn't get one, or lost one at a critical moment. Causes of inconsistent erections can be physical, psychological, or a combination of the two.

Some possible physiological causes for problems with erections include age, alcohol use, diabetes, kidney disease, neurological disease, lack of sleep, or vascular diseases, such as hypertension, high cholesterol, or atherosclerosis. Other physical causes include hormonal imbalance or side effects of medications.

Psychological causes include stress, anxiety, guilt, depression, low self-esteem, and pressure from a new or "demanding" partner, or any pressure a man might be placing on himself.

Psychological issues can also compound a physical problem. For example, if issues of blood flow cause inconsistent erections, then anxiety over one's ability or inability to get erections, or to get erections when a man wants them, creates additional pressure and as a result, fewer erections.

On the upside, and regardless of the cause, information, counseling, lifestyle changes, and perhaps medication can help.

Some lifestyle changes a man can make to help diminish his chances of developing inconsistent erections include:

  • Not smoking: Smoking can reduce blood flow to the penis.
  • Maintaining a healthy body weight: Overweight men are more likely to have erection problems.
  • Exercising regularly: Men with sedentary lifestyles are more likely to experience difficulty with erection.
  • Seeing your health care provider regularly: Poorly managed or undetected chronic conditions, such as diabetes or high cholesterol, can lead to erection troubles.
  • Drinking alcohol moderately: Excessive drinking of alcohol restricts blood flow to the penis and affects testosterone production.
  • Not using illegal drugs: Marijuana, cocaine, and other illicit drugs can damage blood vessels and/or restrict blood flow to the penis.
  • Managing stress: Stress and anxiety are leading causes of temporary problems with erection.

Given all of this, it's a smart idea to start with your health care provider. By asking you about your erections, their frequency, the conditions when they are present (i.e., morning erections), and the degree of hardness, as well as by examining you, the provider will be able to identify if the cause is related to blood flow, blood pressure, and/or related physiological causes. You might feel awkward talking with her/him about personal issues such as erections, however, your sexual response is a part of your general health, so take the risk. You can even your health care provider this Go Ask Alice! Q&A. In addition, either s/he has encountered at least some of the 30 million men who have trouble with erections and will know exactly what to do or say, or s/he will refer you to a specialist who does.

If your health is given the A-OK after the exam, the health care provider may prescribe an erectile support medication for you. Know that these medications do not have to be your first step or be relied on as an instant "cure," despite what your health care professional may say. Consider what else can affect erections from the list above, and see what other changes you might make, including reading Michael Castleman's Great Sex: A Man's Guide to the Secret Principals of Total Body Sex and other sexuality books to learn more about your body.

Hope this helps,