Why can't I stay erect?

Dear Here and Gone and Mr. Softie, 

So, you’ve fallen on hard times when it comes to gettin’ hard? You’re definitely not alone in this—about 30 to 50 million people in the United States alone experience erectile dysfunction (ED). While there’s a laundry list of potential causes of ED, rest assured that there are also several avenues to pursue for improvement. These include lifestyle changes, treatments like oral medication, and meeting with a mental health professional. Read on to get more hard facts on the subject. 

What is ED and what causes it? 

While having problems with erections from time to time can be common, ED is a condition in which people regularly have trouble getting or keeping an erection. Symptoms of ED may worsen over time and sexual desire may decrease. The causes of ED are often classified into two categories: 

• Physical conditions: This includes heart and blood vessel problems, high cholesterol, being overweight, pelvic and spinal cord injuries or surgeries, and low testosterone levels.
• Mental health conditions: This includes depression and anxiety, as well as less severe concerns such as stress and relationship issues. 

How can you manage ED on your own? 

You may be able to reduce the risk of physical conditions that contribute to ED. Some areas you may be able to change up routines include: 

• Increasing physical activities, such as brisk walking, jogging, and swimming
• Eating foods low in saturated fats and instead full of whole grains, fruits, and vegetables
• Controlling substance use, including quitting smoking, stopping recreational drug use, and reducing or stopping alcohol use
• Getting quality sleep 

List adapted from Cleveland Clinic 

As for dietary supplements, research has shown mixed evidence on their effectiveness. Some supplement examples include ginseng, L-arginine, and Yohimbe. They may come with some side effects of their own or create unwanted effects when combined with current medications or conditions.  

What treatment is available for erectile dysfunction?  

If you choose to meet with a health care provider, you’ll likely receive a thorough assessment for an ED diagnosis. This often entails answering questions about your medical, personal, and sexual history and getting a physical exam. Some treatment options may include: 

• Oral medications, like sildenafil and vardenafil.
• Penile low-intensity focused shockwave therapy (LiSWT), which enhances blood flow with sound waves. 
• Injectable medicine that quickly increases blood flow to penis.
• Penis pump (vacuum constriction device) that creates and maintains an erection.
• Testosterone replacement therapy, which includes using gel, injection, patches, or pellets to increase your testosterone levels. 
• Penile implant procedure, which involves putting a device into penis to cause erection. 

List adapted from Cleveland Clinic 

Speaking with a mental health specialist may help you feel less stressed and anxious, both generally and in relation to your sexual activities. If you are partnered, your partner may also participate in these sessions. This can help to support you as an individual or together work through any relationship issues that might be contributing to how you feel about sex. 

Lastly, while it could feel awkward to address the elephant in the room with your partners, you might find that your concerns are relieved once you’ve had the chance to talk about it. Your partner(s) might even be interested in exploring other ways to make each other feel good. After all, sometimes two heads are better than one.