1 in 5 men find that they regularly need help getting or keeping erections. But it’s not always the same cause.
A lot of things can affect the reliability of your hard-ons, making it tough to figure out why it’s actually happening.
So welcome to our quick and simple guide, taking you through everything that could be going on.
Follow the links in the answers to the questions below, and find your way to what might be a likely cause of your erection difficulties.
Or, go straight to the causes you think might apply to you.
Myths about the causes:
Which of these fits best for you?
- Every now and again I can’t get or keep erections – go to ‘one offs'
- I often can’t get or stay hard, but I can get them by in some situations, like by myself or when I wake up – go to ‘psychological causes of erectile dysfunction'
- It doesn’t make a difference what I’m doing or who I’m with: I often can’t get or keep erections – go to ‘physical causes of erectile dysfunction'
Which of these is you?
- I sometimes drink or use drugs before I want an erection – go to ‘drugs, alcohol, and erections'
- I am sometimes stressed or tired when I try and get an erection – go to ‘stress, fatigue, and erections'
- Neither – go to ‘none of the above'
Alcohol does the exact opposite of erectile dysfunction medication. It stops as much blood getting to your penis, so getting hard is way harder.
Some illegal drugs do almost the same thing.
Try an experiment: try getting an erection without drinking first and compare it to times where you have been drinking and you tried to get an erection.
Drinking heavily and taking drugs long-term, can make your erection problems last longer, even when you’re sober.
On a side note: always drink responsibly, and avoid illegal drug use. Because your erection isn’t the only thing that can take a hit from these.
Anxiety and stress can affect the blood flow to your penis, and the chemical signals your brain is putting out to get erections going.
Fatigue and tiredness can stop you feeling aroused altogether
Making sure you’re well-rested and relaxed before and during sex can improve your chances of getting and staying hard. Chronic stress can be managed with relaxation techniques, exercise, and counselling. Fatigue should go away with rest. If it doesn’t, then you might want to talk to the doctor and consider chronic fatigue or depression as possible causes.
Although it can be a short-term cause of erection problems, stress can also lead to longer-term erectile dysfunction. Stress can lead to high blood pressure, weight gain, drinking more alcohol, relationship problems, and anxiety and depression. All of these, in turn, can negatively affect your erections.
Which of the following most applies to you?
- I know I have anxiety related to getting erections, I find it difficult to get erections with partners, or I generally feel uncomfortable with getting erections – go to ‘performance anxiety'
- I often have low moods, I know I have depression, or I know of other mental health problems I have that sometimes get in the way of my erections – go to ‘other mental health causes'
- I find it difficult to get or keep erections with one partner specifically, but have no problems with other partners, or on my own – go to ‘relationship problems'
- None of these seems right – go to ‘none of the above'
It’s like a fear of public speaking, or when someone’s looking over your shoulder and you immediately forget how to type.
Performance anxiety, sometimes called ‘stage fright’, is when you can’t do what you’re trying to do because the experience of being watched is too overwhelming for you to focus. Performance anxiety is linked to social phobia in some men.
When it comes to sex, the same thing can happen. People feel like they have to do a good job in bed, and this pressure can make you less aroused, and also mess with the mechanics of your erection.
Other reasons for bedroom anxiety can include worrying about ejaculating earlier than you want, fear of STIs, and even fear of erectile dysfunction itself.
When you’re stressed out by anxiety, your blood is pumped away from places like your penis, and into the heart and lungs to try and help you get ready for ‘fight or flight’. It can also get in the way of you releasing the chemical from your brain that cause erections.
Erectile dysfunction medication can be used to offset the physical effects of performance anxiety, so you can get an erection more easily, even when you’re stressed. Also, counselling can help you overcome your anxiety in the long-term and potentially cure your erection problems. Counselling can also help social phobia, which between ¼ and ½ of men with performance anxiety also have.
Depression and anxiety can both affect erections. General anxiety can increase your stress levels and distract you, making it difficult to feel aroused. Depression can also limit arousal and interest in sex.
The main treatments for both depression and anxiety – selective serotonin reuptake inhibitors (SSRIs, antidepressants) – can also cause erectile dysfunction as a side effect. They can also make it difficult to orgasm, too.
If treatments are causing side effects, you could talk to your doctor about switching meds. Counselling might also improve your erections symptoms too.
Medications for treating erectile dysfunction don’t usually react with antidepressants, so they could help you get and keep erections, without affecting what you’re already taking.
It’s never good to jump to conclusions about your relationship just because you’re having erection problems. There are lots of causes of erectile dysfunction that have absolutely nothing to do with your partner(s).
On the other hand, relationships can sometimes be a cause.
If you find that you often lose erections with one person then it could be your feelings towards them are getting in the way. It doesn’t necessarily mean you aren’t still attracted to them (but this is a possibility).
It could be that the way you’re thinking about them has changed or that there are unresolved tensions you can’t move past.
Communication with your partner is a good place to start trying to find a solution. You might not need to talk about your erectile dysfunction specifically, but talking about how your relationship feels right now might be a good start.
Which of the following most applies to you?
- I think or know that I have one of the following conditions: high blood pressure, high cholesterol, heart or circulation problems, diabetes, obesity, hormonal problems like thyroid issues, neurological conditions like multiple sclerosis or Parkinson’s disease, or an unusual penis shape – go to ‘Health Conditions'
- I think or know that I am taking one of the following types of medication: diuretics, antihypertensives, fibrates, antipsychotics, antidepressants, corticosteroids, H2-antagonists, anticonvulsants, antihistamines, anti-androgens, cytotoxics – go to ‘other mental health causes'
- I regularly do a lot of cycling – go to ‘cycling and erections'
- None of these seems right – go to ‘none of the above'
If you know you have one of the conditions below, or you think you might have one, it could be that it’s an underlying cause:
- High blood pressure
- High cholesterol
- Heart or circulation problems (could be caused by long-term, regular smoking)
- Hormonal problems like thyroid issues
- Neurological conditions like multiple sclerosis or Parkinson’s disease
- An unusual penis shape
Depending which condition you have, you might be able to take erectile dysfunction medications to improve your erections.
You should also speak to a doctor about your condition and get a treatment review. If your treatment isn’t cutting it then it could be make your erection situation worse.
If you’re not sure whether you have one of these conditions then you could think about getting tested. Some conditions, like diabetes or thyroid function, can be tested at using home test kits you can order online. They involve taking a sample at home and sending it off to a lab for testing. Others might require a trip to the GP.
Erectile dysfunction can be a side of effect of a number of different medications. If you know you’re taking one of the types of medication below (or you’re receiving treatment for one of the conditions mentioned) then it could be that side effects are the cause of your erection problems:
- Diuretics – used to treat high blood pressure and some other conditions
- Antihypertensives – used to treat high blood pressure
- Fibrates – used to lower cholesterol (but not the same as statins)
- Antipsychotics – used for some mental health conditions, like schizophrenia
- Antidepressants – used for anxiety, depression, premenstrual syndrome and other conditions
- Corticosteroids – a type of steroid used for asthma and other conditions
- H2-antagonists – used for stomach ulcers
- Anticonvulsants – used to treat epilepsy
- Antihistamines – used for allergies like hay fever
- Anti-androgens – used to treat a number of conditions related to male hormones, like testosterone
- Cytotoxics – used in cancer treatment
Still not sure? You can find out if your medication can causes erectile dysfunction by searching for a patient information leaflet online, or checking the one that comes in your medication packaging. A quick search and you should find one quickly (they’re often in PDF format).
If your erection problems could be a side effects of your medication(s) then talk to your doctor. They can help you decide if you could switch medications, or if erectile dysfunction medications can be taken on top of your other ones, to help solve your erectile dysfunction symptoms.
Definitely one of the more surprising causes, but it’s true – spending a lot of time on a bike can throw a bit of a spanner in your works.
Regular cycling puts a lot of pressure on the area below your penis – the perineum, or ‘gooch’. This can affect the blood flow to the area around your penis, which in turn can make erections less reliable.
If you cycle regularly, you could try taking a break for a little while to see if your erections improve.
Or there are special seats you can buy that apply less pressure down there, which might help reduce the effect.
If after you cut out cycling, your erections don’t improve, you can rule cycling out and go back and consider the other possible causes.
This probably isn’t the place you wanted to end up if you’re looking for answers about your erection situation – the ‘no obvious causes’ section.
The good news is that just because it’s not obvious right now, doesn’t mean you can’t still figure out the causes of your erectile dysfunction, or get treatment.
We have an online assessment you could fill out. There are also test kits that can rule out some of the health conditions that causes erection problems, or talking to your local GP could also help.
Feelings of anxiety or guilt could affect erections, and if porn use is giving you these feelings, it could be that it’s not helping you.
But we’ve put this one under ‘myths’ because there isn’t enough research to show a clear link between porn and erectile dysfunction.
It’ll probably be a lot more helpful to think through all the other possible causes first.
Masturbating before sex can definitely mean you end up less aroused, making it harder to get an erection. But that’s not the same thing as erectile dysfunction.
Like with porn, if it’s causing you to feel anxious or guilty, that’s something that could be affecting your erections.
And a very aggressive masturbation technique could cause a bit of bruising or inflammation which might make erections a bit harder to achieve.
But if neither of the above apply to you, masturbating is no more likely to cause erectile dysfunction than sex.
Most people associate testosterone with men and male sexuality. And it’s true that a real testosterone deficiency can cause erectile dysfunction.
But, testosterone deficiency is very rare, even in older men. The chances that your erectile dysfunction is related to testosterone deficiency is about 4% if you’re under 50 years old and 9% if you over 50.
If you want to check your testosterone levels then you can order test kits online, or you can visit your GP and they may agree a testosterone test is necessary.
You can check your testosterone levels with a test kit from an online doctor, or visit your GP and they may agree a testosterone test makes sense for you.
Great work scrolling this far. Hopefully the mystery’s not so mysterious any more – and remember, you can always find more info on Superdrug Online Doctor.
Ordering treatment online
At Superdrug Online Doctor, you can order treatment for erectile dysfunction online, and we offer over 30 other digital health services.
Complete a short health questionnaire, create an account, and place an order for your preferred treatment. Every order is checked by a UK-registered doctor before treatment can be approved. If your treatment is approved it can be posted to you fast and free of charge. Or if you prefer, there are express and click and collect delivery options.
Our doctors are right there with you to answer any questions when you order and while you’re using your treatment. They’re only one message away, reachable through your personalised account.
No appointments 2 weeks away, no need to travel, and no waiting rooms – upgrade your healthcare online with Superdrug Online Doctor.
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- Nichols, D. J., Muirhead, G. J. and Harness, J. A. (2002). Pharmacokinetics of sildenafil after single oral doses in healthy male subjects: absolute bioavailability, food effects and dose proportionality. Br J Clin Pharmacol., Feb; 53(1): 5S-12S.
- Raheem, A. A. and Kell, P. (2009). Patient preference and satisfaction in erectile dysfunction therapy: a comparison of the three phosphodiesterase-5 inhibitors sildenafil, vardenafil and tadalafil. Patient Prefer Adherence; 3: 99–104.
- Steers, W. et al (2001). Assessment of the efficacy and safety of Viagra® (sildenafil citrate) in men with erectile dysfunction during long-term treatment. International Journal of Impotence Research; 13: 261–267.
- Zinner, N. (2007). Do food and dose timing affect the efficacy of sildenafil? A randomized placebo-controlled study. J Sex Med., Jan; 4(1): 137-144.