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? Many are all too familiar with the frustration of being unable to get an erection on-demand or losing an erection at a critical moment with that special someone. While most penises play hard to get from time to time, experiencing repeated and frequent issues may be a signal that your buddy down south requires a bit more attention. There could be a number of factors at play sabotaging your sex life. It may also reassure you to know that erectile dysfunction (ED) — being unable to develop or sustain an erection — is actually pretty common. The National Institutes of Health reported that ED may affect as many as 30 million men in the United States alone. Rest assured, though: while there are a laundry list of potential causes of ED, there are also several different avenues to pursue for getting your penis up and running again.

Getting from a turn-on to a hard-on is a bit like dominoes: you experience stimuli, your brain relaxes the muscles in your penis, the arteries fill with blood, your penis closes off the blood’s escape route so it stays hard, and — voilà! Your erection is sustained. However, if even one of these dominoes isn’t lined up, things can go awry. Here’s a quick overview of just some of the issues that could be at play:

• Physical causes may include diabetes, spinal cord injury or nerve damage, cardiovascular disease (like stroke, blood pressure issues, or high cholesterol), Parkinson’s disease, or kidney disease. Some medications — including antidepressants, antihistamines, and blood pressure medications — can also cause ED.
• Behavioral or lifestyle causes can include smoking, excessive alcohol consumption, lack of physical activity, use of some illicit drugs, or lack of sleep.
• Psychological causes may include relationships stress or turmoil, depression, low self-esteem, anxiety, or past sexual trauma.

To know more about what might be contributing to your issue, a visit with a health care provider might be a good place to start. Doing so is worth consideration because ED can sometimes be a warning sign that something more serious is afoot with your health. But, before you start imagining the worst, keep in mind that about 15 percent of ED cases are due to psychological causes and that many mild physical causes are actually exacerbated by psychological factors. Imagine that you’ve got slightly high blood pressure, which is leading to some erection issues occasionally. But then, you start to feel anxiety about this, or maybe your partner starts to take it personally (as in your case, Here and Gone), which causes you stress. A mild issue then snowballs into a major one, and suddenly you’re unable to get it up at all. As you see, psychological factors can play a key role. Checking in with a mental health professional could also be a step toward harnessing your hard-ons once again.

Beyond psychological interventions, ED can sometimes be treated effectively with relatively simple means, like lifestyle adjustments. But, health care professionals also have some more heavy-duty options in their arsenal, if the front line strategies fail. Here are just a few of the options to consider, ranging from lifestyle changes to medical interventions:

• Quitting smoking if you smoke
• Maintaining a healthy weight and exercising regularly
• Drinking alcohol in moderation
• Avoiding drugs like cocaine and marijuana, which can damage or restrict blood vessels
• Seeking help for stress, anxiety, or other mental health concerns before they escalate
• Using a “penis vacuum,” which is a device that can help you maintain an erection
• Trying prescription ED medications which relax muscles around the penis to allow for increased blood flow
• Looking into surgery to improve blood flow or enhance erections

Lastly, ED can undoubtedly cause stress for both you and your partners. Have you thought about opening up with your partners about your concerns and struggles? While it could feel awkward to address the elephant in the room, you might find that some of the feelings of stress, embarrassment, or disappointment will be relieved once you’ve had the chance to talk about it. Your partners might even be interested in exploring other ways to make each other feel good that wouldn’t need to involve an erection in the meantime. After all, sometimes two heads are better than one.