Patient information from BMJ

Erection problems

Last published:Sep 14, 2022

If you have problems getting an erection you're not alone. Millions of men have erection problems. Doctors see men with this problem all the time. And, once you see your doctor, there are good treatments that can help.

What are erection problems?

Most men have trouble getting an erection at some point in their life. It can happen for all sorts of reasons. But when doctors talk about erection problems, they mean that you can't usually keep an erection long enough to have sex.

Many men sometimes have problems getting or keeping an erection. In young men this is usually because of nervousness or worrying about whether they will be 'good in bed' (so-called 'performance anxiety').

Drinking too much alcohol can also make it difficult to get an erection. And most men don't get erections as easily as they get older. This doesn't usually mean that they can't get an erection: usually it just happens more slowly.

If you repeatedly can't get an erection it's worth thinking about whether the problem might be psychological (caused by nervousness or anxiety) rather than physical, before getting treatment. Talking to your doctor can help you figure out why it might be happening.

Physical problems

The most common physical cause of long-term erection problems is poor blood flow to the penis. This is caused by problems with the blood vessels in the area.

Diabetes can lead to erection problems. Other illnesses, physical injuries, or problems with your hormones can all cause erection problems, too.

Conditions that affect the body's nervous system can sometimes cause erection problems. These conditions include Alzheimer's disease, Parkinson's disease, stroke, and multiple sclerosis.

Some medicines can cause erection problems as a side effect. Other things that can play a part in erection problems are long-term excess alcohol intake and smoking.

Your emotions can also be a factor. Stress, unhappiness, and depression can all cause erection problems.

If you've had surgery in your pelvic area, such as an operation on your prostate, this can also lead to erection problems.

What are the symptoms?

Some men with erection problems can't get an erection at all. For others, the problem comes and goes. Some men can get an erection but it doesn't last long enough or isn’t firm enough to have satisfying sex.

Men who have erection problems often don't like to ask for help. But there are at least two good reasons for seeing a doctor. First, there are treatments that can probably help you. Second, erection problems can be an early warning of serious health problems, such as diabetes and heart disease.

If you are having erection problems your doctor might suggest tests to check for other health problems, just to be safe.

What treatments work?

Most men can find a treatment that helps them have erections again.

If your erection problems are caused by another health problem, the first thing your doctor will suggest is doing everything possible to get that condition under control.

For example, if your problems are caused by poor blood flow to the penis, your doctor might suggest some changes to your lifestyle to improve your circulation. These could be changes to your diet, or a plan to help you lose weight and do more exercise.

Drug treatments

You've probably heard of Viagra. It's the brand name of a drug called sildenafil. It's a type of drug called a PDE5 inhibitor. These drugs help open up the blood vessels around the penis so that blood can flow more easily into the penis. About a quarter of men with erection problems take them.

Most men who use these medications take them as tablets. But they can also be taken as injections or suppositories. If you take them as tablets you need to take them between half an hour and an hour before you want to have sex.

These drugs don't work for everyone but they seem to help about 7 or 8 out of 10 men to have firmer, longer-lasting erections. These drugs seem to work for men with a variety of causes of erection problems. For example, they can help if you have heart problems, prostate cancer, diabetes, or an injury to your spinal cord.

Some men get side effects from these drugs but they're usually mild. You might get a headache, get heartburn, or turn red in the face. The side effects aren't usually bad enough for men to stop taking their treatment.

Not everyone can take these drugs safely. Your doctor should explain in detail who should not take them. Some of the reasons you shouldn't take them include:

• if you are taking medications called nitrates

• if you have severe heart disease or you have had a heart attack in the last three months

• if you have other heart conditions including unstable angina

• if you have either very high or very low blood pressure

• if you have had a stroke in the last three months

• if you have a history of a condition called priapism. This is where you get painful erections that last for several hours, even when you are not aroused.

In most countries you need a prescription for PDE5 inhibitors such as sildenafil (Viagra). For example, in the UK, even though it's legal for a pharmacy to sell these drugs on the internet, you will still need a prescription.

But many companies sell treatments for erection problems on the internet and it isn’t always easy to tell which ones are reliable or safe. If you're in any doubt about what is being offered, talk to your doctor.

Injections

If you are not able to take the usual drug treatments for erection problems, you might be able to have a treatment that involves you (or your partner) injecting medicine into the base of your penis. If you have this treatment your doctor will explain exactly how to give yourself the injection.

This treatment is not suitable for everyone and your doctor should explain in detail who can and cannot use it.

This treatment can have side effects. Some men get pain or an ache in their penis. Giving yourself an injection can be painful. A few men get a lump of thickened tissue in their penis.

Talking treatments (psychosexual therapy)

Sometimes erection problems are caused by thoughts or emotions rather than by a physical problem. Stress, anxiety, and worry can all lead to erection problems.

Similarly, having erection problems can in turn lead to stress and anxiety - which can then make your sexual problems worse. Or it might be that you become anxious or depressed if other treatments aren't working.

If you are affected in any of these ways your doctor might suggest a talking treatment (psychotherapy), either as a treatment on its own or alongside other treatments. You can see a therapist on your own or with your partner.

If you have psychosexual therapy (sometimes called sex therapy), a counsellor listens to your problems and makes suggestions. For example, they might help you find ways of being relaxed with your partner or help you to understand the feelings you get from your body during sex.

Other treatments

If you can't take PDE5 inhibitors or have injections, or if you have tried them and they haven't worked, you might be able to use intraurethral suppositories. These are small pellets that you insert into the end of your penis using an automatic dispenser. Some men use these because they don't like the idea of injections.

Some men with erection problems use vacuum pumps to help them get an erection. These are devices that have a plastic tube connected to a pump. The tube fits over your penis, then the pump sucks blood into your penis and gives you an erection.

You put a special elastic band around the base of your penis to keep it firm while you have sex. You shouldn't keep this band on for more than about half an hour. Doctors usually only recommend using pumps if other treatments haven't worked. These devices can cause side effects, such as bruising.

Drug treatments for erection problems now include a cream medication that you rub into the penis to help open up the blood vessels. But this treatment is not available everywhere.

If all other treatments have failed, or if you have had certain types of injury in your groin area, your doctor might suggest surgery. You will be referred to a specialist called a urologist. Although surgery can help, your urologist will carefully discuss with you the risks and possible complications of this type of operation. These include infection and the possible need for a second operation.

What will happen to me?

You might have thought of erection problems as something you just had to put up with, or even a normal part of getting older. But there are treatments that work for most men.

It's also worth remembering that there are lots of ways to give and receive sexual pleasure. If you have a partner it's often helpful for them to understand your difficulties and for you to approach these together.