I'm having trouble staying erect during sex, what can I do?

If you’re like us, you’ve experienced the stigma around talking and learning about sex and admitting your curiosity. In these articles, we hope to add excitement and enjoyment in your life, by answering the sexual health questions you're too afraid to ask. Have additional questions? Contact our friendly "sexperts".

Erectile dysfunction is defined by difficulty in obtaining and/or maintaining an erect penis during sexual activity.

A penile erection occurs because sexual arousal causes the blood vessels in the penis to expand and increase the volume of blood retained in the penis. The penis is able to remain erect because, as it expands, the penis restricts the veins that normally carry blood out, so the penis becomes further engorged.

A decrease in erectile rigidity that cannot be explained by the normal aging process can also be a sign of erectile dysfunction or an underlying medical condition. Erectile issues can be caused by both psychological and/or biological factors. A healthy adult male should have regular erections during REM sleep. In order to know if this is happening for sure, you may need to take part in a sleep study. If nocturnal erections are non-existent, it may be an indicator that the erectile issues are more of a biological/physiological problem.

Having erection issues from time to time does not necessarily warrant concern. However, if erection problems are ongoing, markedly distressing, and/or causing personal or relationships problems it may be time to seek assistance. It is important to talk to your healthcare provider about any issues you have with obtaining or maintaining an erection. Problems in this area may be an underlying symptom of another serious health condition that needs treatment.

What causes Erectile Dysfunction?

  • Low libido (male hypoactive sexual desire disorder).
  • Psychological factors:
    • Lack of self-confidence or anxiety about sexual activity
    • Unmanaged depression or stress.
    • Relationship issues:
      • Communication problems
      • Distrust
      • Overdependence
      • Criticism
      • Contempt
      • Blame
      • Defensiveness
  • Past or recent psychological trauma (domestic violence, sexual abuse, post-traumatic stress disorder, etc.)
  • Biological Factors
    • Obesity or sedentary lifestyle
      • Excess fat in the arteries and around the heart can make it difficult for the blood to maintain an erection.
      • Excess abdominal fat (common among men) can lead to lower levels of testosterone.
    • Past or recent physical trauma
    • Certain prescription medications
    • Medical conditions:
      • High blood pressure or cholesterol
      • Atherosclerosis – a build-up of fats, cholesterol, and other substances in and on the artery walls
      • Sleep disorders
      • Anemia
      • Coronary artery disease
      • Neurological diseases
      • Hormonal imbalance
      • Peyronie's disease – development of scar tissue inside the penis
      • Diabetes
      • Cancer and associated cancer treatments (read more on prostate cancer)
  • Alcohol, substance, or tobacco use
  • Pain associated with having or maintaining an erection
  • Surgeries or injuries that affect the pelvic area or spinal cord

Treatments for Erectile Dysfunction

  • Use penis pumps and a c-ring to help maintain an erection. Learn how to use penis pumps and c-rings.
  • If penetration is very important to either you or your partner but you are unable to maintain an erection with medication or penis pumps, consider using a prosthetic penis in concurrence with a vibration device for your own genitals (vibrating c-ring, anal plug, or prostate massager) to enhance sexual experiences.
  • Seek counseling for family, relationship, and/or sexual issues for a licensed mental health professional or certified sex therapist.
  • Seek treatment for depression, anxiety, or other mental health issues.
  • Eat a heart-healthy diet and increase exercise to reduce excess fat and increase healthy blood flow.
  • Seek treatment for an existing medical condition.
  • Medications:
    • Oral Medications – Viagra, Cialis, etc.
    • Self-injections
    • Urethral suppositories
    • Testosterone replacement therapy
  • Surgery and Implants
    • Blood vessel surgery
    • Penile implants