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What is erectile dysfunction?
Erectile dysfunction is a fairly common condition. It’s where a man can’t get or maintain an erection that’s firm enough (or lasts long enough) for sex.
Erectile dysfunction symptoms can range from very moderate and occasional, to severe and often. Impotence in men is more likely the older they get, but it can also occur in younger men.
So what does erectile dysfunction mean for our overall health, and what does ED mean for our sex lives? Is it permanent, and what can we do about it?
ED symptoms can vary in severity and impact different men in different ways. The symptoms of erectile dysfunction, and other problems indirectly related to it might include:
The symptom
The details
Ability to get a partial erection, but not all the time.
Your penis does increase in size when you feel aroused or sexually stimulated, but not every time you’d like to have sex.
Ability to get an erection, but not for long enough.
You’re able to achieve a partial or full erection, but not one that lasts long enough for sex. After some time, your erections are not as hard as they should be for penetration.
Inability to get an erection at all.
You’re aroused or sexually stimulated, but you can’t achieve an erection at all.
Reduced sexual desire.
Loss of libido means you aren’t interested in having sex or getting an erection. Can be linked with relationship problems, stress, tiredness or underlying health issues.
Feeling low or down.
When the inability to get or maintain an erection is accompanied by feelings of inadequacy or reduced mood.
Erectile disorders are common and probably impact the majority of men at some point in their lives.
If it only happens occasionally, it’s usually nothing to worry about. If you’re able to resume comfortable and regular sex after an episode of ED, you probably don’t need to speak with a doctor or take the matter further. It was likely just an isolated incident.
But if you’ve noticed the quality of your erections slowly declining over time, or you’re losing an erection midway through sex and it’s started to happen more often when it didn’t in the past – these could be signs of onset physical ED. This is the kind of impotence that becomes more likely with age.
Your chances of cardiovascular disease grow as you get older. This can be related to lifestyle choices, underlying health conditions or it can be inherited if heart problems run in your family. With this, noticing a semi erect penis some or all of the time, or symptoms of ED, also becomes more likely. This is because erections depend on good blood flow and vascular function.
If you’ve struggled with the symptoms of ED during sex, but you’re able to masturbate or you wake up with hard erections in the morning (aka morning glory), this might be a sign that the type of ED you have is psychological.
Psychological or psychogenic ED can stem from mental health issues like depression or anxiety, but they can also be caused by the pressure to perform sexually.
Alcohol and recreational drugs can affect the quality of erections. So if you’re having that extra drink for ‘Dutch courage’, or to reduce your inhibitions, bear in mind that you might be making it more difficult to get hard.
What does erectile dysfunction look like?
Erectile dysfunction isn’t always easy to recognise. Any man can experience erectile dysfunction and it can be difficult for doctors to determine that you’ve got it based on it just happening once or twice.
ED is more about what you notice over time and how it makes you, and your partner, feel. So to make a diagnosis, a clinician will likely ask you a series of questions which can include things like:
How often do you experience erection problems?
How hard or rigid does your penis get typically when you’re aroused?
How often are you able to penetrate your partner during sex?
Do you enjoy sexual intercourse?
How often have you felt sexual desire?
But they may also ask about any underlying health conditions you have, or medications you take, because these things can impact your ability to get or maintain an erection. They may also ask you to keep a record of your experiences with ED, or may test your nocturnal erections to differentiate between physical and psychological causes.
Other warning signs of erectile dysfunction
The signs of erectile dysfunction aren’t always clear-cut or straightforward. The classic, easily-recognisable symptoms include only being able to get partially erect, getting hard but not for long enough to have sex, or not being able to get an erection at all.
But there are other warning signs of erectile dysfunction to look out for. One example is loss of libido or sexual appetite. Defining healthy libido is also difficult because it’s partly subjective. We all define sexual fulfillment differently. But as a rule of thumb, if your lack of interest in sex becomes distressing or interferes with your quality of life, you should discuss it with your doctor.
Common causes of low or reduced libido can include relationship problems, overfamiliarity with a partner, loss of sexual attraction, frequently arguing or unresolved conflict. Sexual problems like premature ejaculation or erectile dysfunction can also impact libido. For example, if you’re struggling frequently to get an erection, it might make you feel like avoiding sex all together, rather than addressing the problem.
Other warning signs linked with ED can include mental health illnesses. Depression, anxiety, post-traumatic stress disorder (PTSD) or personality disorder can all contribute towards ED symptoms and low or reduced libido.
Are there different types of erectile dysfunction?
Male impotence or ED problems normally fall into two types, although sometimes you might have a mixture of both.
If you can get an erection but can’t maintain it during sex, only get a partial erection or you’re unable to get an erection at all, and you noticed these changes gradually and over time, you may be experiencing physical ED.
A physical ED disorder is when blood flow to the penis (specifically the chamber called the corpus cavernosum) is obstructed. For erections to happen, blood vessels have to dilate in moments of arousal and then constrict again once the penis is filled, and this helps you stay rigid. But poor lifestyle choices and certain health conditions can damage blood vessels, which, in turn, makes it harder to achieve erections.
The other type of male impotence is when it’s caused by something psychological. Mental health problems or things like performance anxiety can contribute to the symptoms of ED.
Sometimes, both physical and psychogenic factors can play a role in influencing ED symptoms.
Difficulty getting an erection
If you can’t get an erection, you may not need to see a doctor or medical professional right away.
Firstly, you can try some simple lifestyle changes to see if you notice a difference in your erections. This can include eating a balanced diet and making sure your weight is within the healthy BMI range.
Regular exercise can help too. 150 minutes of moderate physical activity or 75 minutes of vigorous activity is the recommended weekly amount to keep you fit and reduce risk. If you smoke, consider quitting. If you drink a lot of alcohol, try to cut down so that your consumption falls within 14 units per week.
Aim to sleep regularly for between six and eight hours a night. Sleep deprivation can also contribute to ED symptoms and increases the risk of health conditions that can make impotence more likely.
After trying these steps, if you’re still having problems getting hard, it might be worth discussing your symptoms with a doctor.
What do I do if I can’t get hard?
If you’re having persistent problems (for example you’ve had no erections for weeks, despite wanting to and feeling aroused), this could be a sign that you have severe erectile dysfunction. If this is the case, it might be worth taking an International Index of Erectile Function (IIEF) questionnaire.
The ED test asks questions about your symptoms and asks you to ‘score’ yourself from 1 to 5. At the end, the total score can give you a better idea of how bad your symptoms are and the type of erectile dysfunction you have.
How hard should an erection be?
A fully erect penis should feel firm, rigid, and hard enough for penetrative sex. If you feel your erection isn’t as firm as it should be, especially when you’re aroused or sexually stimulated, this could point to ED.
One thing you can try is measuring your erectile firmness over a period of time (for example a month). You can ‘score’ your erections as follows:
0
1
2
3
4
0 - Penis doesn't enlarge.
1 - Penis is larger, but not hard.
2 - Penis is hard but not large enough for penetration.
3 - Penis is hard enough for penetration but not completely hard.
4 - Penis is completely hard and fully rigid.
A healthy, average male should usually have an erection score of four when aroused. But it’s also normal to score less than this occasionally.
If you find on average that your erectile firmness is scored three or less, then your erections aren’t as hard as they should (or could) be, and this may be indicative of ED.
Difficulty maintaining erections
Some men find that when they’re aroused they become erect initially, as they’d typically expect. But then they can’t maintain an erection long enough for sex.
If you have problems maintaining an erection or your penis won’t stay hard whilst you’re aroused, this is also a sign of erectile dysfunction. It might just be moderate ED, as opposed to severe ED where you can’t get an erection whatsoever.
Losing an erection during sex can be a symptom of both physical and psychological ED. You can address the physical problems by improving your overall lifestyle and general health. Some men try pelvic floor exercises to improve ED, but how effective these are hasn’t been well studied.
If you’re unable to maintain an erection and you think the causes may be psychogenic, try and talk it through with your partner. Problems with libido or difficulties in a relationship can often cause psychological ED. If you think the problem may be to do with the overall state of your mental health, you might want to consider speaking with a counsellor or sexual health expert.
If you still have problems maintaining an erection after you’ve tried these steps, it’s best to see your doctor and talk it through with them.
How long does an erection last?
The length of time an erection lasts varies from person to person.
And how long you have an erection for can depend on what you’re doing (such as whether or not you’re having sex).
If you are having sex, erections invariably end at the point of ejaculation. And it’s virtually impossible to get one right away afterwards (this is called the refractory period).
One study on 500 couples found that the average time it took to ejaculate was around 5-and-a-half minutes. But what about maintaining an erection when you don’t ejaculate?
Nocturnal penile tumescence (NPT), colloquially known as nocturnal erections or morning glory, are erections that occur in sleep. For healthy men, they’re entirely common and are said to last between 25 and 35 minutes at a time . They can be experienced between three and five times a night.
But the length of time you have an erection for is also partly subjective and down to what feels comfortable and fulfilling for you. If you’re unhappy with the length of time you can keep an erection, you might try and practice erection control exercises, including pelvic floor exercises.
You can also try the ‘edging’ technique, an orgasm control practice. Edging refers to reducing sexual stimulation at the point of climax, to stop and prevent ejaculation in that moment. You’ll wait for an amount of time that feels comfortable, and then start having sex again. The edging practice was originally designed as a treatment for premature ejaculation in 1956, but is also thought to help with ED.
What does ED mean for my sex life?
You may feel that good erection health and firm erections are key to a healthy sex life, and this is true a lot of the time. But it is possible to have sex without an erection and this has a lot to do with how we define ‘sex.’
If you define sex as wholly penetrative, then ED can obviously be a big problem for your sex life. But it’s also worth thinking about other practices like oral sex, or other ways you can have sex besides penetration. It might be worth sitting down with your partner to talk about your symptoms, and how you might be able to have sex without an erection. You can also think about toys, prosthesis and pumps.
It is possible to orgasm and ejaculate while only being partially erect. So impotence in men might be common, but it certainly doesn’t have to spell the end of your sex life.
Is erectile dysfunction permanent?
While erectile dysfunction can be difficult and personally distressing, it doesn’t have to be forever. Dealing with both the physical and psychological causes can affect how long erectile dysfunction lasts.
For example, one study published in the journal of sexual medicine found that, after five years, rates of remission were found in up to 29% of those studied. They stated that ‘sexual dysfunction in aging men is a dynamic disorder whose incidence and remission are predicted by a range of modifiable risk factors.’ Put a bit more simply, making healthier lifestyle choices can help with erectile dysfunction over time and, in some cases, reverse the symptoms.
However, if your symptoms haven’t subsided even after you’ve taken steps to reduce them, or you’ve struggled with ED for a number of years and it’s affected your overall quality of life, there are many effective, well-tolerated ED treatments available to choose from.
How can I find out if I’ve got ED?
You should speak with a doctor or medical professional, particularly if you’re experiencing ED for the first time. They’ll be able to discuss your symptoms and help you figure out what’s causing them, and whether ED treatment can help.
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