Erectile dysfunction

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What is erectile dysfunction?

What is erectile dysfunction?

Erectile dysfunction is a fairly common condition where a man is unable to get or maintain an erection that is firm enough or lasts long enough for sex.

Erectile dysfunction symptoms can range from the very moderate and occasional to the severe and often. Impotence in men typically increases in likelihood with age, but it can also occur in younger men.

But what does erectile dysfunction mean in terms of our overall health, and what does ED mean for our sex lives? Is it permanent, and what can be done to help us to avoid it?

Navkaran Singh Sandhu
Medically reviewed by
Navkaran Singh Sandhu, Lead Doctor

Erectile dysfunction symptoms

ED symptoms can range from moderate to severe, and can impact different men in different ways – but what exactly are the symptoms of erectile dysfunction?

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 they don’t last 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 cannot 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. The inability to get or maintain an erection is accompanied by feelings of inadequacy or reduced mood.
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Medically reviewed by
Dr Navkaran Singh Sandhu
Lead Doctor
on November 18, 2022.
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When are erection problems ED?

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.

However, if you’ve noticed the quality of your erections slowly decline 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 and is more commonly observed in older men. (But not always).

ed-specs-02Over time, things like heart and cardiovascular health can decline. This can be related to lifestyle choices, underlying health conditions or it can just be a natural part of getting older. With this, noticing a semi erect penis some or all of the time, or symptoms of ED, also get 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, also known as morning glory, this can mean that the type of ED you have may be more psychological in nature.

Psychological, or psychogenic, ED can stem from mental health illnesses like depression or anxiety, but they can also be caused by the pressure or stress that comes with the idea of performing sexually.

Alcohol and recreational drugs can affect the quality of erections, if you’re having that extra drink to reduce your inhibitions, bear in mind that you might be making it harder 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 or medical professionals to make a diagnosis by examining you the same way they might with something like a rash or skin infection, for example.

ED is more about what you notice over time and how it makes you, and your partner, feel. So to make a diagnosis, a doctor 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 do you feel sexual desire?

But they may also ask about any underlying health conditions you have, or medications you may be taking. This is because these things can impact the 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 physical causes from psychological.

Other warning signs of erectile dysfunction

The signs of erectile dysfunction aren’t always clear-cut or straightforward. The common and easily-recognisable symptoms include things like only being able to get partially erect, getting hard but not long enough to have sex or the complete inability to get an erection.

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 – it can be worth discussing with your doctor.

Common causes of low or reduced libido can include relationship problems, overfamiliarity with a partner, loss of sexual attraction or frequent 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 can be thought of roughly in two ways.

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 caused by something that impacts the blood’s ability to fill two chambers in the penis known as the corpus cavernosum. To do this, blood vessels have to dilate in moments of arousal and then constrict again once the penis is filled, inducing a state of rigidity. However, poor lifestyle choices and certain health conditions can damage the vascular system and blood vessels, which, in turn, makes it harder to achieve erections.

The second ‘type’ of male impotence is more psychological in nature. Mental health problems or things like performance anxiety can contribute to the symptoms of ED. These are more commonly observed in younger men who tend to be physically healthier.

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 or can’t get hard, you may not need to see a doctor or medical professional immediately. There might be some initial steps you can take, if your penis won’t get hard and it’s starting to impact your sex life.

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.[4] You can also exercise regularly, up to 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 and if you drink a lot, try to cut down so that your consumption falls within 14 units of alcohol per week. Furthermore, aim to sleep regularly for between six and eight hours a night. Sleep deprivation can also contribute to ED symptoms and increase the risk of certain health conditions that may make impotence more likely.

After attempting these steps, if your penis still isn’t getting hard, it might be worth discussing your symptoms with a medical professional or sexual health expert.

What do I do if I can’t get hard?

What do I do if I can’t get hard?

If you’ve had no erection for weeks, despite wanting to and feeling aroused, this is a clear sign that you may be suffering with 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 participants must ‘score’ themselves from 1 to 5. At the end, the cumulative score can provide a better indication of your symptoms and the type of erectile dysfunction you may have.

How hard should an erection be?

A fully erect penis should feel firm and rigid, particularly hard enough for penetrative sex. If you feel your erection is not 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. Say four weeks, for example. You can ‘score’ your erections as follows:

  • 0
  • 1
  • 2
  • 3
  • 4

Penis doesn't enlarge.

Penis is larger, but not hard.

Penis is hard but not large enough for penetration.

Penis is hard enough for penetration but not completely hard.

Penis is completely hard and fully rigid.

A healthy, average male should usually always have an erection score of four when aroused. But it’s also normal to score less than this occasionally.

If you find, on average, 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 erection

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 clear sign of erectile dysfunction. It might just mean you suffer moderately, as opposed to severely where you have an inability to 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. You may also want to try pelvic floor exercises to improve ED, though their effectiveness has not been widely studied.

If you’re unable to maintain an erection and you think the causes may be psychogenic, you can 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 will vary from person to person. It can be defined as the length of time between getting an erection and ejaculating. One study on 500 couples found that the average time it took to ejaculate was around 5-and-a-half minutes.

However, it’s physically impossible to maintain an erection after the point of ejaculation – this is known as the male refractory period. So, what about maintaining an erection when you don’t ejaculate?

Nocturnal penile tumescence (NPT), colloquially known as nocturnal erections or morning glory, are erections which 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 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 can 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, as to completely stop and prevent ejaculation in that moment. You 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 can also help with the inability to maintain an erection.

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 in a lot of instances. However, it is entirely 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 represent a real problem for your sex life. But it’s also worth thinking about other practices like oral sex and how you can be sexually fullfilling to your partner in other ways outside of penetration. It might be worth sitting down with your partner to talk about your symptoms, and how you might be able to engage in sexual activity without an erection. You can also think about toys, prosthesis and pumps.

Impotence in men might be common, but it certainly doesn’t have to spell the end of your sex life. It’s entirely possible to orgasm and ejaculate while only being partially erect. You can even orgasm without an erection whatsoever. One option may be to practice mindfulness techniques and meditative approaches to deal with ED.

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 impact how long erectile dysfunction lasts.

For example, one study published in the journal of sexual medicine found that, after 5 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.’[9] Simply put, making personal changes surrounding a healthier lifestyle 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 diminish them, or you’ve struggled with ED for a number of years and it’s impacted your overall quality of life, there are many effective, well-tolerated ED treatments available to you.

How can I find out if I’ve got ED?

How can I find out if I’ve got ED?

If you’re still unsure whether you’re suffering with erectile dysfunction, you can use the Treated ED self-assessment tool. It’s a quick and easy test, designed by doctors, to help establish whether you might have ED or not.

You can also speak with your own doctor or medical professional, particularly if you’re experiencing ED for the first time. They have access to your medical and medication history, which will help them make a potential diagnosis and establish the underlying causes of your symptoms.

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When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

This page was medically reviewed by Dr Navkaran Singh Sandhu, Lead Doctor on November 18, 2022. Next review due on November 18, 2022.

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