Irrespective of how stage one was achieved, the next part is all about your plumbing. Courtesy of your nervous system stimulus, a powerful blood vessel dilator, nitric oxide, is released into the trabecular arteries and smooth muscle in your penis. This causes the arteries and the main bulkhead of your penis, the corpora cavernosa, to become engorged with blood. Helpfully, to keep this blood in place and maintain your erection, the ischiocavernosus and bulbospongiosus muscles of your penis constrict, effectively blocking the veins of your penis from draining blood out.
Cigarette smoking is a risk factor for ED, according to the 2014 Report of the U.S. Surgeon General. Excess weight can also contribute to erectile dysfunction. A 2004 Italian study found that one-third of their 110 obese study subjects were able to eliminate their erectile dysfunction problems by losing fifteen percent of their weight through diet and exercise.
Remember those cultural messages we discussed earlier, about how men are wild sex aliens from the planet Weenus? Well, men are raised hearing those messages, too, and they can end up screwing with their sexual self-image —for instance, they can lead men to obsess over their own virility, and panic about impressing a new partner, until they've thought their boner into a corner and can't get an erection. Performance anxiety is one of the most common culprits behind lost erections, especially among younger, less experienced men.
Another way to keep your libido up is to act when you do get aroused. This might mean going home at lunchtime to have sex with your spouse, or leaving a party early with your date if you’re both aroused. Staving off an arousal trains your body to disassociate arousal with erections. You want the opposite. You want to get and keep a strong erection when you feel aroused so that you can have better sex. So this is a great excuse to tend to your sexual needs as they come, if you can.
As the nervous system of autonomic response, the erection can result in different stimuli that include the sexual arousal and stimulation which is not even under the control of the conscious mind. The absence of the nocturnal erection is also used commonly for distinguishing between the psychological and physical cause of impotence and erectile dysfunction.
Additionally, financial struggles, issues at work, and issues at home with children or external family can impact the quality of sex you’re having. Remember that sex is a two person game. Both people need to be invested in it for it to be good. And good sex leads to longer, stronger, more powerful erections. It’s in both of your best interest to have better sex.

Something James, 26, knows for sure about his penis is that it won’t get hard when he’s sleeping with a woman for the first time. No, it has nothing to do with how attracted he is to her. It’s just a classic case of performance anxiety, caused by his personal fears about how awkward and uncomfortable the experience could be—which, of course, turns into a self-fulfilling prophecy.

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Additionally, extensive cigarette, alcohol and drug use can play a role, hence the terms "whiskey dick" and, most recently, "weed dick." According to a recent Playboy article by Dr. Justin Lehmiller, a social psychologist at Ball State University and author of the Sex and Psychology blog, recent studies show that erectile dysfunction's prevalence is "three times as high for daily marijuana smokers compared to those who don't use it at all."
Don’t approach sex like a race. If you struggle with losing your erection quickly, you might be used to speeding things up. That’s counterproductive, though. Work on slowing things down and don’t be afraid of what happens in your body. By slowing down, you’re retraining your body to expect something different from sex. Right now, your body probably expects to climax in a very short period of time. If that’s not what you want, you have to train your body to take a little longer.

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Try to think of love-making as fun, not a trial. Laugh more, be more playful, and try to create opportunities for being together in situations that would be enjoyable for you both, even if sex does not occur. Most importantly, explore non-penetrative styles of eroticism. These things will help increase your sexual comfort and confidence, and reduce the pressure you currently feel to be an on-demand sex machine. You are merely human.
"We used to think that ED in young men was 90 percent psychological, but we now know that most cases are caused by a combination of risk factors. Erectile function depends on hormones, blood supply, nerve function, and psychological health,” said Run Wang, MD, professor of urology at The University of Texas Health Science Center in Houston and director of sexual medicine at MD Anderson Cancer Center.
If he's over 40 and not the most healthy, then years of "bad habits" could have provoked the incident; lack of exercise, shitty eating, alcohol abuse, drugs, tobacco, all damage our blood vessels. The same exact blood vessels that take the long juan from 6 to 12. Plus, you guys were taking a hot bath together, which also thins blood. So, right off the bat, there are six different variables you have no control over. If his exterior his A-ok, then lets dig deeper...
Medications for erectile dysfunction don't work for everyone and may cause side effects that make a particular drug hard to take. "Work with your doctor to find the right treatment. There are still options for people who fail at medical treatment," advises Feloney. Alternatives to erectile dysfunction drugs include vacuum pump devices, medications injected into the penis, testosterone replacement if needed, and a surgical penile implant.
Some men experience erectile dysfunction as a result of physiological factors, including medications that can interfere with sexual response, chronic illness (e.g., heart disease, high blood pressure, diabetes), physical disability, alcoholism, drug use, or injury that impedes blood flow to the erectile tissue. High cholesterol, which can limit blood flow through the atreries that supply the genital area, can also be associated with erectile dysfunction. For others, psychological concerns, including stress, anxiety, self-esteem, or fatigue are the source. Researchers believe that for many men erectile dysfunction is caused by a combination of physical, psychological, and cultural factors.

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Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

Despite some very recent legislative changes, opioids—ultra-strong narcotic painkillers—have never been more popular. According to the newest stats from the Centers for Disease Control and Prevention (CDC), enough opioid prescriptions are written each year to stock the medicine cabinets of every single adult in America (with plenty left over for teens, too). “These types of narcotics suppress testosterone levels,” says Dr. Köhler. That means they also mess with your hard-on. So does smoking, drinking a lot of booze, and any other bad habits that hurt your heart and/or vascular function.
Erectile dysfunction is your body’s “check engine light” because ED can be an early sign of serious health problems like high blood pressure, diabetes, high cholesterol or low testosterone. The blood vessels in the penis are smaller than other parts of the body. So ED symptoms often occur long before more serious problems like a heart attack or stroke. When an otherwise healthy man in his 20’s experiences ED, it’s cause for concern.
Now, it may be that all you need to do is tackle some of the issues outlined in these key tools. However, yes, that advice may also come in the form of a small magic blue pill. Sildenafil (Viagra) is a phosphodiesterase type 5 inhibitor, designed to promote blood flow to your penis and achieve a sustainable erection. It can sometimes be a short-term option to help you "get back on the horse" or a longer-term method (if there is an irreversible dysfunction) to help you enjoy a healthy intimate relationship.

"When it's persistent and consistent, it's extremely likely to have biological factors" regardless of age, Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and the director of San Diego Sexual Medicine, told Mic. But the cause of ED can also be psychological: For instance, if a man can get an erection on his own but not with a partner, then his ED is more likely to be rooted in performance anxiety or a deeper psychological issue.  

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The most common diagnostic test for erectile dysfunction is called penile ultrasound. This test uses sound waves to look for abnormal penile blood supply. Another test that may be done is nocturnal penile tumescence testing, in which a type of computer is attached to the penis to see if nighttime erections are occurring. If a young man is having nighttime erections but can’t get an erection during sex, a psychological cause becomes more likely.
Depression, anxiety, stress, insecurity, conflicted emotions, missing the last quarter of the basketball game, all can have an effect. If your man is a healthy dude, then his brain could be cockblocking your giving of "brains." As a man, it is a very defeating feeling and not something you just talk out with your penis. He has got to remain cool. If it happens, the faster he pushes it out of his brain the faster his subconscious will kick in his arousal. Try something like this: grab a glass of water, take a pee break and then just hang in bed together. Share laughs, talk about other things and let your companionship do the work. The less he is engaging his inner dialogue and the more he is engaging you, the faster his inner workings will settle and his libido will be back in action. That is, of course, if he really does want it to happen.

Don’t approach sex like a race. If you struggle with losing your erection quickly, you might be used to speeding things up. That’s counterproductive, though. Work on slowing things down and don’t be afraid of what happens in your body. By slowing down, you’re retraining your body to expect something different from sex. Right now, your body probably expects to climax in a very short period of time. If that’s not what you want, you have to train your body to take a little longer.

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Condom troubles. Can the simple act of putting on a condom cause so much stress that it actually leads to erectile dysfunction? Sure it can — in fact, one recent survey of 234 young men conducted by the Children's Memorial Hospital in Chicago found that 25 percent had lost an erection while putting on a condom. “Putting on a condom requires a break from stimulation, and when it is on, it can reduce sensation,” says Dr. Montague.
Most men may not openly talk about their erection problems, but erectile dysfunction — when a man cannot achieve or maintain an erection well enough or long enough to have satisfying sex — is very common. According to the National Institutes of Health, 5 percent of 40-year-olds and 15 to 25 percent of 65-years old have ED. But while ED is more likely to occur as a man gets older, it doesn’t come automatically with age.
"When it's persistent and consistent, it's extremely likely to have biological factors" regardless of age, Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and the director of San Diego Sexual Medicine, told Mic. But the cause of ED can also be psychological: For instance, if a man can get an erection on his own but not with a partner, then his ED is more likely to be rooted in performance anxiety or a deeper psychological issue. 
Low libido can be caused by many different things including medications, fatigue, recreational drugs, alcohol, depression, relationship problems, fear, systemic illness, and testosterone deficiency. Problems with maintaining an erection is a common symptom of erectile dysfunction (ED), and can be frustrating to deal with when trying to engage in any type of sexual activity. In most cases, ED is triggered by one or more health problems or unhealthy lifestyle habits, but can be improved or resolved by treating the underlying cause, which may be vascular, neurologic, penile, hormonal, drug induced, or psychogenic.
Regular exercise and a diet rich in antioxidants is also the foundation of permanent weight control and diabetes prevention. Studies at the Duke University Diet and Fitness Center show that weight loss is strongly associated with better sexual function. Other studies show that diabetes is a major risk factor for ED, and that a healthy lifestyle prevents the disease and can restore erection function.

Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.


The strength and frequency of your erection are an important indicator of your overall health. The blood vessels in the penis are smaller than arteries and veins in other parts of your body, so any problems like blockages, blood vessel dilation issues, or hormone imbalances will often show up as erectile dysfunction (or less firm erections) before something more serious like a heart attack or stroke.

Stiffy Solution: Again, saying "stop being so stressed out so you can get boners again" is easier said than done — but a lot of people find sexual dysfunction to be a stronger motivator to live a healthier lifestyle than the threat of, say, a heart attack down the road; so there's a chance that this could actually be a good thing in the long run for your boo, if it helps him take his stress seriously. Relaxation techniques like yoga, exercise, meditation, tai chi, and getting adequate sleep can all lessen the impact of stress on your body (and your dong).


There are a lot of explanations for these high ED rates, some of which are psychological. “A lot of men may have an off night, and then that sticks in their head and hurts their performance for a few weeks or months,” Dr. Köhler explains. He says anxiety stokes hormones like the fight-or-flight chemical adrenaline, which is a serious boner killer. (In evolutionary terms, it would be tough to run away from a predator with an erection.)
Gray-haired men soaking in Jacuzzis overlooking canyons, thumbing through the morning newspaper in their thick reading glasses, cuddling their wives on gently swaying hammocks while drinking sensible glasses of cabernet...the classic erectile-dysfunction commercials of the past 20 years were pretty clear about who they wanted to reach. Ever since, those iconic images have defined who we as a society assume are in need of penis pills: men of retirement age.
For many young men, performance anxiety plays a large role in erectile dysfunction. Other factors include money and work problems, as well as relationship issues and even issues about sexual orientation. Undiagnosed depression and post-traumatic stress disorder can cause erectile dysfunction--especially if the PTSD is related to a past sexual experience.
Men with a healthy lifestyle and no chronic disease had the lowest risk for erectile dysfunction; the greatest difference was seen for men aged 65-79. For instance, men who exercised at least three hours per week had a 30% lower risk for ED than those who exercised little. Obesity, smoking, and excessive TV watching were also associated with having a greater risk of erectile dysfunction.
UW Health urologists with advanced training offer medical and surgical treatment options for men and their partners affected by erectile dysfunction. There are several different ways that erectile dysfunction can be treated. For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition. 

My husband is suffering from erectile dysfunction. He has been to many doctors, including a urologist, neurologist, orthopedist, you name it. After many diagnostic tests, it seems that nothing physical can be found. He used to have full erections almost daily. Now nothing. Although he can get hard, he cannot maintain enough for intercourse. What can we do at this point?

Erectile dysfunction is about more than just the ability to get an erection (although that’s certainly a big part of it). It’s also about how hard your erections normally get, and if you can get an erection that’s hard enough and lasts long enough to have “satisfactory” sex. ED is really about how you (and your partner) feel about your sex life. And a lot of that has to do with how firm your erections get.
"Some physical problems that can lead to weak erections are the inability of your brain to send signals to your penis, which can be caused by neurological conditions like MS, Parkinson's disease and Alzheimer's," adds Axe. "Studies suggest that stress, anxiety and depression can produce major chemical changes in your brain, leading to the inability of smooth muscles to relax and allow for an erection. On top of this, researchers have also indicated that the failure to achieve an erection can aggravate a man's anxiety levels, leading to a vicious cycle."

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