Injury to the nerves and arteries near the penis can lead to erectile dysfunction. According to the National Institutes of Diabetes and Digestive and Kidney Diseases, surgeries for prostate and bladder cancer can injure penile nerves and arteries, although it doesn't always happen. Spinal cord injuries can affect the ability to achieve and maintain an erection, as can injuries to the penis, prostate, bladder and pelvis.
While physical anatomy and chemical reaction are both important for getting and keeping an erection, the brain is one of the most vital parts of this puzzle. "An erection is controlled by multiple areas of your brain, including the hypothalamus, limbic system and cerebral cortex," notes Axe. "Stimulatory messages are sent to your spinal erection centers and this facilitates an erection. When there's an issue with your brain's ability to send these important messages, it can increase the smooth muscle tone in your penis and prevent the relaxation that is necessary to get an erection."
“Although having sex at 70 is not the same as having sex at 20, erectile dysfunction is not a normal part of aging,” according to Michael Feloney, MD, urologic surgeon and expert on sexual dysfunction issues at the Nebraska Medical Center in Omaha. “You should still be able to have a satisfying sex life as you age." If you are experiencing erectile dysfunction, these 10 dos and don'ts may help.
If the problem is physiological, that is, if a man cannot maintain an erection due to illness, it is best to go to the doctor or specialist and treat the problem accordingly. Sometimes treating this problem with medication is enough to solve the problem; other times, however, a doctor might recommend the use of Viagra in order to achieve full erection.
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"Diseases and illnesses can hamper one's ability to achieve an erection," he explains. "Cancer, diabetes and heart disease is the cause in many cases. Low testosterone count caused by genetics, inactivity or unusual level of estrogen in the body can limit penile function as well." High blood pressure and high cholesterol can also be detrimental to erections.
Improve your nutrition. Certain foods, such as those that are fatty, fried, sugary, and processed, can result in decreased blood flow throughout your body and can contribute to a vascular form of erectile dysfunction. Increase your intake of fruits, vegetables, whole grains, and heart-healthy fats to improve your blood circulation and increase the amount of time you’re able to maintain an erection.
If ED happens to a boyfriend or husband, ask (outside the bedroom) if he’s ever seen a doctor about it. Only 15 percent of men have, according to our survey—but a doc visit might be the simplest solution. For instance, if your guy’s ED seems like a psychological issue, his doctor may refer him to a therapist who can help him work through whatever’s getting him down. Or he may be given a temporary prescription for sildenafil, the active ingredient in Viagra, which is safe and effective when used correctly.
"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."
Just as certain meds can make it difficult for men to have an orgasm, some can keep the flagpole from even getting raised in the first place. Anti-depressant medications like Prozac and Zoloft, anti-anxiety pills like Valium, high blood pressure medicine like Diuril, and even over-the-counter cold medicines like Sudafed and anti-heartburn pills like Zantac can inhibit erections.
Achieving an erection is a complex process involving the brain, hormones, nerves, muscles and blood circulation. If something interferes with this process, the result may be erectile dysfunction. In some cases, erectile dysfunction is the first sign of other serious underlying health conditions, such as cardiovascular problems, that need treatment because erectile dysfunction can share the same risk factors for heart attacks and strokes.
"Stress and anxiety can adversely affect sexual performance and are common causes of erectile dysfunction,” warns Feloney. “Feelings of stress and anxiety can also lead to depression and a loss of interest in sex." It's important to get these feelings out in the open where you can deal with them. Issues that can lead to erectile dysfunction include fear from previous bad experiences with sex, family or work related stress, poor communication with your partner, and unrealistic goals and expectations.
Pycnogenol is a compound found in the French maritime pine (Pinus pinaster), which grows in southern Canada. Several studies show that in combination with the amino acid L-arginine, it boost synthesis of nitric oxide, which plays a significant role in erection. Other studies show that pycnogenol helps restore wilting erections. In one study, 124 ED sufferers took either a placebo or pycnogenol and L-arginine (four tablets a day, 20 mg pycnogenol, 700 mg L-arginine). After six months, the supplement group showed a modest but significant improvement in erection, without side effects.
"Start by cutting out junk, processed and packaged foods. Instead, focus on eating high fiber foods, like fruit, vegetables, nuts and seeds, and foods that will help to improve blood flow, such as leafy green vegetables. It's also helpful to avoid drinking too much caffeine and alcohol. Next, make sure you are getting regular exercise. This will help you to balance your hormone levels, improve circulation and manage stress."
“Studies looking at men under 40 with ED have found certain psychiatric conditions, like depression and anxiety, at a higher rate than other groups,” Trost says. And as he explains it, anxiety and depression—two things millennials experience at uniquely high rates—can make it more difficult for a man’s brain to respond to arousing stimuli, which can cause a low sex drive or issues getting an erection.
“With the success of Viagra-type drugs, there has been a tendency to start all patients with ED on one of these drugs and not look much further for a medical cause. But we now know that ED may be an early warning for heart and blood vessel disease, so it is important to look for common risk factors. These include high blood pressure, diabetes, medications, smoking, drinking, and drugs,” said Dr. Wang.
"I like to recommend that couples think outside the box," Dr. Hartzell said. "Intercourse doesn't always have to be the goal; look at sex as pleasure oriented vs. goal oriented." She suggested couples incorporating oral sex and manual stimulation into their bedroom routine. She also advised couples to "have fun" with their sex lives by not adhering to a specific schedule or routine: One woman she works with, for instance, leaves her partner's injection on her pillow as a subtle signal that she's in the mood to have sex.
It can be difficult and frustrating for men and their partners to cope with erectile dysfunction, especially when the cause is unclear. At this point, it is important to be supportive and understanding of the situation and of one another. Erectile difficulties can cause feelings of inadequacy in both men and their partners. Each may internalize the situation, fearing that s/he is the one to blame. Therefore, open and honest communication with one another is an essential ingredient in strengthening your relationship as you work through this situation together.
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.
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.
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.
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Getting hard is also an overwhelmingly mental task. "Yes, men are saddled with the scheduled 'morning boner' and may experience an occasional random erection but by and large an erection needs to be achieved through mental stimulation," says Backe. "If you aren't turned on, your body isn't going to send more blood to the penis — bottom line. So, ultimately, you need a clean and clear mind for healthy and clear erections. Keeping the mind healthy will allow proper mental stimulation to occur at the right time."
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.
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Depending on the age of the man, the reason why he is experiencing deficiencies in maintaining an erection will be due to a cause or another. Among young men, it is often due to psychological factors, either due to the size of the penis, past experiences, depression, undervaluation or other reasons, but can be summarized as: fear of sexually disappointing the couple.
But recently, slick, millennial-chic ads started popping up on social media from new men’s brands like Roman and Hims. Even though the (young) founders of these companies say they aren’t trying to market ED meds to your Tinder dates or male partners, clearly they are looping 20- and 30something guys into the deflated-D narrative for the first time ever.
So not only are erectile problems common, they're nothing for you or your special friend to be freaked out about. Check out the nine most common reasons that dudes sometimes can't get it up, and get ready to become the soothing voice of reason the next time the guy you're with has a hard time pitching his tent in your happy valley. Everything (and every penis) is gonna be fine!