Erection problems - What is it?
In this section
Most men have trouble getting an erection at some time in their life. But some men can't get an erection at all. And some men have trouble keeping an erection long enough to have sex that is satisfying. But there are treatments that can help. If you have erection problems, talk to your doctor about finding the right treatment for you.
Doctors call this condition erectile dysfunction. The word dysfunction means that something doesn't work properly. This problem used to be called impotence. But erectile dysfunction is a more accurate name. Also, some men find it upsetting to be called impotent.
If you have erection problems, you may feel embarrassed or ashamed. These feelings stop many men seeing their doctor. But it's important to remember that many men have trouble getting erections at some time in their life, and doctors see this problem all the time.
Thanks to recent advances in medicine, most men can find a treatment that works.
Try our quiz to see how much you know about erection problems.
Key points about erection problems
- If you have erection problems, you have trouble getting an erection or keeping an erection long enough to have sex that is satisfying.
- As you get older, you're more likely to get erection problems.
- About 8 inn 10 erection problems happen because of physical problems such as diabetes and heart disease. Many drugs can also cause erection problems.
- You should see your doctor. Erection problems can be an early sign of heart disease, diabetes or depression.
- Most men with an erection problem feel embarrassed, which can make the problem worse. And these problems can be difficult to talk about.
- Viagra (sildenafil) works well but not for everyone. There are other good treatments.
- If you're married or have a partner, it's important to involve them if you talk to your doctor about your erection problems.
What happens when you get an erection
To understand erection problems and how they can be treated, it's useful to know how your penis works and how erections happen.[1]
How your penis works
Your penis is mainly made up of spongy tissue and blood vessels.
The tube that carries urine and semen runs through the middle. It's called the urethra.
The tip of your penis is called the glans. The rest of your penis is called the shaft.
Two columns of spongy tissue run through the upper part of your penis. When you have an erection, the spongy columns get stiff.
How you get an erection
There are lots of spaces inside the spongy columns in your penis.
When your penis is limp, these spaces are empty. When you have an erection, the spaces are full of blood. This makes the columns firm.
Blood vessels called arteries supply the extra blood that you need to get an erection.
There are also nerves in your penis. They send messages around your penis to help erections happen.
Other nerves bring messages from your brain about what you're thinking and feeling about sex.
Erections happen when nerves in your penis release certain chemicals that change the way blood flows into your penis.
Erection problems: what goes wrong
You may have problems getting an erection or keeping an erection long enough to enjoy sex. There are several different possible causes.
Emotional reasons
Stress or unhappiness can cause erection problems. Your emotions can stop you having an erection or make it disappear too soon.[2] This can make you lose interest in sex or you may avoid having sex.
If you have erection problems, you may feel anxious or guilty. And if you're worried about whether you'll get an erection, this worry can make it more difficult to get one.[3] But in more than 8 out of 10 men who have had erection problems for more than a year, there is a physical cause.[3]
If you think your erection problems may be caused by stress or unhappiness, it can help to talk to a psychosexual therapist or counsellor.
Damaged nerves
You may get erection problems if your nerves can't tell your penis to make erections happen.
This may happen if you have:
- Diabetes (an illness that can damage the nerves in your penis and in other parts of your body)
- Multiple sclerosis or another neurological disease that stops your nerves working well
- An injury to your groin area
- Surgery in your groin area, which can damage the nerves in your penis
- Radiotherapy to your pelvis to treat prostate cancer.
Damaged blood vessels
If you have a condition called atherosclerosis, where your arteries become clogged, it can stop blood flowing into your penis. This can cause erection problems.
And if blood isn't kept in your penis but starts leaking out through your veins, then your erection may not be firm or last long. This may happen naturally as you get older. It can also happen if you have diabetes.
A condition called Peyronie's disease changes the way blood flows through your penis.[3] See Peyronie's disease.
Levels of hormones
If you don't have enough of a hormone called testosterone, you may have erection problems. Testosterone is the hormone that gives you your sex drive (libido).
Having too much of a hormone called prolactin can also give you erection problems.
If you have one of these problems, you may need to see a doctor who specialises in hormones.
Why me?
There may be some things about you that make it more likely that you'll have problems getting erections.
For example, if you're taking drugs to treat other medical problems, these drugs may cause erection problems.
To read more, see Risk factors for erection problems.
How your doctor can help
Most men who have an erection problem don't talk to their doctor about it.[4] But there are at least two good reasons for doing so.
- You don't need to suffer. There are treatments that can help you have satisfying sex again. These treatments will help you feel better about yourself and your relationship. If you're feeling depressed, you're more likely to have erection problems. Sorting out these problems can make you feel less depressed.[5]
- Erection problems can be an early warning sign of serious diseases like diabetes and heart disease.[6] The same thing that goes wrong in your body to give you these illnesses can also cause erection problems. Your doctor can check whether you have these diseases. See How do doctors diagnose erection problems?
References
- Martini FH, Ober WC, Garrison CW, et al. Fundamentals of anatomy and physiology. 5th edition. Prentice Hall, Upper Saddle River, NJ, USA; 2001.
- Jordan GH. Erectile function and dysfunction. Postgraduate Medicine. 1999; 105: 131-134, 137-138, 143-144 passim.
- Morgentaler A. Male impotence. Lancet. 1999; 354: 1713-1718.
- Ansong KS. Lewis C. Jenkins P. Bell J. Help-seeking decisions among men with impotence. Urology. 1998 Nov;52(5):834-7
- Seidman SN, Roose SP, Menza MA, et al. Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. American Journal of Psychiatry. 2001; 158: 1623-1630.
- Lewis RW. Epidemiology of erectile dysfunction. Urologic Clinics of North America. 2001; 28: 209-216, vii.
Glossary
- diabetes
- Diabetes is a condition that causes too much sugar (glucose) to circulate in the blood. It happens when the body stops making a called (type 1 diabetes) or when insulin stops working (type 2 diabetes).
- heart disease
- You get heart disease when your heart isn't able to pump blood as well as it should. This can happen for a variety of reasons.
- depression
- Depression is a mental illness in which your mood is low and you feel sad much of the time. It can range from a mild illness through to a severe one in which you lose interest in life and may be suicidal.
- semen
- Semen is the whitish fluid that is released through the penis during an orgasm. Semen is made up of millions of tiny sperm floating in fluid. Sperm are the part of the semen that can join with a woman's eggs to make her pregnant. Sperm are made in the testicles, and travel through tubes (called the vas deferens) to get to the penis. Along the way, the sperm are joined by fluid that is released from the prostate and seminal vesicles. This fluid helps the sperm to travel and provides them with nutrients.
- arteries
- Arteries are the blood vessels that take blood that is rich in oxygen and food away from your heart. The arteries carry this blood to all the tissues in your body.
- multiple sclerosis
- Multiple sclerosis (MS) is a disease that damages the walls of your nerves. No one knows for sure what causes it. If you have multiple sclerosis, you may lose feeling in certain parts of your body. You may also have trouble with your vision or problems controlling your movements.
- radiotherapy
- This is also called radiation therapy. It is a treatment that uses high-energy X-rays to kill cancer cells. It's most often used for tumours that are hard to treat with surgery alone. You won't feel any pain during this treatment, but you may get some side effects afterwards.
- atherosclerosis
- Atherosclerosis s also called 'hardening of the arteries'. It happens when fatty material sticks to the inner wall of the arteries. Over time, cholesterol, fats and other things in the blood stick to the same area and the artery wall becomes thick and narrow, making it progressively more difficult for blood to flow through the affected vessels.
- hormones
- Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone is made in a woman's ovaries. Oestrogen has many different effects on a woman's body. For example, it makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.
- testosterone
- Testosterone is a sex hormone. When boys go through puberty, testosterone causes the development of male characteristics like a deep voice and a muscular body. Testosterone is also known to affect men's sex drive and mood. Although testosterone is thought of as a 'male hormone', women also make testosterone (although they make much less of it then men).
- prolactin
- Prolactin is a hormone that your body makes. Its main job is to prepare a woman's breasts for breastfeeding after she's had a baby. If men have too much prolactin in their blood, it can lower their sex drive and make it difficult for them to father a child.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
