Erection problems in men: Causes and treatment

Sexually aroused men get an erection thanks to the good cooperation of hormones, muscles, blood vessels and nerves. An erection problem (erectile dysfunction, erectile dysfunction, impotence) is a common problem that occurs when a man cannot get or maintain an erection during sexual intercourse. Sometimes a man does not get an erection at all, or else he loses the erection during intercourse. If this occurs more than one in five times, it may have a medical or psychological cause such as heart disease, the use of antidepressants or anxiety. Environmental factors may also lead to impotence. Erection problems usually do not affect sex drive. Often the problem goes away with little or no treatment. But sometimes the problems persist.

  • Causes of erectile dysfunction
  • Physical conditions or problems
  • Psychological and emotional problems
  • Environmental factors
  • Symptoms
  • Diagnosis and examinations
  • Contact the doctor
  • Therapy
  • Prognosis of impotence in men
  • Complications of erection problems
  • Prevention of erectile dysfunction


Causes of erectile dysfunction

To get an erection, the brain, nerves, hormones and blood vessels all have to work together. If there is a problem somewhere, this will lead to erection problems. Most men occasionally cannot get or maintain an erection. If it happens more often (more than 20% of the time), it may be due to a physical or psychological problem, although sometimes environmental factors are also the cause of impotence.

Erection problems are sometimes the result of obesity / Source: Tobyotter, Flickr (CC BY-2.0)

Physical conditions or problems

Often erectile dysfunction is due to a condition, medical problem or medical treatment such as:

  • congenital problems with the genitals
  • atherosclerosis (clogged arteries)
  • high blood pressure
  • a high cholesterol level in the blood
  • a liver disease
  • a kidney disease
  • a spinal injury
  • a trauma or injury to the genital region
  • heart disease
  • the metabolic syndrome (condition in which the patient has elevated blood pressure, high insulin levels, body fat around the waist and high cholesterol)
  • low testosterone levels. This makes it difficult to get an erection and sometimes reduces a man’s sex drive.
  • multiple sclerosis (chronic autoimmune condition)
  • prostate problems: treatments for prostate cancer, an enlarged prostate, nerve damage from prostate surgery
  • radiotherapy in the pelvic area
  • thyroid disorders
  • sleep problems
  • diabetes
  • Parkinson’s disease (neurological disorder with tremors)
  • Peyronie’s disease (penile scarring resulting in a bent penis and penile pain)
  • obesity


Psychological and emotional problems

Psychological and emotional problems are also linked to erection problems in men. These causes are more common in younger men.

  • anxiety (for example about not being able to get or keep an erection or fear of intimacy)
  • a depression
  • poor communication with the partner
  • feelings of doubt and failure
  • long-term emotional distress due to economic, professional or social problems
  • anxiety
  • relationship problems
  • stress
  • too many expectations of sex: this makes sex a chore instead of fun.
  • fatigue
  • fury


Environmental factors

Some medications lead more quickly to erectile dysfunction, such as:

  • anti-anxiety medication
  • anticholinergics (medications that inhibit muscle movement)
  • antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants
  • blood pressure medications (especially beta blockers)
  • diuretics (water pills: diuretic medicines)
  • medicines that act on the central nervous system, including some sleeping pills and amphetamines
  • medicines to treat prostate problems
  • heart medications such as digoxin
  • hormone medications
  • opioid painkillers
  • some medicines to treat stomach ulcers
  • some cancer drugs, including chemotherapeutic agents
  • muscle relaxants

Other environmental factors
Some other environmental factors are also known to cause erectile dysfunction. These are more common in younger men:

  • alcohol consumption (alcoholism)
  • cocaine use (drug addiction)
  • nicotine use (smoking)



Some symptoms of erectile dysfunction include:

  • an erection that is not firm enough for sexual intercourse
  • less interest in sex
  • problems maintaining an erection
  • problems getting an erection


Sometimes a blood test is necessary / Source: Frolicsomepl, Pixabay

Diagnosis and examinations

The doctor asks the patient various questions about his erection problems, his lifestyle, the medications he is taking, his state of mind, etc. The doctor then carries out a physical examination, such as a blood pressure measurement and an examination of the penis and rectum to identify any problems. to identify. Sometimes additional tests are necessary, such as:

  • a device that the man wears at night to detect normal nocturnal erections
  • an ultrasound of the penis to detect problems with blood flow
  • a stiffness check to measure erection strength
  • a urine test or blood test to detect diabetes mellitus, heart problems or low testosterone levels
  • psychological tests to detect depression and other emotional problems


Contact the doctor

In a number of circumstances it is wise to consult a doctor:

  • persistent erection problems after lifestyle changes
  • the patient has other symptoms, such as lower back pain, abdominal pain or urinary problems
  • an erection that lasts longer than four hours when using erectile dysfunction medications
  • a medication that may be the cause of erection problems
  • the problem starts after an injury or prostate surgery


For erectile dysfunction, the doctor may use medication / Source: Stevepb, Pixabay


Treatment depends on the cause and the man’s health condition. Lifestyle adjustments often help with erectile dysfunction, such as reducing anxiety and stress, exercising more, eating healthy, drinking less alcohol, quitting smoking and drug use, losing extra weight, sleeping well and solving relationship problems. Talking to your partner about sexual problems is also important. Therapy is sometimes necessary (for both the man and the partner) when relationship problems are present. Other treatments may be needed, such as medications, surgery to place implants in the penis, a vacuum device (vacuum pump: stimulate blood to flow to the penis causing an erection), and testosterone replacement if testosterone levels are too low. Furthermore, the doctor treats the health problem that causes or aggravates impotence. All treatments have possible side effects and complications. A doctor therefore provides information about the risks and benefits of each treatment.

Prognosis of impotence in men

Many men overcome erection problems with lifestyle changes and/or medical treatment. In more serious cases, the man and partner must adapt to the influence of erectile dysfunction on sex life. Thanks to therapy, it is often possible to overcome the stress that erectile dysfunction places on the relationship.

Complications of erection problems

Persistent erection problems result in dissatisfaction with sex life, low self-esteem, stress, anxiety and/or relationship problems.

Quitting smoking is good to prevent impotence / Source: Geralt, Pixabay

Prevention of erectile dysfunction

To prevent erection problems, there are some tips:

  • maintain good control of blood sugar levels when diabetes mellitus is present
  • taking the time to relax
  • maintain a healthy weight
  • not use illegal drugs
  • drinking less alcohol (no more than two alcoholic drinks per day)
  • exercise and consume a healthy and balanced diet to maintain good blood circulation
  • quit smoking
  • get enough sleep
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