Wilting flowers in a vase

Why You Can’t Get And Keep An Erection

Plus how to get your prized appendage back to full strength.

Fast Facts

  • As many as 30 percent of men suffer from erectile dysfunction
  • To get and keep an erection, your hormones, nerves, blood vessels, brain, and emotions all need to cooperate.
  • If you are struggling with erectile dysfunction, medication, lifestyle changes, and other interventions can help you get and stay hard.

You might think of erections in pretty black and white terms—either you get hard or you don’t. But penises are notoriously temperamental. Sometimes you might struggle to get a firm erection full stop. Other times, you may start off rock hard during a sexual encounter, only to not be able to maintain an erection as things heat up. Wondering, Why can’t I get hard? Let us count the ways.

Erectile dysfunction (ED)—the inability to get and keep an erection firm enough for sex—can stem from health conditions, stress, a lack of sleep, low testosterone levels, or a host of other factors. And it’s a hard fact that ED is super common.

As many as 30 percent of men suffer from ED, and while penis problems are more prevalent among older men, erectile dysfunction is a growing issue for younger men, too (1). Per a study (2) in the American Journal of Medicine, only 20 percent of men between the ages of 40 and 59 said they could get a healthy enough erection for sex most of the time.

Your penis may never perform on-demand every time, but if you’re struggling to get or keep a full erection more often than not, it’s worth understanding what might be causing your erection to fail to rise to the occasion, and how you can address it and make sure your member stays in good standing.

How Do Erections Work?

While you probably know the basic biology of an erection—blood flowing into the penis to make it rigid—it’s worth remembering that every erection starts in the brain. So to find the answer to “Why can’t I get hard?” you have to look at your big brain before your little one.

When you see, think, smell, or touch something sexually arousing, it triggers the release of neurotransmitters. These chemical messengers tell blood vessels in the corpora cavernosa—two spongy cylinders of tissue that form the bulk of your penis—to dilate so that more blood can enter. As blood rushes in, your penis expands and becomes rigid. After you ejaculate, the penis softens as blood flow normalizes.

But for an estimated 18 million men, this system doesn’t run smoothly every time.

Related: Erectile Dysfunction and Age

Why Can’t I Get Hard?

The sexual response cycle is a complex system. To get and keep an erection, your hormones, nerves, blood vessels, brain and emotions all need to cooperate (3). Throw a wrench into any of those systems and you might not be able to get as hard as you want, whenever you want.

Some men may have issues with not getting an erection at all, some may find they can only get semi-hard, and others can only get hard sometimes. Or, maybe you can get erect but can’t maintain your erection long enough to last through sex.

The experiences of erectile dysfunction can vary, but the causes are the same. Here are some of the reasons you might be having problems getting hard.

Physiological factors

Some chronic conditions (4) that affect your nerves and blood vessels can make it hard to get and maintain an erection. Treating the underlying condition can often improve erectile function, so if you suspect one of these conditions might be messing with your erections, talk to your doctor:

  • Obesity
  • High blood pressure
  • Diabetes
  • Kidney disease
  • Multiple sclerosis
  • Urinary tract dysfunction
  • Enlarged prostate
  • High cholesterol
  • Low testosterone
  • Metabolic syndrome
  • Parkinson’s disease
  • Sleep disorders such as sleep apnea

 

Psychological factors

The answer to “Why can’t I get hard” might be more mental than physical. Your thoughts and emotions can influence your response to sex.

Stress, performance anxiety, low self-esteem, or a lack of confidence can cause your erection to flag. That’s because when you start to worry, you become tense, which makes it difficult to get hard. Problem is, the more you stress about not getting firm, the tenser you become. The result: a vicious cycle of ED.

Depression and anxiety can make it difficult to get and maintain an erection because a low mood can throw the neurotransmitters that trigger an erection to become imbalanced. As a result, you may be less interested in sex, or struggle to get hard. Some research has found that almost a quarter of men (5) with ED also suffer from depression, anxiety, or both.

Antidepressants Use

Selective serotonin reuptake inhibitors (SSRI) are the primary treatment often recommended for depression. Unfortunately, SSRIs also lead to sexual dysfunction in up to 80 percent (6) of people. If you are on any SSRI medications and now you can’t get hard, talk to your doctor. Often a similar pill, sans side effects, is available.

In one study, only 20 percent of men between the ages of 40 and 59 said they could get a healthy enough erection for sex most of the time.

Lifestyle factors

Your day-to-day activities greatly influence your sexual function. Unhealthy habits can make it harder to get and keep an erection.

Smoking

According to one review (7), men who smoke—especially chronic, long-term smokers—have a 1.5 times higher risk of erection problems than their counterparts who don’t smoke. Smoking weakens the pathway responsible for the release of nitric oxide, a chemical that relaxes blood vessels and improves blood flow in your penis.

Pack in the smokes, and your penis will thank you: In the follow-up study by this group of researchers, the patients who quit smoking saw a 25% increase (8) in erectile function compared to those who continued to puff.

Alcohol

In large quantities, alcohol can mess with the chemical messengers that tell blood vessels in your penis to dilate. One study found that chronic and persistent alcohol use led to sexual dysfunction in men, including erectile dysfunction, low sexual desire, and premature ejaculation.

Excessive drinking can also lower testosterone levels, which can also cause ED. And it doesn’t take long: In one study, men who drank a pint of whiskey every day for 30 days had testosterone levels similar to men with alcoholism by the end of the month.

Poor Diet

When your diet is less than stellar, you’re more likely to gain weight (obesity itself is a risk factor for ED). But what you eat matters, too. Men who follow a typical “western diet” are more likely to have low semen quality and experience ED than men who follow a Mediterranean diet (9), which emphasizes whole grains and vegetables and lower amounts of red meat.

Related: The Best Foods For Your Erection

Lack of Exercise

A sedentary lifestyle is a proven contributor to erectile dysfunction (ED). Being inactive makes it harder to control your weight and hurts your heart, both contributors to ED.

The good news: Men with erectile dysfunction can improve their sexual function with 40 minutes of aerobic exercise, four times a week, according to a 2018 study (10).

Could Low T Be Causing Your ED?

Hone’s test, which you can take from the privacy of your home, can analyze your testosterone levels.

Who is at Risk for Erectile Dysfunction?

While every guy’s penis may occasionally have a problem defying gravity, some factors can increase your vulnerability:

You’re getting older

One of the most common risk factors of erectile dysfunction is age. That’s because as you get older, you become more vulnerable to certain diseases, like heart disease and type 2 diabetes, that have been linked to ED. The risk of erectile problems (11) in men over 50 years is about 67%, which increases to 89% at 75 years.

You have other health problems

Conditions such as high blood pressure, kidney diseases, lower urinary tract obstruction, and diabetes mellitus can obstruct blood flow throughout the body, including to the penis.

You’re carrying extra pounds

Being overweight may increase your odds of ED by as much as 90 percent (12) according to research in the journal Nature. When you’re at a healthy weight you’re less likely to develop chronic health diseases like diabetes and high cholesterol that can cause ED. But obesity itself is a risk factor. According to one study (13), men who have a body mass index of 25 or higher are more likely to struggle with getting hard.

Treating Erectile Dysfunction

If you are asking yourself “Why can’t I get hard” regularly, talk to your doctor. He or she can run tests (such as checking your blood pressure, cholesterol, and testosterone levels) to spot underlying conditions that can contribute to ED. They’ll also ask about any other lifestyle factors that might influence your ability to get firm. 

Related: Exactly What To Say To Your Doctor About ED

Based on this assessment, your doctor may suggest the following:

Lifestyle changes

The fix for flaccidity could be as simple as making adjustments to your diet, alcohol consumption, or activity level. For example, research (14) shows that daily kegel exercises—which tighten the muscles of the pelvic floor—may help men with erectile dysfunction. The same muscle contraction that’s used to stop peeing midstream can also prevent blood from escaping during an erection.

Medication

Your physician might also prescribe a prescription to help with ED. A class of medications called PDE5 inhibitors, which includes tadalafil (sold under the brand name Cialis), sildenafil (Viagra), vardenafil (Levitra), and avanafil (Stendra) can help you rise to the occasion by stopping the action of an enzyme that usually impairs blood flow to the penis when you are sexually aroused. The result: you can get and sustain an erection for longer.

Intracavernosal injections

Putting a needle directly into your penis may sound like the stuff of nightmares, but intracavernosal injections, where a drug that relaxes the smooth muscles of your penis and increases blood flow is injected into the base of your penis, is one of the most effective treatments for ED, with a roughly 85% success rate. You’ll be injected by your doctor the first time to be taught how to do it yourself.

Sex therapy

If your ED is rooted in intimacy issues, a sex therapist can counsel you and your partner (if necessary) on how to manage your performance anxiety or any other mental problem interfering with your sex life.

Could Low T Be Causing Your ED?

Hone’s test, which you can take from the privacy of your home, can analyze your testosterone levels.

The Bottom Line

If you’re wondering “Why can’t I get hard,” there are many potential answers. Erectile dysfunction can be caused by a number of health and environmental factors. Fortunately, medication, lifestyle changes, and other interventions can help you get and stay hard, so talk to your doctor if you need help.

References:
1. Rastrelli, Giulia, and Mario Maggi. “Erectile dysfunction in fit and healthy young men: psychological or pathological?.” Translational andrology and urology vol. 6,1 (2017): 79-90. doi:10.21037/tau.2016.09.06
2. Nunes, Kenia Pedrosa et al. “New insights into hypertension-associated erectile dysfunction.” Current opinion in nephrology and hypertension vol. 21,2 (2012): 163-70. doi:10.1097/MNH.0b013e32835021bd
3. Shiri R, Koskimäki J, Hakama M, Häkkinen J, Tammela TL, Huhtala H, Auvinen A. Prevalence and severity of erectile dysfunction in 50 to 75-year-old Finnish men. J Urol. 2003 Dec;170(6 Pt 1):2342-4. doi: 10.1097/01.ju.0000090963.88752.84. PMID: 14634411.
4. Fouad R. Kandeel, Vivien K. T. Koussa, Ronald S. Swerdloff, Male Sexual Function and Its Disorders: Physiology, Pathophysiology, Clinical Investigation, and Treatment, Endocrine Reviews, Volume 22, Issue 3, 1 June 2001, Pages 342–388, https://doi.org/10.1210/edrv.22.3.0430
5. DeLay, Kenneth J et al. “Modifying Risk Factors in the Management of Erectile Dysfunction: A Review.” The world journal of men’s health vol. 34,2 (2016): 89-100. doi:10.5534/wjmh.2016.34.2.89
6. Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry. 2015 Jul;60:114-8. doi: 10.1016/j.comppsych.2015.03.001. Epub 2015 Mar 19. PMID: 25818906.
7. Jing, E., & Straw-Wilson, K. Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions:A narrative literature review. The mental health clinician, 6(4), 191–196.(2016) https://doi.org/10.9740/mhc.2016.07.191
18. Wu C, Zhang H, Gao Y, Tan A, Yang X, Lu Z, Zhang Y, Liao M, Wang M, Mo Z. The association of smoking and erectile dysfunction: results from the Fangchenggang Area Male Health and Examination Survey (FAMHES). J Androl. 2012 Jan-Feb;33(1):59-65. doi: 10.2164/jandrol.110.012542. Epub 2011 Mar 24. PMID: 21436308
19. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004 Dec;94(9):1310-3. doi: 10.1111/j.1464-410X.2004.05162.x. PMID: 15610111.
20. La J, Roberts NH, Yafi FA. Diet and Men’s Sexual Health. Sex Med Rev. 2018 Jan;6(1):54-68. doi: 10.1016/j.sxmr.2017.07.004. Epub 2017 Aug 1. PMID: 28778698.
21. Gerbild, Helle et al. “Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies.” Sexual medicine vol. 6,2 (2018): 75-89. doi:10.1016/j.esxm.2018.02.001
22. Shiri R, Koskimäki J, Hakama M, Häkkinen J, Tammela TL, Huhtala H, Auvinen A. Prevalence and severity of erectile dysfunction in 50 to 75-year-old Finnish men. J Urol. 2003 Dec;170(6 Pt 1):2342-4. doi: 10.1097/01.ju.0000090963.88752.84. PMID: 14634411.
23. Esposito, K., Giugliano, F., Ciotola, M. et al. Obesity and sexual dysfunction, male and female. Int J Impot Res 20, 358–365 (2008). https://doi.org/10.1038/ijir.2008.9
24. Skrypnik D, Bogdański P, Musialik K. Otyłość–istotny czynnik ryzyka zaburzeń potencji u mezczyzn [Obesity–significant risk factor for erectile dysfunction in men]. Pol Merkur Lekarski. 2014 Feb;36(212):137-41. Polish. PMID: 24720114.
25. Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU Int. 2005 Sep;96(4):595-7. doi: 10.1111/j.1464-410X.2005.05690.x. PMID: 16104916.

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