5 reasons you might not be able to get an erection

Erectile dysfunction (ED) is a common condition that affects men across the world. Despite this, the topic is still taboo and education on the causes of ED is limited.

Every man's experience is unique, but there are several common conditions that can lead to ED. Having trouble getting an erection is not a diagnosis in itself, it's usually a sign of something else going on with your lifestyle, health, or state of mind. We take a look at five of the most likely causes, and what can be done about each one.

1. You're overindulging in alcohol, tobacco or drug use

Alcohol. Occasional drinking is unlikely to cause lasting problems, but heavier and more frequent drinking is associated with sexual dysfunction, including ED.¹ If you're worried about how much you drink, these tips on cutting down are a good place to start. Alcohol can affect erections, both short-term and long-term. In the short term it's a depressant, so it dulls the nerve signals involved in getting an erection. Used heavily over a long period, it can damage the nerves involved in getting hard.² The heavier and more chronic the drinking, the higher the risk, and this is the same dose-response relationship seen with alcohol and liver disease.¹

Tobacco. There's a wealth of scientific evidence linking smoking and ED.³ Cigarette smoke contains chemicals that damage the lining of blood vessels,⁴ and healthy blood flow is essential for a firm erection, so anything that narrows or stiffens the arteries makes erections harder to get and keep.

Drugs. Recreational drugs are sometimes seen as an aid to sex, nicknamed “pilly willy” among other things, but the evidence points the other way for most of them.⁵ Cocaine, for example, constricts blood vessels, and regular use can cause lasting vascular damage.⁶ MDMA, poppers, anabolic steroids, ketamine, and methamphetamine are all linked to similar problems. If you're worried about your drinking or drug use, your GP or a sexual health clinic can help, and charities offer confidential support too.

2. You have an underlying medical condition

A number of physical health conditions are linked to ED, including high blood pressure, obesity, diabetes, heart conditions, peripheral vascular disease, Parkinson's disease, multiple sclerosis, and Peyronie's disease.⁷ Two of the most common and most treatable culprits are low testosterone and high cholesterol, both of which can be picked up with a simple blood test.

If you suspect a more serious underlying condition, such as Parkinson's disease or diabetes, see your GP for a proper diagnosis.

3. It's a side effect of your medication

ED can be a side effect of several types of prescription medications, including some painkillers, tranquillisers, antidepressants, antihistamines, blood pressure medications, antipsychotics, diuretics, hormone treatments, and immunosuppressant drugs.⁸ Blood pressure medication in particular is a common cause, though not every blood pressure drug carries the same risk. Never stop taking a prescribed medication because you suspect it's affecting your erections. Speak to your doctor first, since there may be an alternative that doesn't carry the same side effect.

4. You've had an injury or surgery

Physical trauma to the pelvic area can damage the nerves and blood vessels needed for an erection. A fractured pelvis, for example, is a well-documented cause of ED.⁹ Certain surgeries carry a similar risk, most notably prostate removal (prostatectomy) and radiotherapy targeting the prostate.^10,11 If you've had one of these procedures and are experiencing ED as a result, this is a recognised and common side effect, not a reason to suffer in silence, and there are treatments that can help.

5. It's psychological

Stress, anxiety, and depression can all affect your ability to get and maintain an erection, since sexual arousal relies on being relaxed enough for the right signals to reach the penis.¹² Performance anxiety is especially common: worrying about how you'll perform, or feeling self-conscious about your body, can become a cycle that makes ED more likely the next time.

Relaxation techniques such as yoga or meditation, talking therapy, or support from a charity can all help if stress, anxiety or low mood is at the root of your ED.

The numan take

ED usually isn't a standalone diagnosis. It's a signal that something else, in your lifestyle, medical history or mental health, needs attention. If it's affecting your day-to-day life or your relationships, it's worth looking into rather than ignoring.

References

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