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Enjoy sex like you used to
Older men aren’t the only ones asking their urologists, “Why can’t I get hard anymore?” Some research suggests that 30 to 50 million American men (younger men included) are struggling with symptoms of erectile dysfunction (ED) — and it’s not always clear why.
The causes of erectile function problems can be any number of things: Alcohol, certain medications, medical conditions, and problems with the nervous system can all affect a man’s ability to maintain an erection. ED can even be a symptom of a mental health condition.
If you’re asking questions like “Why can’t I get a boner?” or “Why do I have a semi-hard penis?” then keep reading to figure out an action plan.
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Erections are about two things: blood flow in and no blood flow out. Your penis is essentially a balloon filled with blood (well, more like a sponge, but let's use the balloon analogy). Actually, there are two main ones in the penis, and together they’re called the corpora cavernosa (there’s also a third, softer one called the corpus spongiosum).
When you become aroused, these “balloons” fill with blood, and the increased pressure pushing against the surrounding fibrous tissue seals off the exit, trapping that blood inside your penis. Erections fail to happen only when something interrupts this process, and there are a number of things that can do that.
This may include:
Weight
Age
General health
Alcohol consumption
Drug dependency
Medication side effects
Those are just a few of the physical and mental causes that may explain why you’re not getting hard (and which we’ve elaborated on below).
Whether physical or psychological factors cause your ED issues, you may continue to have a normal sex drive. Or, you may experience partial erections that aren’t firm enough for satisfying sexual intercourse.
FYI: Partial erections are health issues, as well as warning signs of erectile dysfunction. While they’re not as severe as a complete lack of firmness, they represent a problem that must be tackled before it worsens.
A variety of triggers can cause any man to experience sexual health issues.
Below, we’ve organized them into two primary categories: physiological reasons, like those associated with heart health, and psychological reasons, like those related to performance anxiety or depression.
Your erectile health is not independent of the health of the rest of your body, so if something is wrong in another area of the factory, so to speak, it could shut down the production line elsewhere.
For instance, one form of ED, vascular ED, can be caused by inefficient arteries, which are associated with heart disease.
Common physical causes of ED include:
Chronic inflammation associated with diabetes
Metabolic syndrome
Cardiovascular and neurological diseases
Multiple sclerosis (MS)
Parkinson’s disease
Atherosclerosis (clogged blood vessels)
Spinal cord injuries
Peyronie’s disease (penile curvature)
There are even neurological causes of erectile dysfunction to consider, like nerve damage or similar traumas that reduce sensation and function in the penis.
Things like hormonal imbalances (which can be caused by age, weight, or any number of factors) also can contribute to ED and even reduce your sexual desire.
Further, it’s important not to rule out things like lifestyle choices and habits as potential causes of ED, too. The underlying cause of ED could be anything from poor diet and exercise habits to medication side effects.
If you’re experiencing partial erections or are unable to maintain a full erection, it’s possible you’re suffering from one or more of these conditions. Make sure to talk to a healthcare professional if you suspect any of these health conditions may be holding you back in the bedroom.
Even if your body is to blame for some of your erectile issues, your mental health could also be affecting things. Gained some weight recently? That might affect your heart health — but it might also make you self-conscious in intimate scenarios.
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Meanwhile, performance anxiety, depression, and low self-esteem can adversely affect your ability to get hard by distracting you from arousing thoughts or lowering your interest in sex.
Stress and anxiety might cause a loss of interest in sexual activity generally, so if things in the office or the relationship aren’t great, those problems may be following you all the way to bed.
Some believe that pornography can also cause a form of ED, and while the jury is still out on that one, it may be worth assessing your porn habits. Do you feel like you can only get hard or reach ejaculation when you’re masturbating to porn? Do you think cutting back would help?
ED can affect different men to varying degrees. Your medications, underlying health issues, age, and other factors may impact your erectile firmness, so it’s best to ask a professional to assess these possible ED causes.
Your healthcare provider will review your medical history and check you out for things like:
Blood pressure issues, including hypertension
High cholesterol
Side effects or interactions of prescription or over-the-counter medications (such as high blood pressure medications, antidepressants, and antihistamines)
Prostate cancer
They may also inquire about things like relationship problems as well as your smoking, drug, alcohol, and eating habits. All of these are potential ED causes, and you can address them yourself or get help with making lifestyle changes.
Your healthcare provider can help you figure out the right treatment for you. In many cases, they’ll suggest one or more of the following:
Lifestyle-based ED treatments
Medications for ED
Therapy to improve your sex life
When we discuss treatment options for sexual dysfunction, there’s one straightforward solution to ED: Take better care of yourself.
Before you run to the pharmacy, understand that ED is treatable, with various proven options available. Everything from improving your diet to getting more exercise to switching out medications that cause side effects can help you regain firmness.
Your healthcare provider may also prescribe erectile dysfunction medications. There are currently four FDA-approved oral prescription ED pills available:
Viagra® (sildenafil)
Levitra® (vardenafil)
Stendra® (avanafil)
These drugs belong to a class of medications called phosphodiesterase type 5 inhibitors (PDE5 inhibitors) that increase blood flow to the penis to help you get and maintain an erection when you want one.
If you’re looking for something more discreet, you may want to consider an erectile dysfunction treatment like Hims Hard Mints, chewable ED meds that contain the same active ingredient in Viagra and Cialis in customized dosages.
Other medications are also available for ED, such as alprostadil, an injectable medication.
Schedule an online consultation with a healthcare provider today to see if you qualify for prescription treatment.
A word of advice: Don’t assume the cause of your ED is physical. Low self-esteem, performance anxiety, and a slew of other mental health issues can cause ED, and those should be treated with the help of a therapy professional.
There are various psychological treatments and approaches to dealing with the ED problem. You may also benefit from talking to a couples therapist with your partner if you think relationship issues are contributing to ED — or ED is contributing to relationship problems.
“I can’t get rock hard anymore.” It’s a tough thing to admit, to type into a search bar, or to say out loud to a healthcare professional. At least, it may feel that way.
In reality, admitting the problem is a necessary first step to, well, being able to have a full erection again.
If you haven’t been achieving full liftoff recently, remember these key facts:
It’s a whole-body issue. Erections are about more than your penis. Your whole body and your mind also contribute to the health of your erections.
Your mind may be holding you back. Your body can be ready, but if you’re anxious, depressed, or self-conscious, you may be left semi-erect.
This is a fixable problem. Taking ED medication and working towards healthier living can restore your penile power. Talking to a therapy professional can also help if your erection problems are due to psychological causes.
Want to learn more about ED treatments and solutions? Check out these 14 ways to get harder erections, learn more about position-dependent erectile dysfunction, and find out how to know if you have ED.
Dealing with another sexual dysfunction? Learn more about what causes low libido and what to do about premature ejaculation.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.
Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown was previously Medical Director of a male fertility startup where she lead strategy and design of their digital health platform, an innovative education and telehealth model for delivering expert male fertility care.
She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.
Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.
Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.
Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.
Education & Training
Andrology Fellowship, Medical College of Wisconsin
Urology Residency, University of California San Francisco
M.D. Northwestern University Feinberg School of MedicineB.S. in Radiologic Science, Chemistry Minor, University of North Carolina at Chapel Hill
Published as Kelly Walker
Cowan, B, Walker, K., Rodgers, K., Agyemang, J. (2023). Hormonal Management Improves Semen Analysis Parameters in Men with Abnormal Concentration, Motility, and/or Morphology. Fertility and Sterility, Volume 118, Issue 5, e4. https://www.sciencedirect.com/journal/fertility-and-sterility/vol/120/issue/1/suppl/S
Walker, K., Gogoj, A., Honig, S., Sandlow, J. (2021). What’s New in Male Contraception? AUA Update Series, Volume 40. https://auau.auanet.org/content/update-series-2021-lesson-27-what%E2%80%99s-new-male-contraception
Walker, K., Shindel, A. (2019). AUA Erectile Dysfunction Guideline. AUA Update Series, Volume 38. https://auau.auanet.org/content/course-307
Walker, K., Ramstein, J., & Smith, J. (2019). Regret Regarding Fertility Preservation Decisions Among Male Cancer Patients. The Journal of Urology, 201(Supplement 4), e680-e681. https://www.auajournals.org/doi/10.1097/01.JU.0000556300.18991.8e
Walker, K., & Smith, J. (2019). Feasibility Study of Video Telehealth Clinic Visits in Urology. The Journal of Urology, 201(Supplement 4), e545-e545. https://www.auajournals.org/doi/10.1097/01.JU.0000556071.60611.37