Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 4/16/2021
When it comes to performance, the bedroom is understandably the last place you want to have a bad outing.
This is why difficulties achieving or maintaining erections can sometimes encourage sexual performance anxiety, and may even cause a few blows to your self-esteem. These erectile difficulties can even leave you fearing for your chances of having erectile dysfunction.
If you have erection difficulties every once in a while, that's nothing to be worried about — everyone has those days. However, if you experience persistent difficulty with achieving or sustaining an erection, you may be dealing with erectile dysfunction.
Erectile dysfunction — also known as ED — is a condition that makes it difficult to get or keep erections for a satisfactory encounter during sex. To help with identifying this condition, we'll be looking at symptoms of ED that set it apart from typical erection difficulties.
To properly understand this condition, however, we'll be examining the causes of erectile dysfunction, as well as possible treatment methods for its management.
Erectile dysfunction is a very common condition — around 30 million men in the United States will experience it at some point in their lives.
However, despite being a common condition to encounter, this doesn't make erectile dysfunction an expected part of every man's life. And while the risk of developing erectile dysfunction increases with age, this is not to suggest that age is a leading cause of this condition.
Instead, any number of factors can be responsible for the appearance of ED, the only issue is, it’s a little hard to pinpoint exact causes.
Broadly, physical and psychological factors may be to blame for erectile dysfunction.
Erections occur through a complex process regulated by the brain, hormones, nerves and blood vessels in the penis.
Ultimately, this process causes the corpora cavernosa — sponge-like cylindrical tissue in the penis — to fill with blood, causing an erection to form.
Factors that affect blood vessels, the production and distribution of hormones or the nervous system can affect the formation of a firm erection. They may be responsible for the occurrence of ED.
Cardiovascular diseases: Conditions like coronary artery disease can lead to blockage in the coronary arteries of the heart, as well as the arteries of the corpora cavernosa present in the penis. Where the latter arteries are clogged, this can lead to ED.
Similarly, hypertension can lead to erectile dysfunction.
Metabolic conditions: Metabolic conditions like diabetes are notorious for causing sexual dysfunction in patients. This condition may lead to nerve damage, vessels that are important for achieving erections.
Diabetes may also prevent the relaxation of muscles in the corpora cavernosa, disturbing the flow of blood into the penis. There is also the suggestion that this disease may be responsible for low testosterone in patients. This is bad news for erections as low levels of testosterone can affect the libido.
Neurological illnesses: Erectile dysfunction is a common sexual complaint from men living with neurological conditions like multiple sclerosis. This condition may cause severe nerve damage which can prevent nerves from communicating. This damage can make it difficult to sustain satisfactory erections.
As we’ve highlighted, hormonal conditions such as hypogonadism (low-testosterone production) can lead to erectile dysfunction. Other diseases like Peyronie’s disease and chronic kidney disease may also lead to ED.
Likewise, physical trauma in the form of injury to the penis, spinal cord, prostate bladder or spinal cord can cause erectile difficulties. Just as injuries from prostate cancer treatment can affect erectile function.
In addition to physical factors, psychological conditions can make it difficult to maintain or achieve erections.
These include performance fears, depression, anxiety, low self-esteem or ongoing life stressors.
The easiest way to identify erectile dysfunction is to experience difficulty in achieving and maintaining erections.
Erectile dysfunction makes it near irrelevant how aroused you are — you may find it difficult maintaining an erection hard enough for sexual activity. In other instances, achieving an erection at all may be hard to achieve.
Erectile dysfunction can severely mar your sexual experience by making it difficult to hold on to an erection.
This condition makes it difficult to keep an erection firm or long enough to engage in enjoyable sexual activity.
Leading from these symptoms, erectile dysfunction is usually grouped into mild, moderate and complete cases.
In mild instances, erections can be touch and go — some days you have erections, other times you don't, despite wanting to engage in sex.
In moderate cases, erections are achieved, but not quite long enough for pleasurable sexual activity.
Complete cases of erectile dysfunction however come with an inability to achieve erections at all.
Erectile dysfunction can put a big question mark on sexual activity, which is why its proper management takes priority.
Despite being a very serious condition, erectile dysfunction is also a very treatable one.
PDE-5 inhibitors are popular treatment methods for this condition.
They work by preventing the activities of an enzyme that causes an obstruction to the flow of blood to the penis. They permit increased blood flow to the penis
These inhibitors include:
Viagra: This is the most common ED medication on the market. Operating through its active ingredient sildenafil (generic Viagra), this medication is available in 25mg, 50mg and 100mg doses to manage this condition.
Viagra® should be taken at least 30 minutes before engaging in sexual activity and typically lasts for around four hours. Be mindful of side-effects however, as this drug has been known to cause headaches, flushing and indigestion.
Because Cialis® (tadalafil) can last up to 36 hours, this allows for spontaneity when taking the daily dose, doing away with the need to wait one hour before sexual activity.
The as-needed dosage is to be taken on a day when sexual activity is expected. Like Viagra, adverse effects may include headaches and indigestion.
Levitra: Through vardenafil its active ingredient, Levitra® is also able to increase the flow of blood to the penis.
However, setting this drug apart from other ED medication is how quickly it can help with achieving erections once consumed.
A satisfactory rigidity may be produced after only 15 minutes following administration.
This drug is also known to increase the duration of erections when used.
Its side effects are typical of PDE5 inhibitors i.e headache, indigestion, flushing etc. Levitra is available in 5mg, 10mg and 20mg doses.
Stendra: Stendra® also stands out as a contender, as its terminal half-life of five hours makes it effective for slightly longer than Viagra, and its onset of action is as short as 15 minutes, making it a little faster-acting than Viagra.
It has the usual side effects of PDE5 inhibitors, and is available in doses between 50mg and 200mg.
The bedroom is a mishap-friendly zone — some days you're not in the mood, other times you're more than excited, either of which can lead to minor erectile issues.
However, where these issues become frequent, it may be a sign of erectile dysfunction. To identify this condition, you may find it difficult to achieve or maintain erections over a period of time.
Multiple treatment options are however available. Determining the right option for you will however require consultation with a qualified healthcare professional.