What Causes Erectile Dysfunction?

From certain medications to stress, there are a number of reasons why some people are unable to get or maintain erections. Learn all the causes of erectile dysfunction here. Are you or someone you know unable to get or stay hard? Learn about the possible causes of erectile dysfunction here.

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The Quickie
4 minute read

You’re fooling around, enjoying kissing and getting turned on. You feel their hand go down between your legs to your cock to feel you getting hard… but nothing’s happening down there. “What’s going on?” you wonder. After a few more minutes: nothing. You start to worry, “When will it wake up? What if I don’t get hard at all?”

What Is Erectile Dysfunction?

Erectile dysfunction—also called ED—occurs when a person has trouble getting or maintaining an erect penis. For some people, it’s difficult to get an erection at all, while others may find they lose their erection before they want to. Both can be disruptive to partnered sex and masturbation, and a source of worry.

The Impacts Of ED

The impact that erectile difficulty has on a person or relationship depends on their unique set of circumstances and personality. For some people, it may be no big deal if erections are not the main focus of their sexual activity. For others, it may be frustrating but manageable. But for others still, the inability to get or maintain an erection may be a major source of distress, leading to a negative self-image and relationship strain. If erection issues are troubling you or your partner, it’s helpful to understand the causes of ED and to consider which may be at play in your situation.

Causes Of Erection Difficulties

Causes for erection issues can be physical, psychological, or a combination of both. Physical causes for ED include: heart problems, blood pressure issues, diabetes, prescription and recreational drug use, pelvic floor dysfunction, and the after-effects of prostate surgeries. Psychological causes include: performance anxiety, mental distraction, past sexual trauma, and not being sufficiently aroused.

Conditions That Cause ED: High Blood Pressure, Heart Problems, Diabetes

In order to have an erection, blood needs to flow into the penis. For an erection to be sustained, the blood needs to stay in there for as long as needed. This requires that the circulatory system is in good working order. Heart problems, high blood pressure, and nerve and blood vessel damage due to diabetes can interfere with circulatory system functioning, and as a result cause erection issues—especially as people get older.

The Pelvic Floor And Erectile Dysfunction

For the penis to become erect, the pelvic floor muscles need to relax enough to let blood flow into the penis to make it hard. The pelvic floor also has to be strong enough to keep the blood inside, and prevent it from flowing back into the rest of the body. So having a pelvic floor that can relax and contract when needed is important. When pelvic floor muscles aren’t functioning properly, Kegel exercises may help.

Prescription And Recreational Drugs That Interfere With Erections

Some medications make it more difficult to get erections. For example, erection trouble may be a side effect of antidepressants or blood pressure medications. Alcohol, cannabis, and other substances can also interfere with the ability to have an erection.

Erectile Issues After Prostate Surgery

Prostate surgeries and drugs used to treat prostate cancer can lead to erectile problems. Depending on the specific procedure, surgery can damage nerves in the pelvis and make erections difficult or impossible.

Performance Anxiety And An Inability To Perform

That’s right, the fear of not being able to get an erection can become a self-fulfilling prophecy! If, perhaps, it was difficult to get an erection at a recent sexual encounter, or if a partner made fun of your erection difficulties in the past, the fear of it happening again can be so distracting that the body can’t relax enough for an erection to happen. In general, it’s harder to become and stay erect when you’re stressed out—especially so when it’s stress related to your ability to perform.

Mental Distraction And Erections

If you’re thinking about work, are worried about money, or are still dwelling on an argument you and your partner had earlier, these mental distractions can be real—literal—boner-killers. A busy mind makes it difficult to relax into pleasure and be in the moment.

The fear of not being able to get an erection can become a self-fulfilling prophecy!

Past Trauma And Sexual Functioning

The aftereffects from past sexual abuse or assault can also be an underlying cause of erection problems. It may be difficult to feel safe and present in a sexual encounter. Flashbacks, worry, or triggers may disrupt sexual enjoyment and arousal.

Lack Of Arousal And Erectile Dysfunction

For some people, difficulty with erections may be context-specific, perhaps because they’re not having a sexual experience that turns them on enough. This can happen when, for example, they’re participating in a sexual activity that’s not appealing to them. Porn can also play a role. Some people become used to the arousal they get from watching porn, and when they are in a context where there’s no porn playing, they can find it difficult to get erect.

Whatever the cause of your erectile issues, ED is never something to feel ashamed of. Erectile dysfunction is a common, if frustrating, medical condition that affects more than 30 million Americans—one out of four of them under the age of 40.

Happily, a number of effective treatment options exist, from pelvic floor exercises, to medication, to therapy and acupuncture. If you’re troubled by ED symptoms, reach out to your primary care doctor to get diagnosed and learn which treatment options may be best for you.

Related Articles:

Penis Parts And Pleasure

Meet The Pelvic Floor

How To Do Kegels

How To Stretch And Relax Your Pelvic Floor

What Causes Premature Ejaculation?

Tips For Managing Premature Ejaculation

Porn Addiction Test


"Pelvic-floor muscle rehabilitation in erectile dysfunction and ... - NCBI." 31 Jul. 2014, https://www.ncbi.nlm.nih.gov/pubmed/25082919. Accessed 16 Jan. 2019.

“Erectile Dysfunction” Harvard Health Publishing  https://www.health.harvard.edu/topics/erectile-dysfunction Accessed 22 Feb. 2019

Myths and facts

Setting the record straight.

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At O.school, we know that few things are one-size-fits-all. Read on for insights from Pleasure Professionals and other experts:

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Video transcript

Circumcision Myths And Facts

Is circumcision medically necessary? Is it cleaner? Find out more about circumcision and sort the facts from fiction.

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The Quickie
3 minute read

While circumcision of the penis is a commonly accepted practice in many geographical areas, a lot of misunderstanding still exists around the procedure, and the differences between cut and uncut penises.

Read on to explore some of the most common myths about circumcision, and clear up some potentially confusing misinformation.  

Myth: Most Penises Are Circumcised

Circumcision is more common in areas such as the United States, Canada, Africa and the Middle East. Folks who live in these areas may perceive circumcision to be fairly common, because many or most of the penises they’ve encountered have been cut. However, only approximately 30% of penises worldwide are circumcised.

Myth: Foreskin Is Unnecessary

Since so many people are circumcised, clearly people with penises are able to function and survive without foreskin! However, there are some functional purposes of the foreskin.

Intact foreskin can provide protection for the head of the penis (or glans). Similar to the clitoral hood on a vulva, foreskin on a penis can help maintain the sensitivity of the glans by protecting it. The foreskin can also minimize friction and chafing during penetrative sex, as it moves in a gliding motion.

Myth: People Who Are Circumcised Are Cleaner

It is commonly recommended that the foreskin of uncircumcised penises be pulled back during bathing to be cleaned. While this is a step that those with an circumcised penis do not have to consider, it is a relatively simple task that folks with uncircumcised penises get accustomed to performing during their regular bathing routine.

Myth: Circumcision Prevents HIV

This myth is kind of a myth. There has been some compelling research that circumcision can sometimes help prevent the penetrating partner from contracting HIV in some situations and populations, but those results are not necessarily generalizable to everyone everywhere.

Intact foreskin can provide protection for the head of the penis

It may be something to consider for those living in areas with epidemic levels of HIV, but would not be the most effective prevention method for people living elsewhere. Other risk reduction strategies such as using condoms properly and routine HIV testing provide significantly more protection than circumcision.

Myth: Uncircumcised People Are More Likely To Have A Sexually Transmitted Infection (STI)

The connection between circumcision and sexually transmitted infections has been studied for decades, with mixed results. There are no clear and consistent findings that circumcision has any impact on the general population’s risk of acquiring an STI.  

Myth: Circumcision Is Medically Necessary

As previously noted, approximately 70% of penises around the world aren’t circumcised and are nonetheless able to function and survive… so that would indicate that removing the foreskin is not a medical necessity.

In a minority of cases - if there are problems with a tight foreskin for example - circumcision may be medically recommended. However, circumcision is most often practiced for cultural or religious reasons, or just because it is the norm in a given community.

Myth: Uncircumcised Penises Are Prone To Smelly Buildup

Just like any moist area of the body (such as the skin flaps of the vulva, behind the ears, the armpits, between rolls of skin), the foreskin can breed bacteria and buildup that can produce an odor if not cleaned. Regular washing can easily prevent this from happening.

Is Circumcised Or Uncircumcised Better? Either Is Fine!

The truth is that circumcised and uncircumcised penises have more similarities than they do differences. Both cut and uncut penises can be of various shapes and sizes, can get erect when turned on, can ejaculate, and can provide and experience pleasure.  

When learning about circumcision (or any sexuality topic!) it’s important to think about whether what we hear are true facts or just myths. So much of our sexuality education is rooted in generalities, shame, and misinformation. The truth is, sexuality is diverse! Different choices are going to work for different people, and circumcision is no different!

Related Articles:

What Is Circumcision?

Penis Parts And Pleasure

Circumcised And Uncircumcised Penis Anatomy

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Video transcript

So, imagine like, this is my, this is a penis, a very large one that is gray and made of yarn. So, at the head of the penis, the foreskin can kind of be like that, like hanging off a bit, it can be pretty tight down, it can look all sorts of different ways, and this is probably a lot like more scrunched up. But this looks all different for anyone who has a penis. So, the foreskin though, it can retract, and then, the head of the penis, which is where a lot of the pleasure centers are, they're very concentrated, so that just means that when is touched or stimulated, it sends signals to the brain, that's like: "Hey, something fun's happening, "so, wanna just put some blood down there "so it's a little more sensitive, that would be great." So, it's just their brain being like, "Oh yeah, do that more, please."

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