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.