Erectile dysfunction

Getting an erection is a complicated process. During an erection, the blood vessels that let blood into your penis relax and widen (dilate). This lets more blood in, which causes the sponge-like tissues of your penis to swell and harden. Your thoughts and senses (touch, hearing, smell and sight) influence a part of your brain that can trigger an erection.

In addition, hormones and other substances determine how your nerves transmit ‘sexual signals’ and how blood vessels respond to the received signals. Arousing thoughts or nervous-system mechanisms such as touch reflexes are 2 ways you can get an erection.


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Some estimates indicate that about 40% of men over the age of 40 will have erection problems at times.

Symptoms of erection problems include:

• being unable to get an erection
• experiencing a partial erection
• having an erection of a shorter than usual duration.

Erectile dysfunction occurs when sexual stimulation or arousal does not result in enough blood flow to your penis, even though you may still have the urge. For some men there is a physical or medical reason for this. For others the problem is related to thoughts or emotions.

Even when there is an initial physical reason, when this has passed you may still feel anxious about having sex and this can add to the problem.

Alcohol, smoking and recreational drugs

Smoking, drinking alcohol and the use of recreational drugs such as narcotics, stimulants and hallucinogens can all affect sexual function. Chemicals from smoking can interfere with blood flow to your penis and damage the lining of the blood vessels or lead to atherosclerosis (hardening of the arteries). It can also affect the smooth muscle tissue that needs to relax to allow blood to flow in.

Short-term use of alcohol affects sexual desire, reduces performance and delays orgasm and ejaculation.

Medical reasons

Medicines 

Some medicines, including over-the-counter medicines, can cause sexual problems, including getting and maintaining an erection. Medication is a common cause of erectile dysfunction for 25 out of 100 men using medication. This varies depending on the person and type of medication.

If you are taking a medicine and are worried about its effects, don't stop taking it suddenly. Instead discuss this with your doctor or pharmacist. There might be a different medicine you can take that is less likely to cause sexual problems. Read more about medicines and sexual problems.

Psychological reasons

There are a range of psychological factors affecting erection including:

• existing values or attitudes towards sex
• stress, guilt, depression or fatigue
• performance-related anxiety about your performance during sex
• traumatic past experiences including sexual abuse 
• poor body image
• relationship problems (possible anger, power or control issues with your partner)
• problems with intimacy and communication
• intercourse less than once per week (twice the risk of developing erectile dysfunction).

Pornography consumption is not generally a cause.

There is often a vicious cycle linking performance anxiety and erectile dysfunction. If you still have erections at times and the problem started rapidly (except after surgery), this usually means psychological reasons are involved.

Many men are unhappy with their ability to get or maintain an erection, but only 5% of these men seek help. This is because most men, in general, are unwilling to discuss their sex life, even when it is going well.

Understanding that erectile dysfunction could have a medical cause, just as asthma or arthritis do, can help you to feel more at ease in mentioning it to your doctor. Your doctor is used to talking about these issues. By opening up this discussion, which is confidential, your doctor can help you in a number of ways.

They can check your health and any current medications for likely side effects. If psychological reasons are suspected, your doctor can advise you on what would help, including helping you access counselling services you (and your partner) may benefit from.

Tests by your doctor may include:

• a physical examination, which may include your genitals and prostate gland
• checking your medications for side effects
• blood and urine tests for hormones, blood lipids, thyroid, liver and kidney function and diabetes.

If your erection problems have a medical cause, your doctor can explain the treatment options, the techniques needed to make them work and their suitability for your needs based on your overall health.

There are several treatments for erectile dysfunction. Your doctor can advise you on the benefits and drawbacks of each.

Lifestyle changes

Lifestyle changes are one of the most effective treatments. Weight loss, increased physical activity, cutting out smoking, getting enough sleep and reducing alcohol can all have a big effect on erectile dysfunction. If you have obstructive sleep apnoea, make sure you are using your CPAP machine.

Psychological counselling 

This can be useful even if there is a medical cause, as it gives you a chance to talk about how you feel about having erectile dysfunction. If there is an underlying psychological reason for the difficulty, this is a safe place to explore what this might be and what you can do about it. This is generally not available as a funded service and you would normally need to pay for this privately. If you have been sexually abused, then you may be able to access free counselling through ACC.

Sensate focus exercises

Sensate focus exercises are intimacy exercises you do with your partner. Sensate focus is about setting the stage for sensuality rather than sexuality, focusing on touch and being touched, and being mindful during the experience. The exercises are progressed in steps starting from non-genital touching. Read more about sensate focus exercises.(external link)

Tablets (taken by mouth)

Tablets for erectile dysfunction are called phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra, Silvasta, Vedafil), tadalafil (Cialis) and vardenafil (Levitra). These medicines usually enable an erection by relaxing the blood vessels in your penis, but only when you are stimulated or aroused. They are all similarly effective. Read more about PDE5 inhibitors and frequently asked questions about their use. 

Self-injection

If the tablets mentioned above don't work, then injecting a medicine called Caverject into the base of your penis is another option. It allows most men to get an erection, which may last beyond ejaculation. Some men may be put off by this method, but the injector devices are simple and convenient to use and the procedure is virtually painless. Your doctor or sexual health specialist needs to show you in person how to use it safely.

Other possible treatments

For some men, vacuum pump devices, rigid or inflatable surgical penile implants or testosterone replacement (only for men with unequivocally low levels of this hormone) may also be options. Constriction bands at the base of the penis can be a treatment option for men with non-sustained erections. Discuss these options with your doctor.

Do herbal products work?

Many herbal products such as horny goat weed, ginkgo, yohimbe and ginseng claim to improve sexual function. There is no sound evidence that these herbal products work well for erectile dysfunction. They have not been well studied or tested. Since some erectile dysfunction is related to psychological problems, herbal products may help with anxiety, which may indirectly help sexual function.

Some herbal products and supplements can cause side effects or interact with other medicines. Talk to your doctor or pharmacist before you try an alternative treatment for erectile dysfunction, especially if you're taking medications or you have a chronic health problem such as heart disease or diabetes. 

Most ageing men manage to get erections, but to do so requires more stimulation. It is up to each man to decide whether his erection is adequate. You can consider (with your partner) how important sexual intercourse is to your relationship. There are other aspects to intimacy and not all couples require an active sex life to have a fulfilling relationship.

You can help yourself by cutting down on alcohol, stopping smoking and reducing the stress in your life.

Apps reviewed by Healthify

You may find it useful to look at some Self-management and healthy living apps.