Causes

Most men have had an occasional erection problem. Physical or emotional stress, fatigue, or problems in a relationship can cause occasional erection problems. Difficulty getting and keeping an erection increases with age. But if a man of any age frequently has erection problems, it can be a sign that something is physically or emotionally wrong.

Most erection problems have a physical cause and are the result of illness, injury, or the side effect of medication or illegal drugs. Physical causes include diabetes, prostate surgery, spinal cord injury, hormonal disorders, alcoholism, drug abuse, and some heart disease. There also can be psychological causes, including stress, depression, and fatigue.

A physical cause of erection problems can lead to worry and anxiety about the problems, adding emotional stress that only increases the problems.

Treatment

Erection problems are difficult for many men to talk about, because being able to have sexual intercourse is part of a man’s self-image. Most erection problems can be successfully treated, so it’s important to talk to a doctor if the problem persists for 2 months or more.

Treatment for erection problems can be anything from counseling to medication to implanted devices that help create an erection. Usually your doctor will start with the least drastic treatment, which might be correcting medications you are taking for another condition. Treatment options include the following:

• Sildenafil (Viagra) allows increased blood flow in the penis, improving the chances that sexual stimulation will cause an erection. Viagra is not a miracle medication—and it can be a problem for men who have some underlying conditions that are causing erection problems—but it has allowed many men, particularly healthy older men, to return to satisfactory sexual relations. There are other medications besides Viagra that can help increase blood flow in the penis. Some of these are injected into the penis or are in a suppository that is inserted into the tip of the penis.
• Hormone replacement therapy is an option for men whose bodies don’t make enough testosterone.
• Vacuum devices actually pull blood into the penis. The device, a plastic tube, is put over the penis and then a hand pump is used to create a vacuum in the tube that forces blood into the penis. When the penis is erect, bands are placed around the base to keep blood in it so it will stay erect long enough for intercourse. Vacuum devices are available only by prescription.
• Surgery can either correct problems with the blood vessels in the penis or implant a device that allows the man to get an erection with rods or inflatable cylinders.

Prevention

Although nothing can completely eliminate the possibility of an occasional erection problem, there are some things that help decrease problems:

• Exercise regularly.
• Drink only small amounts of alcohol or don’t drink at all.
• Don’t smoke.
• Try to reduce stress in your life, or find ways to cope with it without becoming anxious.
• Make sure you get enough sleep.
• Get regular medical checkups.