Why is my 🍆 not getting or staying hard?

In this article:

🍆 Do I have erectile dysfunction?
👀 How hard is hard enough?
➡️ Erection Hardness Score
👉 6 Steps to take if you’re struggling with erection issues
✅ 5 Root causes
✏️ What to do next?

“Do I have erectile dysfunction?”

Not being able to get an erection that is firm enough to have penetrative sex is something most men will experience at some point over the course of the sex life. It’s easy to feel scared and wonder: “Shit, do I have erectile dysfunction!?”

I think not enough experts (and articles written by experts) differentiate between Erectile Dysfunction and Sexual Performance Anxiety. Even though these two both can contribute to problems with erection, they are not the same!

➡️ Sexual Performance Anxiety (SPA) is a state of anxiety around sexual performance which can cause significant distress and fear around future sexual activities. SPA can affect any person regardless of their sex and gender! SPA affects 6-16% of women, and 9-25% of men and contributes to Premature Ejaculation and Erectile Dysfunction (ED).

➡️ Erectile Dysfunction (ED) instead is persistent inability to get or maintain erections in most of sexual interactions over the period of at least 6 months. Medical conditions, lifestyle choices, psycho-physiological, relational and socio-cultural factors can cause ED.

SPA can contribute or worsen symptoms of ED. Experiencing ED can create distress and anxiety around sexual performance. ED and SPA can coexist, but they aren't synonyms! Remember:

• SPA can sometimes lead to Erectile Dysfunction.

• Erectile Dysfunction can cause Sexual Performance Anxiety.

• Some men experience both ED and SPA at the same time.

If you are experiencing any sexual problems, consider booking a consultation (link).

👉 Let’s dive into what is erectile dysfunction, what causes it, and what can you do about it.

How hard is hard enough?

When the erection doesn’t score the perfect 4, men tend to get worried. But what happens when they get worried? The penis that was hard enough get’s softer. Now men are even more worried. And in this state of worry, it’s really hard to convince your penis to perform…🚫

So when this happens, men can get stuck in the loop of anticipating an erection problem, that ends up being the cause of the problem itself.

👉 Remember: normal erec­tile function fluctuates - it’s not always a perfect 4, sometimes it’s a 2 and that’s completely normal. Don’t let your expectations scare you into thinking that your penis is not performing as it should.

Popular advice to give is “don’t worry about it!”. However, this rarely (if ever) helps, so if the anticipation of a potential erection issue is causing or worsening your ability to maintain an erection, consider booking a consultation: (link).

6 Steps to take if you’re struggling with erection issues

➡️ If the problem persists, causing you to struggle getting it up or maintaining a hard enough erection in most of your sexual interactions over a period of at least 6 months, here’s what you should do:

1. Don’t aliment your anxiety around it, and tell your partner not to make a big deal out of it.

2. Read the side-effects list of any medication you’re currently taking - certain medications such as antidepressants and blood pressure pills can affect your erection.

3. Rule out any physiological problem - that means go to the doctor and make sure it’s not due to a medical condition, such as vascular, neurological, or endocrine disease that obstructs normal erectile function.

4. Get a prescription if necessary to start feeling more confident about your erections.

5. Consider a lifestyle change: tobacco, drug and alcohol use, being overweight or obese, and a lack of physical activity are risk factors for developing erectile dysfunction.

6. Take the pressure off - don’t make your whole sex life about penetration. There are so many things you can do in the bedroom, and penetration is just one of them, read my article about how to have sex with a soft penis to get more ideas! (link)

🎯 Key takeaway: To diagnose ED there needs to be a failure to obtain or maintain erection persistently over a period of 6 months and in at least 75% of sexual activities. ED may be sustained by a fear or avoid­ance of future sexual activities.

📝 The factors that cause Erectile Dysfunction can be categorised as follows:

1. Bio-physiological factors: Medical conditions, substance/medicine side effects, comorbidity, age.

2. Partner factors: partner's health status, behaviour or attitudes.

3. Relationship factors: poor communication, discrepancy in sexual desire, inadequate stimulus.

4. Individual factors: Sexual history, childhood abuse, body image and insecurities, psychological stress, lifestyle.

5. Socio-cultultural factors: religious upbringing, prohibitions against sexual activity, stigma, internalized homophobia.

Having a less than “4” Erection Hardness Score can be caused by a variety of factors, such as situational factors (partner, relationship struggles, stress) as well as individual biological and psychological conditions and upbringing. It’s important to rule out any medical conditions because ED may be an early sign of cardiovascular disease that needs attention and treatment.

🎯 Key takeaway: Erectile dysfunction itself is a symptom, not a disease. This is why it’s important for individuals to undergo thorough evaluation and receive appropriate treatment for a possible underlying condition that could be causing ED.

👉 After ruling out any medical concerns, it's wise to look into other factors that may be affecting your performance. Consider booking a session with a certified sex counsellor to discover what exactly is influencing your ability to maintain erections and how to fix it. You deserve to feel confident and satisfied, and I'm here to help you achieve that.

When you're ready, here's how I can help:

1. Individual counselling session (link)

2. Couples counselling sessions (link)

Learn more (link)

My kink is to see YOU thriving.

Helina Metsik 💌
Sex Counsellor

References:

Allen, M. S., & Walter, E. E. (2019, April 1). Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes. Journal of Sexual Medicine. Elsevier.

Defeudis, G., Mazzilli, R., Tenuta, M., Rossini, G., Zamponi, V., Olana, S., Faggiano, A., Pozzilli, P., Isidori, A. M., & Gianfrilli, D. (2022). Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes/Metabolism Research and Reviews, 38(2), e3494.

Goldstein, I., Mulhall, J. P., Bushmakin, A. G., Cappelleri, J. C., Hvidsten, K., & Symonds, T. (2008). The erection hardness score and its relationship to successful sexual intercourse. Journal of Sexual Medicine, 5(10), 2374–2380.

Hatzimouratidis, K., Amar, E., Eardley, I., Giuliano, F., Hatzichristou, D., Montorsi, F., Vardi, Y., & Wespes, E. (2010). Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Urology, 57(5), 804–814.

Huang, K., Yin, S., Xiao, Y., Wang, J., Cui, J., Wang, J., & Bai, Y. (2024). Sexual dysfunction in patients with diabetes: association between remnant cholesterol and erectile dysfunction. Lipids in Health and Disease, 23(1), 55.

Leisegang, K., Sengupta, P., Agarwal, A., & Henkel, R. (2021). Obesity and male infertility: Mechanisms and management. Andrologia, 53(1), e13617.

Manalo, T. A., Biermann, H. D., Patil, D. H., & Mehta, A. (2022). The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction. Journal of Sexual Medicine, 19(2), 201–206.

Mulhall, J. P., Goldstein, I., Bushmakin, A. G., Cappelleri, J. C., & Hvidsten, K. (2007). Validation of the erection hardness score. Journal of Sexual Medicine, 4(6), 1626–1634.

Pizzol, D., Demurtas, J., Stubbs, B., Soysal, P., Mason, C., Isik, A. T., … Veronese, N. (2019). Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. American Journal of Men’s Health. SAGE Publications Inc.

Pyke R. E. (2020). Sexual Performance Anxiety. Sexual Medicine Reviews, 8(2), 183–190.

Salonia, A., Bettocchi, C., Boeri, L., Capogrosso, P., Carvalho, J., Cilesiz, N. C., …, Minhas, S. (2021). European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction. European Urology.

Terentes-Printzios, D., Ioakeimidis, N., Rokkas, K., & Vlachopoulos, C. (2022). Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nature Reviews Cardiology, 19(1), 59–74.

Yannas, D., Frizza, F., Vignozzi, L., Corona, G., Maggi, M., & Rastrelli, G. (2021). Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men's Health? Journal of Clinical Medicine, 10(10), 2221.

Books:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).