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Impotence ("erectile dysfunction" or ED) and the penis

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There are few things more frightening to the average man than an attack of impotence. Suddenly the penis, the ultimate symbol of maleness, refuses to get hard.

A soft penis equates to failing to assert one's masculinity, failing to lead, to dominate, to push through obstacles, and, most of all, not being able to enjoy the ultimate expression of masculinity - penetrative sex.


If you are finding it takes you a long time to reach the point of ejaculation during intercourse, then it's probably worth you having a look here, a comprehensive review of what can cause delays in ejaculation.

Video - erectile dysfunction

So what should you do if you have erectile dysfunction?

First, see a doctor to rule out any physical causes, then, if there's no obvious medical problem, take a close look at your thoughts and feelings about yourself, your life and your relationships.

Sometimes, especially in mid-life, impotence is caused by a mixture of psychological and physical factors like worries about aging and lowering of testosterone - and despite what some doctors say, low testosterone level prevent you getting hard erections and may even mean your penis loses some of its size.

By the way, if you're blaming your lover, stop it. A woman's approach to lovemaking might be a factor in the mix, but it's never the whole reason. If it were, you'd have no responsibility whatsoever for the actions of your own penis, and that can't be possible, can it?

Any kind of medical difficulty such as hiatal hernia can be sufficient to stop you getting erections or enjoying sex.

Physical causes of erection problems (erectile dysfunction)

Many illnesses - ranging from flu to chronic tiredness and more serious issues like heart surgery - will deplete the body's resources to the point where your penis just won't stand up. Usually things return to normal when you are well again. You also need a good emotional and sexual relationship. There is some useful information about maintaining good relationships here.

Diabetes is the most common cause of impotence. About half of all men with diabetes develop erection problems.

Given this news, many a man is so traumatized that his penis simply stops working from that moment on. Diabetes may also cause nerve damage, producing erection problems. 

Arteriosclerosis, which is the buildup of fatty plaque deposits on the walls of your arteries, may also impair your erection. Your penis simply can't get enough blood through the narrowed arteries to become erect.

High blood pressure is another factor. Of course it's a serious problem in its own right which frequently leads to a stroke and/or a heart attack, so have it checked regularly. 

If you're on kidney dialysis you might have some erection problems. Dialysis seems to deplete the body's store of essential minerals like zinc; this is necessary for a man's reproductive system to work properly. 

Sickle cell anemia can cause erection problems in black men. The deformed red blood cells characteristic of this condition can block the arteries supplying the penis or the veins leaving it, resulting in either non-erection or priapism. 

Injuries to the penis may affect its ability to become erect. Most well known is fracture of the penis, an unpleasant injury which can happen when an erect penis is suddenly bent sharply.

The resulting injury can damage the the walls of the erectile chambers, which then heal in such a way that the penis cannot become fully erect.

Sadly, about a third of all men who receive radiation treatment for prostate cancer develop erection problems because of radiation damage to the nerves involved in generating an erection.

And another prostate operation called transurethral resection, which is performed to alleviate problems associated with benign prostatic hypertrophy (i.e., non-cancerous enlargement of the prostate), produces erection problems in 10 to 15 percent of men.

Mid-life hormonal problems, mentioned elsewhere on this website, can cause erection problems. The shortage of testosterone can also make your penis shrink as it becomes erect less often.

Body builders or sportsmen who take anabolic steroids risk shutting down their own natural hormonal system. They usually lose their sex drive and stop having erections. Their penis may also shrivel up. They look big, though.

Smoking certainly isn't good for your penis. There's a clear correlation between smoking and non-erection, lower sperm counts, and depressed testosterone levels.

It's also been suggested that smoking will, over time, cause your penis to shrink.

Dr Pedram Salimpour, of Boston University, believes that smoking causes a loss of elasticity in the blood vessels of the penis, just as it does in the blood vessels of the lungs and heart. However, the vessels in the penis are much smaller, so constriction in this area may have much more severe consequences.

Environmental issues are always important these days in any health issue, whether this be a lack of those micro-nutrients known to play a role in a man's reproductive system, like zinc, or exposure to chemicals which can reduce his sexual potency, like pesticides.

Though how you can tell if you're not getting enough zinc, or you're overdosing on pesticides, I wouldn't know...... 

Drugs and alcohol can stop you getting erect. But I guess if you're already taking them, you know that anyway. What you may not know is that conventionally prescribed drugs are often the cause of declining sexual potency.

Drugs prescribed for anxiety, depression, ulcers, high blood pressure, among other things, can contribute to erection problems. For example, Tagamet, the brand name for cimetidine, an anti-ulcer drug, has been associated with erection problems. Guess what? Tagamet is one of the nation's most frequently prescribed drugs. 

Getting an erection problem after you've been given a drug to relieve stress seems somewhat ironic really, since the lack of an erection may well be even more stressful.

In case you're wondering, the prescribed drugs that can keep your penis from getting hard include: Barbiturates, hypnotics, tranquilizers like Valium, narcotics, both natural and synthetic, some high blood pressure drugs, some drugs used to treat angina, some drugs used to treat migraine headaches, ulcers, spastic colon, and glaucoma may impair erection.

In addition, tricyclic antidepressants and antipsychotic drugs also may affect erection. 

And here's a link to a site which explains how you might be able to cure erectile dysfunction and explains what causes it - physical causes & cures for erectile dysfunction - though of course, this may be harder if the erectile dysfunction is caused by diabetes or other physical problems like Parkinson's disease.

Psychological causes of erectile dysfunction

If your penis is regularly erect when you wake, or you can masturbate OK, but you can't get hard when you try and have sex with your partner, you probably have a relationship issue rather than a dodgy penis.

Even so, if your erections are fewer in number and not as hard as you'd like, you might want to get your system checked out by a doctor - particularly one who knows how to check male hormone levels. A prostate check-up is also a good idea for men over forty.

The first step is several lab tests: a glucose test to check for undiagnosed diabetes; a thyroid profile, because thyroid disorders may cause erection problems; a free and total testosterone test; and LH and prolactin tests - these are hormones involved in the erection process.

Your doctor should also order a study of penile blood pressure and possibly a penile arteriogram, a more sophisticated test of blood flow, to see if enough blood is reaching your penis to potentially raise an erection. 

If you never wake with a morning erection, your doctor should see if you have nighttime erections using a nocturnal penile tumescence test. That's a test which involves attaching a gauge to your penis to detect erections while you sleep.

If you're into Do-It-Yourself, you can simply get a row of gummed postage stamps, lick the ends and attach it snugly around your soft penis. If the perforations are torn in the morning, you've had a night-time erection. 

Whatever your doctor finds, the next step is to think about the emotional issues in your life that might be screwing up your erections. 

Strangely, erection problems often have the same cause as premature ejaculation: an excessive focus on performance and a perceived requirement on the man to perform.

 Whenever there is a focus on performance, the penis responds like an actor with stage fright - it stops performing smoothly, and sometimes stops performing at all.

So, simple as these suggestions may sound, they help many men rediscover their erections: relax, both in and out of bed; slow down your lovemaking; de-emphasize the role of the penis; try to develop a greater appreciation for whole-body sensuality; make love only when and how it feels right for you; and, above all, discuss any problems with your lover. 

Many types of fears and stress can be the cause of erection problems (especially if you're primed with drugs or alcohol). Having sex for the first time often kills a boy's erection.

Read what Dr Joseph Mercola has to say about erectile dysfunction.


Causes Of Erectile Dysfunction

unahppy man sitting on side of bedSo does having sex with a stranger, or someone who you don't really fancy - casual sex is really not as exciting for most people as popular culture suggests. And worrying about AIDS or disease may play a role in loss of erection.

If your lover ridicules you about your performance or your penis size, this can make you lose your erection: once that's happened, the fear of it happening again can be a potent erection killer.

Lastly, a very common situation where men lose their erections is putting a condom on: the answer is for the woman to do it for him. 

Stress kills men - it also kills their erections. Whether it's the pressure of a divorce, job loss, injury, illness, business reversals, feelings of growing old, or criticism by someone significant, these things can all contribute to non-erection. 

Even positive stress can be just as bad for a man's erectile capacity: a big job promotion, a sudden increase in responsibilities, or a cross-country move that uproots a man from old friends and familiar surroundings, will all have an impact on his sexual performance.

A lover's career success can also engender feelings of inferiority and self-doubt that might contribute to an erection problem. 

Depression is a major cause of erection difficulties. Which comes first, the depression or the lack of an erection, is not always easy to establish, of course, but the result may be the same: a man who withdraws into himself, rejecting his lover or sexual contact with her, out of fear that when he needs to "perform" he will not be able to.

A man may resent having to comply with his lover's demands or having to initiate sex all the time. He may get upset making love the same old way all the time.

And arguments about money, children, marriage, conflicting job schedules, sexual frequency, visits to relatives, or sharing the responsibilities in the household, can also take their toll on his erections. 

Even nowadays, in our supposedly enlightened times, men are not generally given permission to say "No" to sex. So how does a guy who doesn't want to make love turn a woman down without hurting her feelings?

Cure For Erectile Dysfunction

One thing's for sure - if he goes on accepting her offers of sex when he doesn't really want to, after a while his penis may begin to say no for him!

If you think you're under some kind of stress that may be causing your erection problems, what do you do about it? Well, first off, don't try and change everything at once.

 Take it one step at a time. For example, you might delegate just one responsibility on the job. You might stop having beer or wine with lunch or reduce your usual number of cocktails.

You might eliminate alcohol and substitute an after-work nap or swim or jog, some pleasurable reading or talk with a friend, or some stretching or meditation. Or you might consider making love at a different time, when you feel refreshed instead of tired - in the morning for example.

And give yourself time to work out what is happening: it isn't always very easy to identify the causes of stress if they're deep rooted and have been around in your life and relationship for a long time.

If you find it difficult to discuss your feelings or you take refuge behind a general emotional numbness of not feeling anything (or feeling "OK"), then discovering the joys of communicating about feelings with your lover can be beautiful or painful. Usually there are aspects of both.

You don't have to be particularly skilful or emotionally articulate to work things through with your lover - you just need to try. Being the strong silent type will solve nothing!

Evolving beyond that role means voicing both your positive and negative feelings about your relationship.

Developing trust in a lover means that each allows the other to be him- or herself without judgment or criticism. Above all, maintain your sense of humor, for laughter is a great way of dispelling tension! 

Unfortunately, a man's penis can cease to co-operate with him for many reasons. But what most men who lose their erection have in common is the downward spiral of depression and anxiety that starts after the first episode of erectile failure.

A man who worries a lot will tend to assume the worst when he can't get hard and may then develop higher levels of anxiety than one who is more laid-back - and his higher anxiety will cause his erection problems to get worse.

The same is true of the perfectionist and the performance-oriented man. When these personality types are combined with sexual inexperience, the chances of a man's erection failing are high. 

Other causes of erectile failure

Arousal has two components - physical and mental. As men get older, they require more physical stimulation for their penis to get hard. But some men learn early on in life to rely mostly on mental fantasy and stimulation to get horny - for example, watching porn, or watching their partner undressing, or thinking about what they'd like to do to whom: and this can become a problem later in life as they become more and more detached from their bodies as a source of arousal.

As all men over forty know, it becomes harder and harder to get an erection just by means of mental stimulation alone as time goes by - and if you never learnt how to respond to physical stimulation in the first place, you're likely to have a fairly major problem as you move into mid-life.

You may, in fact, not even know what is missing (physical stimulation) when you can't get hard. 

Another group of men who are likely candidates for soft penises are those who try and tune out their sexual feelings because they have premature ejaculation.

They may manage to do this so successfully that they completely lose touch with their sexual experience - and even with their ability to get an erection. 

Separating the physical and emotional causes of erectile failure

Often a man would never develop an erectile problem in the first place if only he had been more aware and better informed about how male sexuality - his sexuality - works. So, to clear up some myths and misconceptions:

  • Men should not expect to get an erection and have sex with any woman who is willing. If your penis doesn't get erect, it means something important (maybe you don't want to have sex with her?). As the old saying goes, "The penis never lies!"
  • Men may well get nervous before sex; it's not shameful to reveal this fact to a woman (e.g.: "I just have to tell you that you're so attractive and gorgeous, I feel anxious about being able to please you.")
  • Men do not have to take the sexual initiative all the time, nor be totally knowledgeable about sex; it is OK to ask a woman to help or to take the lead during sex. If she can't cope with this, that's her problem. In particular, it's OK to ask her to help you guide your penis into her vagina!
  • A man may not be able to get an erection if his partner is disinterested or tuned off. There's nothing more exciting for a man than a turned-on partner, and without a turned-on partner, his penis may stay flaccid.
  • Some men need to be in a committed relationship to be able to enjoy sex. Just as some women need to feel that level of commitment from their partner, so do some men. Even when a man thinks he is happy to sleep around and screw women who are available, his penis may reveal the deeper truth by staying resolutely soft when he tries to have casual sex.
  • Men over 30 or 40 often need physical stimulation (a soft mouth around their penis, a caress from a woman, or whatever) to get erect. That's one of the side-effects of ageing.
  • A man can enjoy intercourse with a penis that's not completely erect. See this page: Non-erect penis intercourse.
  • A man's erections naturally come and go during sex. This is not a crisis, it's natural! And this, incidentally, is true for men of any age, though it's more common as a man gets older.


Lastly, most men do not need penile implants - however much their urologist may tell them they do.

How women can cause erectile difficulties for men


In some cases, the use of Viagra will be a sufficient boost for a man to get over his temporary sexual anxiety and regain his sexual confidence. Other men may turn to a younger partner, begin watching porn movies, or give up sex altogether. But the real cure lies elsewhere.....

An alternative approach to sex

Stopping intercourse temporarily and focusing on alternative sources of pleasure is a good idea for a man who isn't getting erect. There's no performance pressure if you don't have to satisfy your partner vaginally.

For example, you don't need an erect penis to give her an erotic massage or to play with her breasts! This approach allows you the time to get reacquainted with the rest of yourself, and gives you time to play as many sensual games as you and your lover wish.

In short, your penis isn't your only sexual organ. You have fingers, hands, tongue, lips and every other part of your body as well - and using them may take the pressure off your penis.

Let your lover know what turns you on, and let her try it out, rather than thinking of sex as the penis-in-the-vagina-routine.

You may find that without pressure to perform, you respond much better than you expect. And she probably has a few things she'd like you to do to her, so try focusing on her rather than on your erection for a change.


Masturbation can be a very helpful way of getting back in touch with your sexuality and your erections.

But you need to approach it in the right way: with a relaxed attitude, knowing that what you are going to do is for your pleasure alone. You can make it a sensuous, relaxed experience, with oil to lube your penis, and time on your hands to ensure it is a slow and unhurried experience.

You can masturbate, relax, resume, watching your erection rise and fall - which, by the way, is what erections normally do during lovemaking - and you can play with your testicles, scrotum, nipples, anus and any other part of your body that you want to enjoy touching.

The difference between this approach and the more rushed approach to masturbation that most men have is this: you are enjoying your sexuality and getting in touch with your body and its feelings and needs.

Approach the vagina slowly

You may find your erection disappears the minute you approach your partner's vagina. There are several ways to lessen the chance of this happening. Above all, don't feel any performance pressure. Breath deeply, relax, and make the experience fun!

Approach her vagina slowly, as many times as you like. Let her rub her vulva along your penis and scrotum without any pressure on you to insert and thrust. Instead, lie back and let her take control of insertion, preferably using the woman on top position.

Take it all slowly. You don't have to get your penis fully in her right away - play with her. Enter only the outermost part of her vagina with only the glans of your penis. Tease her with small movements in and out. If you lose your erection, back off and enjoy more sensual touching and caressing before you try again.

Let her play with your testicles, nipples, anus, perineum, whatever. Suck her breasts, rub her stomach, play with her labia - above all, to repeat, avoid any pressure to insert.

And don't worry if your erection flags: what this probably means is that you need to be more aroused before you put penetrate her. (As I mentioned before, though, if your lack of arousal means you don't really want to be with her, this may have some implications for whether or not you stay together as a couple.)

What if this doesn't work?

Then you have the option of turning to a professional sexual therapist for assistance. In the United States, the Association of Certified Professional Sex Educators will be able to give you a name of a qualified sex therapist. Or you might want to try something more sophisticated such a sexual surrogate. This is a partner who knows how to draw out your sexual responses and overcome any inhibitions or problems you may have. For example: Tara Livingston. You could also do a search on Google for "sexual surrogate". 

If none of this works, there are still options open to you! 

There's also Erecaid, a suction-based device, which elongates the flaccid penis temporarily into an artificial erection. It's easily available on the internet, just do a search on Google for "Erecaid". Your health insurance may cover the cost. 

Testosterone replacement therapy

Testosterone is a crucial part of the sexual process in men, but it isn't always very easy to understand how it interacts with emotional factors. If you want to research this, and discover whether a lack of testosterone is affecting you or not, I strongly recommend you start by buying one or all of these books, which are currently the best popular works on testosterone deficiency available.

The Testosterone Revolution: Rediscover Your Energy and Overcome the Symptoms of Male Menopause by Malcolm Carruthers

The Testosterone Syndrome by Eugene Shippen and William Fryer

Androgen Deficiency in the Aging Male by Malcolm Carruthers


Other pages of penis problems

My penis is too large / too small
My foreskin is too tight
Problems with arousal
I can't get an erection
Urethral opening abnormal
Torn frenulum - breve
My penis is twisted
Erectile dysfunction
Penis problems solved!
Andropause & mid-life crisis
Penile problems & injuries
Yeast Infections
Sex addiction & obsession
Sexually transmitted infections
Testosterone declines with age

Other sections on the site

The penis, masculinity and sex
A Cultural History Of The Penis
Penile & Other Problems