Difficulty Maintaining an Erection

Erectile dysfunction can have both physical and psychological causes. Understanding these issues can help treat ED.

When me and my girlfriend are fooling around she tries her hardest to make me hard but I never end up hard. Why is this?

Dr. Owens at Sexualhealth.com: You are probably trying too hard to get an erection. Do you have erections at nighttime or in the morning, and can you get erections by masturbating? If so, you have little to worry about. First of all, your problem is very, very common, and there is a very good chance that it will disappear altogether once you are less nervous. It is basically a physiological reaction. When you are nervous, your body produces adrenaline, which reduces the blood flow to your penis and makes it difficult to get an erection. Erections happen when blood rushes to the penis, allowing it to swell up. So the trick for you will be to try to be less nervous.

One way you can accomplish this is to get to know your partner and feel more comfortable around her. It takes a while to become comfortable and to begin enjoying sex. Sex is not just a physical stimulation of the genitals. The mind is playing a very important role. The more comfortable you are with your partner and yourself, the better will your sexual experience be. This usually takes time in any relationship. Be patient, and allow yourself the time to let your relationship develop. Do not rush into having intercourse.

There are many other ways of showing your affection and caring and you do not need an erection to do so. By the way, your partner may be as nervous as you are. Allow yourself time just to kiss and explore each other without focusing so much on intercourse. Also be sure that once you are having intercourse, to feel comfortable with the birth control you are using. Condoms are not 100% safe, and there is a small chance of becoming pregnant, despite the use of condoms. This thought alone can be so powerful and frightening to some that they loose their erection. So be sure to discuss appropriate birth control methods with your partner, such as the use of birth control pills in addition to condoms.

Dr Owens, please help!!!! I am a 37 yr. old male and I have a 24 yr. old girlfriend. We get along just great the first few months of our sex life. it was all the time and strong. Lately I've been having a problem with maintaining an erection. Mentally I want her all the time but physically I can't perform the way I want to. She is understanding but I feel bad. I compensate by starting out giving her oral sex to get her to her orgasms in hope of maintaining an erection long enough to further satisfy her. Please any help you can provide medically or naturally. Thanks in advance.

Dr. Owens at Sexualhealth.com: How are your erections at nighttime or when you wake up in the morning? Have they changed from earlier times? How about when you masturbate? If you have noticed that your erections have become less strong in all three situations (morning/night, masturbation, when you are with your girlfriend), I recommend that you see your doctor. In this case, there may be an underlying reason affecting your general health, as for example, diabetes. A physical exam and a few lab tests would reveal much information.

Your doctor can also evaluate, whether you could take one of the three FDA approved oral treatments, Viagra, Cialas, or Levitra, in order to improve your erections. If your erections are only changed when you are with your girlfriend and unchanged during masturbation and in the mornings/at night, your problem probably has psychological roots. It may be that you feel a pressure to perform with your younger girlfriend and that this pressure has a negative effect on your erectile capabilities.

I suggest that you read the chapter "Resolving Erection Problems with Sex Therapy" in the book, The New Male Sexuality by Bernie Zilbergeld. I can highly recommend this book to you. Also, when you have sex, try not to focus too much on intercourse. Take some of the pressure off. You are already doing good by including oral sex and bringing her to orgasm that way. Give each other massages, take a bath together, watch an erotic movie together or use a vibrator or other sex toys. Check out Sexualhealth.com for inspiration.

There are countless things you can do and enjoy together without having an erection and intercourse. Just use your imagination. Once you focus less on intercourse and the quality of your erections, your erections may improve. At the same time you may enjoy expanding your sexual repertoire! Good luck!

The brain may be the most important sexual organ, but sometimes insertion is nice as well. What do you suggest for people who don't have, or can't sustain, erections?

Mitch Tepper at Sexualhealth.com: When insertion is desired, there are at least five options--listed from the least invasive and lowest risk to the most invasive and highest risk: 1. The "stuffing" technique is an option for anyone. If you experience reflex erections, stuffing the penis into the vagina or anus while your partner provides stimulation may cause erection and help maintain it. Often both partners are satisfied with this sexual activity whether an erection is attained or not. 2. Erection requires increased blood flow to the penis and restricted blood flow out of the penis. A constriction device--usually a ring of rubber, metal, silicone or leather--can help maintain an erection. Use plenty of water-based lubricant to avoid skin breakdown when applying the device, and make sure the fit allows some blood flow. Don't leave it on for more than 30 minutes. 3. Vacuum erection devices have been successful with many men. A cylinder is placed over the penis and a pump is used to create a vacuum and draw blood inward. Then a constriction device is used to trap the blood in the penis. 4. Injecting a medication such as papaverine directly into the shaft of the penis has been very effective with men who have difficulty attaining an erection. Risks include bruising, scarring at the injection site and priapism--an erection that lasts for many hours. This method requires a prescription and training from your urologist. 5. Surgical implants--semi-rigid rods or inflatable tubes inserted in the shaft of the penis--permanently alter the erectile tissue and carry considerable risks including long-term infection, erosion of the device through the skin, malfunction and the need for replacement. Surgical implants are the option of last resort. Make sure you consult a doctor who is familiar with your disability and all the options listed above. Beware of the doctor who prescribes only one option or who primarily performs implant surgery.