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Why Can’t I Get an Erection?

Like the stock market and foreign-car engines, erections are mysterious things that seem to have a mind of their own. When they don’t happen, it can be hard (so to speak) to figure out why. But these answers should help.

Is It All in My Head?

Probably not. Most cases of erectile dysfunction (ED) are caused by physical problems or a combo of physical and emotional ones.

Decreased blood flow -- in particular, narrowing of the vessels that supply blood to the penis -- is often the cause of ED in older men.

Emotional issues are more often a cause with younger men.

Regardless of the reasons, ED can lead to performance anxiety, depression, stress, and guilt. So it’s important to look for answers.

Is the Problem Physical or Psychological?

Stress, anxiety, and depression can cause ED. Do you have erections in the morning or while sleeping? If so, the problem probably is not physical. If you’re not sure, there are tests available to check for nighttime erections.

Just about any medical condition that affects your nerves or blood vessels could hurt your ability to have erections. A doctor can help you find out if a health condition is involved in your ED. You’ll be asked about your symptoms and medical history. The doctor may also run some tests.

High blood pressure, heart disease, multiple sclerosis, and diabetes can all lead to ED. In fact, as many as 60% of men with diabetes have problems with erections. Hormonal issues such as low testosterone levels can also factor in, more often in older men. Prostate cancer treatments (surgery, radiation) can also cause ED.

Can I Blame My Medicines?

Maybe. Several types of medications, like blood pressure drugs (especially beta-blockers) and certain antidepressants, can make it tough to get an erection. If you think your medicine may be causing your problem, don’t just stop taking it. Talk to your doctor. You may need to switch to something different, or consider taking an ED medication too.

Could My Lifestyle Play a Role?

Absolutely. Being overweight, getting too little exercise, and smoking all can work against the good blood flow that is key to erections. And while for some men, a little alcohol may help take the edge off, too much, as Shakespeare wrote, “provokes the desire, but it takes away the performance.”

How About My Age?

Aging doesn’t cause ED, but ED is more common in older men. According to the National Institutes of Health, about 4% of men in their 50s and almost 17 percent of those in their 60s are unable to get erections. For men older than 75, the percentage rises to 47%. Treatments can help men of any age.

What Can I Do?

Experts agree these are good first steps:

Then talk to your doctor about your options.

ED medications -- sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) -- are usually effective and can help whether your problem is performance anxiety or poor blood flow.

Self-injections, vacuum devices, and squeeze pumps implanted under the skin are other options.

For men with low testosterone, replacement therapy may help, though it won’t necessarily solve the ED.

Counseling can help you work through any relationship or emotional troubles that may be in play.

WebMD Medical Reference

Reviewed by Arefa Cassoobhoy, MD, MPH on December 24, 2013
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