How to get and maintain an erection

An erection happens when increased blood flow fills the erectile tissue in the penis. Erections can happen through sexual stimulation or excitement, but they can also happen spontaneously.

When you’re aroused, your brain sends messages to the penis through your nervous system. The nerves signal the muscles in the corpora cavernosa (erectile tissue) to relax, allowing blood to enter and produce an erection.

Are there different types of erections?

Yes. There are 3 types of erections. These are known as:

• reflexogenic erections, which occur through direct physical stimulation
• psychogenic erections, which occur in response to thoughts or sensory cues
• nocturnal erections, which take place during REM sleep even when you are not sexually aroused

ED can be caused by various factors. These can be physical, such as underlying medical conditions, or psychological, such as stress or anxiety. According to Asda Online Doctor’s research, over 1 in 3 men report experiencing some form of ED.

Several factors can contribute to erection loss, and often more than one plays a role.

Physical health causes

Research shows that 90% of people experiencing ED have at least 1 underlying physical cause, such as:

• diabetes
• high blood pressure
• high cholesterol levels
• being overweight or obese
• other long-term health conditions

These conditions can damage blood vessels, making it harder to achieve or maintain an erection. Managing these conditions with the help of your doctor can help reduce the impact on erectile function.

Although ED can affect you at any age, it’s more likely to happen if you are over the age of 50. As you get older, your blood vessels can get weaker, so your body will find it difficult to maintain a good blood flow to your penis.

If you need help to bring these physical causes under control and treat ED, speak to a doctor to make a plan tailored to you.

Lifestyle factors

Lifestyle habits can also affect your ability to maintain an erection, including:

• smoking
• excessive alcohol consumption
• a diet high in fat, salt, and sugar

Studies show that weight loss, regular exercise, quitting smoking, and improving diet can significantly improve erectile function, especially in men with obesity or metabolic syndrome.

Changes in medication

Some medicines can affect erections or libido. If you notice changes after starting a treatment, speak to your doctor or pharmacist for alternatives.

There are many medications and drugs that can have side effects that make it difficult to get an erection. These include:

• antihistamines
• certain blood pressure medicines, such as beta blockers
• chemotherapy medicines
• certain painkillers containing opiates
• recreational drugs such as alcohol and illegal drugs

Psychological causes

Psychological factors, such as stress, anxiety, and depression, can impact your ability to maintain an erection. Research has shown a significant link between anxiety disorders and ED.

To manage psychological causes, you can try:

• deep breathing exercises to calm the mind
• relaxing warm baths or showers
• gentle stretches to relieve muscle tension

You might also find that practising mindfulness and controlled breathing may help. Research suggests these methods can reduce anxiety and improve overall emotional wellbeing. Since stress can negatively affect sexual performance, these techniques may help some people feel more relaxed and focused.

Medication that can help with getting and keeping erections

Medications like Viagra, sildenafil, and Vitaros cream can improve erectile function by increasing blood flow to the penis when sexually aroused.

Tablets

Tablets such as Viagra and Spedra work by inhibiting the enzyme phosphodiesterase type 5 (PDE5), which helps relax the blood vessels in the penis, improving blood flow when you're sexually aroused. They typically take 30 to 60 minutes to work, except Spedra, which works in 15 to 30 minutes.

Tablets include:

• Viagra (sildenafil and Viagra Connect)
• Spedra
• vardenafil
• tadalafil (brand name: Cialis)

To take them, you should swallow the tablets whole with a drink of water around 1 hour before any sexual activity (except for Spedra, which works faster). ED medications will not work on their own and require sexual arousal. You should not take them with grapefruit juice, as it could affect the way the medication works.

The effects of ED medications typically last from 4 to 5 hours, with the exception being tadalafil (also found under the brand name Cialis), which can last up to 36 hours. If you take ED medication and get a painful erection, especially if it lasts more than 4 hours, you should speak to a doctor or go to A&E straight away.

Cream

Vitaros cream, which contains alprostadil, can be used as an alternative to tablets if you're unable to swallow pills or if they contain ingredients that may be harmful to you (such as things you’re allergic to). It works faster, typically within 5 to 30 minutes, and is effective if you have nerve damage. You apply the cream using a small, single-use applicator, which delivers the cream directly to the opening at the tip of your penis (the urethra).

Psychotherapy

Psychotherapy can help address the emotional factors affecting erectile function by providing a safe, supportive space to explore underlying issues. Therapy sessions typically involve discussing concerns such as performance anxiety, stress, and relationship dynamics.

By working with a trained therapist, you can learn more about what might be causing your ED, learn to think about intimacy in different ways and find out about ways to communicate with your partner.

You can speak to a doctor to find out more about sex therapy or find a private therapist through the College of Sexual and Relationship Therapists.

If you're struggling with ED, medications are available to help. These treatments can include:

➤ You can order ED treatments from Asda Online Doctor, with a discreet and convenient delivery service.