“I couldn’t perform in bed tonight.” 

“I’m worried about my sexual performance.”

“I love my wife, but I just can’t perform anymore.”

Notice anything here? When it comes to the penis, and the language we use to describe it (and the owner) during sex, I’ve always found this word fascinating: “perform.”

There’s so much shame around the inability to get and stay hard – an incredibly common experience for penis owners. And yet, baked into the language is an expectation that your penis is there to put on a show. Why? When your stomach hurts, do you berate it for not “performing?” 

Just like all of the other organs in your body, your penis is gonna do its thing. And while I’d love to exit the word “perform” from the conversation, I do get it – you want to get an erection, and you want to be able to keep it. So let’s talk about it! 

Erectile dysfunction (the clinical name for this) is a spectrum disorder, meaning that it may happen to you all the time, every once in a while, or somewhere in between; it can manifest in not getting hard at all, or not staying hard after you’ve gotten an initial erection. Let’s have a quick look at the science, the reasons you’re not getting or staying hard, and what you can do about it. 

Crash Course: Why A Penis Gets Hard

In short: because the arteries inside of it swell with blood. 

That blood fills two tubes of spongy tissue in the penis (the corpus cavernosa), they swell, and the penis gets bigger and stiffer. To cap it off, veins narrow, “trapping” the blood in and keeping the penis hard. 

When someone can’t get or maintain an erection, it’s either because of insufficient blood flow to the penis – meaning, their arteries aren’t pumping enough blood in – or, there’s too much blood flowing out of the penis, because their veins aren’t compressing enough. 

So there’s that! Now let’s discuss…

Reasons You’re Not Getting or Staying Hard

Erectile dysfunction can absolutely stem from a mental source. In fact, 10-20% of ED causes are psychological, and they include stress. 

When I spoke with Dr. Edward Karpman on the show, he talked about our body’s fight or flight response, and how stress directs blood away from the penis. That’s because our bodies still carry our ancestral DNA, and thousands of years ago – when we encountered a saber tooth tiger, for example – we needed that blood to immediately reach our arms and legs, to fight off a predator. Fight or flight turns off much of the blood flow in other places, like your stomach for digestion, or your penis for sexy times. So if you’re about to hook up, and feeling nervous – be patient with yourself, and take deep breaths. Doing so will stimulate your parasympathetic nervous system, which is the opposite of fight or flight. It reminds your brain and body that everything is cool.

Now, let’s touch on the remaining 80% of the reasons underlying ED, which are physiological – because at the end of the day, this is a blood flow issue. They include:

• Heart disease
• Smoking or drinking
• Diabetes
• Obesity
• High blood pressure
• Certain medications
• Surgeries
• Injuries
• Clogged blood vessels
• High cholesterol

Now I know what you’re thinking: that’s a long list! But as Dr. Karpman told me, there’s a huge relationship between heart health and penis health. And, so many of the risk factors on this list stem from your heart, the hard-working organ pumping blood everywhere. So knowing that, let’s talk…

What To Do 

Alright, so now you know some of the culprits behind ED. What’s a penis owner to do? Here are five ideas.

• Exercise. Regularly! You’ll have a third lower risk of developing ED if you do so. This improves your heart health, the integrity of your arteries and veins, and makes it easier for blood to fill and stay in your penis. 
• A cock ring. Your veins are doing their best to keep the blood in, but a cock ring gives it a little boost. They tend to work best when you’ve already had an erection and want to hang onto it. 
• Talk to your doctor. I know I know, this is always the advice. But certain medications, like anti-depressants, can affect genital arousal. See what he or she has to say! 
• Medication. While you’re talking to your doctor, you can ask about medication options for ED. Just keep in mind that there can be side effects (usually pretty mild), and Dr. Karpman recommends a holistic approach: medicine is fine, but it’s a good idea to get your heart health checked out and exercise too. 
• Shockwave therapy. It’s a thing! Low-intensity shock waves are applied all over the penis, and as Dr. Karpman mentioned on the show, there’s some evidence that the treatment stimulates stem cells. 

Listen – all penis owners may experience ED at some point, so please know that it’s normal – and certainly not a death sentence for your sex life. By understanding its causes, you can now seek out solutions. Good luck!