Erection difficulties are sometimes referred to as ‘erectile dysfunction’ or ‘impotence’. They refer to any difficulties with getting or keeping erections. 

Occasional difficulties with erections are very common. Erectile difficulties can be caused by a range of physical and psychological contributing factors. It is useful to consider which of the following possible causes might be affecting you.

Physical causes include:

  • Vascular disorders (problems that interfere with blood supply to the penis) such as diabetes, high blood pressure and atherosclerosis (hardening and narrowing of the arteries)
  • Neurological disorders such as multiple sclerosis and stroke
  • Surgery (for example for prostate cancer) and radiation therapy
  • Drugs and medications prescribed to treat high blood pressure, depression, heart disease and cancer
  • Hormone levels, including the impact of low testosterone and/or supplemented oestrogen and progesterone that may be taken by trans women or nonbinary people
  • Lifestyle factors, such as smoking, alcohol and recreational drug use, and poor nutrition
     

Psychological causes include:

  • Stress, depression, and anxiety.
  • Tiredness
  • Worries about sexual performance, using condoms, and sexually transmitted infections (STIs)TIs
  • Not being aroused by the situation, feeling sexually bored, or other feelings about your sexual practices and partners
  • Relationship problems
  • Having other things on your mind and not being able to be in the sexual moment
  • Unresolved feelings about living with an STI or HIV
  • Beliefs about sex (for example, that it is shameful)
  • Body image concerns
  • Unwanted, or negative, previous sexual experiences 
     

It is important to have a medical assessment by an appropriately trained medical professional, such as a specialist in sexual problems, to ascertain the role of any physical or medical factors contributing to erection difficulties. Your GP may be able to help with this, or signpost you to a specialist service.

Changes in erectile function can be an early warning sign of medical problems, so it is important not to delay getting a medical check.