Erectile function — what works, what doesn't, and what to try next

Erectile problems are common. About half of men older than 40 have some degree of difficulty getting or keeping an erection. That doesn't mean you have to accept it. Many causes are treatable, and a few simple changes or tests can point the way forward.

Common causes and quick checks

Think in three buckets: blood flow, nerves/hormones, and mind. Blood flow problems come from high blood pressure, diabetes, smoking, or clogged arteries. Nerve or hormonal issues can follow surgery, injury, low testosterone, or certain medications. Stress, anxiety, depression, and relationship problems often make things worse. A quick home check: morning erections are a clue — if they’re present, physical causes are less likely and psychological factors might be bigger.

When you see a doctor they often do simple tests: blood pressure, fasting blood sugar, cholesterol, and a testosterone level. Sometimes a urine test or basic heart check is added. If needed, providers may order a penile ultrasound or refer you to a urologist for more testing.

Practical steps that really help

Start with lifestyle fixes that improve erections and overall health: stop smoking, cut heavy drinking, lose extra weight, and add regular aerobic exercise. Those changes boost blood flow and energy and often improve results from other treatments.

Oral pills known as PDE5 inhibitors — sildenafil (Viagra), tadalafil (Cialis), and vardenafil — work for many men. They boost the natural response to sexual stimulation. Note the basics: sildenafil and vardenafil usually start working in 30–60 minutes and last hours; tadalafil can last up to 36 hours. Don’t take these with nitrates (common in chest pain meds) — that combo can dangerously lower blood pressure. Expect possible side effects like headache, flushing, nasal congestion, or upset stomach.

If pills don’t help, there are other real options: vacuum erection devices that use gentle suction, penile injections (usually alprostadil), intraurethral suppositories, and surgically implanted prostheses for long-term solutions. For men with low testosterone, replacement therapy can help when levels are clinically low, but you should discuss risks and benefits with a clinician.

Psychological causes respond well to talk therapy or couples counseling. Performance anxiety is common; simple breathing, sensate-focus exercises, and guided counseling often remove the pressure and restore natural function.

Small practical tips: try a PDE5 inhibitor more than once — many doctors recommend several proper attempts before calling it ineffective. Take the pill with time to work, avoid heavy meals or excess alcohol beforehand, and keep a current list of all medicines to check for interactions.

Get urgent help if you have sudden severe pain, an erection lasting more than four hours (priapism), or sudden loss of sexual function after chest pain or new medication. Otherwise, make an appointment with your primary care doctor or a urologist. Fixes range from lifestyle tweaks to simple pills and devices, and a clear plan usually leads to better erections and more confidence.