How to have sex with ED: 10 tips & strategies

One of the hardest (no pun intended) parts of having erectile dysfunction (ED) for many heterosexual men is the concern that they may not be able to satisfy a woman. They may wonder how to have sex with ED at all. 

If you have ED, we’re here to tell you it is absolutely possible to have satisfying sex — for both you and your partner — no matter your condition. With reliable and safe ED treatments, along with some other key strategies, great sex (yes, even with ED) can be within reach for most men. Keep reading to learn more. 

The short answer is yes. With treatment (and sometimes a little creativity), a man with erectile dysfunction can satisfy a woman. 

One study surveyed women whose male partners had ED to find out about their levels of sexual desire, arousal, and orgasm. The study found that women’s sexual satisfaction — and even their arousal levels — are greatly impacted by their partner’s sexual function. But treatment can make a big difference. The women whose partners took medication for ED had significantly higher levels of sexual satisfaction than those whose partners had untreated ED. 

Another study looked at heterosexual couples in which the male partner had ED for at least 16 months. It showed that untreated ED can damage relationships and communication on sexual topics between couples. On the other hand, when ED is treated with medication and mental health counseling, damage can be reversed, relationships can be strengthened, and sex can be satisfying once again. 

And need not forget that penetrative sex is not the only way to satisfy your partner. “Remember that if your partner has a vulva, she likely requires clitoral stimulation to achieve an orgasm,” says pelvic health expert Rachel Gelman, PT, DPT, CSC. “So often, she wants you to stimulate other areas of her body that do not require an erection.”

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Most men with ED can still get hard with the help of medical treatments. 

The drugs most commonly prescribed for ED are Viagra (sildenafil) and Cialis (tadalafil). They’re part of a drug class called phosphodiesterase type 5 (PDE5) inhibitors. 

One review article showed that sildenafil can help up to 87% of men get better erections. A similar review of tadalafil showed that up to 84% of patients reported better erections on this drug. (Other studies report success rates anywhere from 60 to 80%, but in general, PDE5 inhibitor treatment for ED is more successful than not.)

Of course, everyone’s experience is different. But if you have ED, there is certainly hope for your erectile function to improve with treatment. 

The TLDR on how PDE5 inhibitors work? They allow more blood to flow into the penis (and stay inside for longer), which can allow an erection to happen. But let’s dive a little deeper. 

How PDE5 inhibitors help you get hard

PDE5 inhibitors have that name because — you guessed it — they inhibit (or block) an enzyme called phosphodiesterase type 5 or PDE5. We have to back up a bit to understand why that’s important for erections. 

When someone with a penis gets aroused, powerful signals trigger the release of nitric oxide in the penis, which causes a chemical called cGMP to ramp up production. cGMP tells the muscles and blood vessels in the penis to relax and widen, which helps blood flow into the penis. The blood then gets trapped in the penis (in a good way), allowing the penis to harden. 

After some time, ideally after a satisfying sexual experience and an orgasm, the enzyme PDE5, which is naturally present in the penis, breaks down cGMP. This causes the smooth muscles to contract again and the blood to drain out of the penis.

With ED, problems arise when there isn’t enough cGMP or nitric oxide signaling. So, by blocking PDE5, ED medications help preserve cGMP,  making it more likely for that extra blood to flow into the penis and stay trapped there long enough for sex.

If you’ve been struggling with ED for a while, you might be feeling like a pleasurable sex life is out of reach. It’s definitely not! There are many different things you can try and explore to regain a great sex life, including:

1. Focus on the mind-body connection

The mind is a very powerful player when it comes to sexual pleasure.

“Anxiety, especially performance anxiety, is one of the most common barriers to pleasure,” says board-certified urologist Justin Houman, MD, FACS. “I often recommend techniques like guided breathing, mindfulness, or even short-term therapy to help men stay present during sex instead of focusing on performance.”

If your ED is causing you to get a bit too much in your head or your stress levels are high, that can really diminish your ability to enjoy the moment. Try to prioritize techniques that allow you to be mindful and present with your partner.  

2. Redefine what sex means

Penetrative sex isn’t the only way to have a pleasurable sexual experience. “Remember, sex is so much more than penetration, and that sex doesn’t need to end just because someone ejaculated or no longer has an erection,” Gelman says.

Dr. Houman sees another example of this at play. “Many men skip or rush foreplay, which is a huge mistake,” he says. “Spending time on extended arousal increases blood flow, builds emotional connection, and often leads to more intense orgasms for both partners.”

Sensual touch and movement can be highly pleasurable experiences. Don’t be afraid to explore the full range of erogenous zones with your partner. 

3. Try different positions and timing

It’s a good idea to play around with different positions and timing of sex, as these factors can make a difference for some men. 

“Everyone is different, but if certain positions are more stimulating for the man, that can help with maintaining an erection,” Gelman says. For example, “the receiving partner can play around with keeping their legs closer together to apply more pressure to the penis or putting pillows under their hips to help change the angle.”

Timing of sex can also make a difference for many men with ED, according to Marina Voron, PhD, LMFT, CST-S, a couples and sex therapist. 

“There are people who experience more stress in the morning and thus have a harder time performing in the morning,” Dr. Voron explains. “But their stress reduces as the day moves on, and the likelihood of erection and reduced stress around sex reduces.” 

Some people have the opposite experience, waking up feeling energized and positive. This makes morning “their optimal time to have sex,” Dr. Voron says. 

As the day progresses, however, their stress builds and energy reduces. “So it is harder for them to perform later in the day,” she explains. 

Keep in mind that it can take some experimenting and patience to figure out what works for you. But discovering your ideal time for, well, sexy time can boost your bedroom activities with (or without!) ED.

4. Be open with your partner

“Many men have never been taught how to talk openly about what they like or what they need,” Dr. Houman says. But open communication can help you find different things you and your partner like (or dislike). 

Dr. Houman encourages his patients “to reframe sex as a shared experience, not a test.”

“When couples communicate about pleasure, arousal, and expectations, the quality of sex usually improves dramatically,” he explains. 

5. Work with a sex therapist

ED can come with strong emotional components, and sex therapy can be hugely beneficial, both individually and for couples.

“Sex therapy can help individuals with ED by working through the common feelings of shame, guilt, and performance anxiety,”  Dr. Voron says. It can also help them “build more self-esteem and sexual confidence.” 

The same benefits apply to couples in sex therapy, but run even deeper.  Through counseling, couples can improve their communication around sex and ED. This can help “reduce stress and pressure and expand their sexual repertoire and definitions of sex, intimacy, and pleasure,” according to Dr. Voron.

6. Speak with your healthcare provider

If you have persistent ED, it’s important to speak with a qualified healthcare provider because there might be something else going on. 

“ED is often the first sign of underlying vascular issues, so I always emphasize lifestyle optimization like nutrition, exercise, and stress management because pleasure starts with health,” Dr. Houman says. 

He adds that sleep quality and testosterone levels are essential pieces of the puzzle. “Poor sleep or low testosterone can kill libido.”

7. Get your blood flowing

Erections can’t happen without proper blood flow to the penis, so it can be helpful to focus on different ways to get your blood flowing. 

One way to do this is through masturbation, but without a focus on orgasm.

“Self-stimulating without the goal of an orgasm can help promote blood flow into the penis and the nerves, which can be helpful for overall penile health,” Gelman says. She recommends slowing down and bringing your attention to pleasure, instead of just focusing on getting to the “finish” line. 

Another way to get your blood flowing is through good old-fashioned exercise. 

“Getting your heart rate up gets blood flowing everywhere,” Gelman says. And this includes to your penis, where healthy blood flow is essential for getting and keeping an erection. 

Make sure to talk to your healthcare provider before starting any drastic changes to your routine. Sometimes, with exercise, it can be helpful to begin with light-to-moderate activity and ramp up over time.

8. Explore using devices

Some men with ED may find it helpful to use toys or vibrators during sexual activity to help maintain their erection. 

“Penile rings [for example] can help with sustaining an erection, and ones that have a vibrator attached to them can be helpful for everyone involved,” Gelman says. 

Make sure you are using devices safely and as directed. Sometimes, using devices for too long or in an unsafe manner can injure the penis. That being said, devices can be a good option if you’re concerned about your partner having a pleasurable experience despite your challenges with ED. That is, of course, when they’re used safely. 

9. Strengthen intimacy outside the bedroom

When sex becomes something that only lives in the bedroom, many couples can wind up in a rut — and this can get compounded by ED. 

“Don’t expect to have great sex if you aren’t touching and being intimate in small ways continuously outside the bedroom — kissing, hugging, hand holding, and cuddling all fall into this category,” Dr. Voron says. “These make you feel closer and help ‘warm the oven’ [for sex].”  

This beyond-the-bedroom closeness is what Dr. Voron calls “touch intimacy.” But being physical is only half of the equation. The other part? Connecting emotionally. 

“The more couples communicate about sex — anything ranging from fantasy to scheduling sex to fit into the week's busy schedule — the more likely they are to feel sexually comfortable and secure around each other,” Dr. Voron explains. This increased sense of safety and openness is key to intimacy and approaching harder sex-related topics, such as ED. 

10. Try ED medications

Of course, as we’ve discussed already, ED medications can be an excellent option for many men dealing with erectile dysfunction. They are safe for most people, come with few side effects, and work well for most men who take them. 

Even though ED drugs are at the end of this list, this is truly a last-but-not-least situation. In other words, they should not be seen as a last resort. In fact, they’re generally considered first-line treatment for ED. So if you are dealing with the condition, consider discussing ED medication as an option with your healthcare provider.

Common PDE5 inhibitors include:

• Viagra (sildenafil)

• Cialis (tadalafil)

• Vardenafil

• Stendra (avanafil) 

In addition to these oral pills, some PDE5 inhibitors can be found in newer formulations, such as:

• Ro Sparks: a sublingual (under-the-tongue) lozenge that combines sildenafil and tadalafil (the active ingredients in Viagra and Cialis, respectively) for fast-acting treatment. 

• Daily Rise Gummies: fruit-flavored gummies featuring tadalafil that are meant to be taken every day, thereby increasing spontaneity. 

While the last two options aren’t approved by the US Food and Drug Administration (FDA), they contain active ingredients that have been individually FDA-approved for ED. 

If your healthcare provider thinks ED medication is appropriate for you, it can work well alongside any of the other lifestyle-based techniques and tips discussed above. 

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So, can a man with erectile dysfunction satisfy a woman? The answer is a resounding “yes.” Even with ED, it is possible to have a satisfying sex life — for you and your partner. You just might need to employ a few simple strategies to make especially sure sexy time goes off with a hitch. Here’s what to remember: 

• Not only is it possible, but sex with erectile dysfunction can be fully pleasurable for you and your partner. You just may need to employ a few different tactics, ranging from bedroom techniques to medical treatments and lifestyle changes. 

• ED medications like Viagra and Cialis can be highly effective at treating ED and can allow for satisfying sexual activity. 

• The mind plays a big role in strong erections and sexual satisfaction. So, managing stress levels and focusing on mindfulness techniques can help you be present with your partner and make a difference in the bedroom. 

• Other strategies for having sex with ED include working with a therapist, practicing open communication with your partner, trying different positions, using toys, and following a healthy lifestyle (e.g. exercising).