Skip to main content

Why do I lose my erection so fast?

14 min read

Written by: 

Jamie Ballard

Reviewed by: 

Peter Schlegel, MD, FACS

 and 

Raagini Yedidi, MD

Updated:  Feb 27, 2025

Verified Badge

Reviewed By

Peter Schlegel, MD, FACS

Peter Schlegel, MD, FACS, is a Ro Advisor, board-certified urologist, and male fertility expert.

View bio

Key takeaways

  • Occasionally losing your erection during sex can sometimes be attributed to temporary factors, such as fatigue or alcohol consumption and may not necessarily mean you have ED

  • Losing an erection during sex more frequently may be due to a wide variety of factors, including vascular disease, low testosterone, psychological factors, obesity, or nerve damage, among other potential causes. 

  • Options that can help in maintaining your erection during sex, depending on underlying factors, include lifestyle changes, oral medications, injections, and hormone replacement therapy. 

Here's what we'll cover

Here's what we'll cover

Key takeaways

  • Occasionally losing your erection during sex can sometimes be attributed to temporary factors, such as fatigue or alcohol consumption and may not necessarily mean you have ED

  • Losing an erection during sex more frequently may be due to a wide variety of factors, including vascular disease, low testosterone, psychological factors, obesity, or nerve damage, among other potential causes. 

  • Options that can help in maintaining your erection during sex, depending on underlying factors, include lifestyle changes, oral medications, injections, and hormone replacement therapy. 

Picture this: You’re getting intimate when your erection suddenly decides to, err, leave the party. Sure, just thinking about this scenario might make you feel uncomfortable. But losing an erection during sex isn’t something to be embarrassed about. If it happens frequently, though, it’s only natural to start wondering, “Why does my erection go away so fast?” or “Why can’t I stay hard during sex?”

Unfortunately, there’s no one-size-fits-all answer to such questions. (That would make life just too easy, huh?) There are plenty of potential reasons for losing your erection during sex, including stress and anxiety, certain medications, vascular issues, hormonal imbalances, and drinking too much alcohol. And while occasionally struggling to stay hard isn’t typically characterized as erectile dysfunction (ED), frequent loss of an erection during the excitement phase can be a sign of the condition. The good news? Losing an erection during sex can be a highly treatable issue. 

Ahead, we break down many possible reasons for losing an erection during sex, clues your difficulties may be due to ED, and some available treatment options. 

Have better sex with Ro

Why can’t I stay hard during sex? Reasons for losing an erection

The short answer: It depends, as there are many reasons for losing an erection during sex. 

But first, let’s review how an erection works. When arousal occurs, the brain sends signals through the spinal cord and nerves, triggering the release of a messenger called cGMP. This relaxes smooth muscle in the penis and allows blood to flow in. Meanwhile, the veins that drain blood from the penis are compressed, which encourages blood to stay in the penis and results in an erection. 

Clearly, several bodily processes are involved in getting and maintaining an erection. Your head, heart, hormones, blood vessels, and so much more have to work in tandem—and if any of these systems are interrupted or fall out of sync, it can result in the loss of an erection. 

As mentioned above, there are multiple answers to the question, “Why can’t I stay hard during sex?” Some possible causes include: 

If you find yourself losing erections during sex, it may be worth considering whether one or more of the above factors might be affecting your hard-ons. Maybe you had a long work week and just couldn’t shake the lingering stress during Friday night’s sex session. Or perhaps you just started a new medication, and it can have certain sexual function-affecting side effects. 

While causes like relationship issues and lifestyle factors may be easier to identify and address on your own, consulting a healthcare provider is always a good idea. They’re best equipped to determine what physical and/or psychological factors may be causing your challenges and help you navigate from there. Clues a healthcare provider may use to determine whether the loss of erections is more psychological or more of a physical change include observations of erections that occur independent of sexual stimulation. For example, men who have hard morning erections but difficulty maintaining an erection during intercourse likely have no physical or medical issue but are “spectatoring”—changing a normal physical response by observing it too closely.

Does losing an erection during sex mean I have erectile dysfunction?

It may…but it also may not. If you occasionally struggle to get or maintain an erection during sex, that’s not necessarily the same thing as having erectile dysfunction (ED). “Losing an erection during sex can be a sign of erectile dysfunction, but it’s not always the case,” says Justin Houman, MD, a board-certified urologist and an assistant professor of urology at Cedars-Sinai Medical Center. “Occasional difficulties maintaining an erection can happen to anyone, especially if stress, fatigue, or distractions are at play. ED is typically diagnosed when the issue becomes persistent and interferes with your ability to have satisfying sexual activity most of the time.” 

Other common symptoms of ED include difficulty getting an erection in the first place or reduced libido. Regular trouble keeping an erection can also be a symptom, so if this is happening to you frequently, it might be time to talk to a healthcare provider about ED. Always tell your healthcare provider if you have painful erections, as this could be a sign something else is going on, such as an infection or another disorder like Peyronie’s disease.

12 reasons an erection doesn’t last 

There are plenty of potential causes for losing your erection during sex, from psychological barriers to physical issues. While losing an erection during sex doesn’t necessarily mean you have ED, many of the reasons an erection doesn’t last, like stress or excessive alcohol use, are also linked to the condition. The two separate problems—losing an erection during sex and erectile dysfunction—may share root causes. From plain old stress to cardiovascular disease, here are 12 potential reasons you might be losing your erection while you’re having sex. 

1. Stress

Everyone gets stressed sometimes. For people with penises (typically men), this can lead to losing your erection during sex. Stress can interrupt the signals between your brain and body and make it more challenging to maintain or get an erection. 

A 2019 study found that chronic stress can contribute to atherosclerosis, which is the hardening and narrowing of the arteries. This condition results in decreased blood flow throughout the body, including to the penis. Without adequate blood flow, it’s pretty much impossible to maintain an erection. Plus, being stressed doesn’t exactly put anyone in a sexy state of mind. 

2. Depression

Depression is another potential contributor to losing an erection during sex—after all, the link between the mental health condition and erectile dysfunction is well-established. For example, a systematic review of nearly 50 studies found that the odds ratio of ED increases when depression is also present. But, as mentioned above, losing an erection during sex doesn’t necessarily equate to having ED. It can, however, suggest broader sexual dysfunction, especially when it happens frequently. And guess what? Another review found that individuals with depression had a 50–70% increased risk of developing sexual dysfunction, a syndrome that often involves difficulty maintaining an erection during sex. 

One possible explanation is that patients with depression tend to engage in negative thoughts, which can result in performance anxiety and impaired erectile function. Another is that depression is associated with dysregulation of the HPA axis, a network of glands and hormones that regulates the body’s stress response. In turn, this can lead to elevated cortisol (i.e. stress) levels and reduced nitric oxide production, making it harder for the smooth muscles in the penis to relax. This can lead to restrictions in blood flow that prevent an erection from occurring. (In case you’re unfamiliar, nitric oxide plays a key role in vasodilation and proper blood flow, such as that to the penis.) 

3. Anxiety

A scientific review found that 37% of people with ED also have an anxiety disorder, such as post-traumatic stress disorder, obsessive-compulsive disorder, social anxiety disorder, or panic disorder. Additionally, research has found anxiety disorders to be associated with an increased risk of cardiovascular disease—a well-known contributor to ED. 

Think about it this way: When you’re anxious—whether due to, say, performance anxiety or a diagnosed condition—your body activates the fight-or-flight response. In doing so, it releases stress hormones that can reduce blood flow to the penis, interfere with nitric oxide production, and, in turn, affect your ability to get or maintain an erection. Similarly, if you are anxious about maintaining your erection, then that can drive the same reductions in blood flow to the penis that reverse the process of getting an erection.

4. Tobacco use

Smoking is linked with many health issues, including decreased erectile function. Many  reviews found that smoking significantly increases the risk of ED. The odds ratio of erectile dysfunction in those with current or former cigarette use has ranged between 1.4 and 3.1, meaning it can be three times more likely for those who smoke cigarettes to experience ED. 

Smoking can contribute to down-there difficulties by interfering with the nitric oxide pathway, which is essential for ensuring proper blood flow to the penis and other body parts. Additionally, smoking disrupts another process that regulates muscle relaxation in blood vessels, which in turn makes it harder to keep an erection. And it’s not just cigarettes: Another clinical study on vaping found people who use e-cigarettes are more than twice as likely as those who have never used them to experience ED. 

5. Drinking alcohol (especially in excess)

Having a couple of cocktails or glasses of wine before sexual activity is common. Unfortunately, though, the dreaded whiskey dick—aka alcohol-related ED—is also common.  If you occasionally lose your erection during sex because you’ve had too much to drink, it’s probably not cause for concern. You just might want to keep that in mind next time you think you’re going to get lucky. 

Alcohol dependence, on the other hand, can be an issue both in and out of the bedroom, as it’s a disease that affects physical and mental health. In terms of sexual activity specifically, alcohol dependence is linked to sexual dysfunction. In one clinical study of 100 male patients with alcohol dependence, 62% experienced sexual dysfunction, 36% had difficulty achieving an erection, and 34% had difficulty maintaining an erection. 

6. Smoking or using cannabis 

Sure, swapping out your date night cocktail might alleviate your sexual function fumbles and frustrations if it gives you erectile dysfunction. But trading it for, say, a date night joint might not be a foolproof plan if you’re wondering how to stay hard during sex. Research suggests the prevalence of ED can be twice as high in cannabis users compared to non-users. There has yet to be conclusive evidence to explain the connection. But one theory is that cannabis affects the endocannabinoid system, a network of receptors in the brain and body that helps regulate physiological processes, including erectile function. Further research is needed to better understand the potential link between cannabis and erectile dysfunction, but the association can be considered concerning.

7. Poor diet 

As the saying goes, everything should be enjoyed in moderation. And that includes your favorite foods, no matter their nutrition. So, occasionally going to town on a burger and fries shouldn’t be cause for concern. But regularly overindulging on certain items—think: red meat, fried foods, high-sodium snacks, and sugary bites and beverages—could have an impact on your erectile function. Reason being some foods and drinks (particularly the aforementioned ones) can cause issues with blood flow and inflammation. 

Diets high in processed foods and unhealthy fats can lead to plaque buildup in the arteries, restricting circulation throughout the body (including to the penis!). This can make it harder to maintain an erection. Together with excess sodium and sugar, these not-so-great eats can raise blood pressure and contribute to inflammation and conditions like diabetes and heart disease over time, all of which are major risk factors for ED. And remember: While losing an erection during sex doesn’t always mean you have ED, the condition is often characterized by frequent or persistent difficulty maintaining one. 

8. Obesity and overweight 

If you’re losing your erection during sex, it could even be related to your weight. There are multiple studies linking obesity or overweight and erectile dysfunction. One study found 73% of men aged 40 and older with abdominal obesity had some degree of ED. Another study found that men with obesity had three times greater risk for sexual dysfunction compared to the general population. Possible reasons for this could be that obesity and overweight are associated with endothelial dysfunction, which impairs blood flow to the penis. Additionally, obesity is linked to reduced testosterone levels, which can also impact sexual function. 

9. Vascular disease

Vascular diseases, which are conditions that affect blood vessels and circulation (e.g. high blood pressure, atherosclerosis), are a major cause of erectile dysfunction. So much so, in fact, that there’s a term for ED caused by these conditions: vasculogenic erectile dysfunction. When blood flow is reduced because of narrowed or hardened vessels, the body has more difficulty directing blood to the penis. This can make it harder to maintain an erection during sex—not to mention achieve one in the first place. 

10. Nerve damage 

ED can also result from neurological issues. More specifically, neurogenic erectile dysfunction occurs when nerve damage disrupts the signals needed to trigger an erection. Since the nervous system controls communication between the brain, spinal cord, and penis, conditions like diabetes, multiple sclerosis, Parkinson’s disease, and spinal cord injuries can interfere with this process. Additionally, surgery in the pelvic region, such as prostate or colorectal procedures, can sometimes damage nerves that affect the area, making it harder to achieve or maintain an erection.

11. Injuries

Though less common, injuries are another potential cause for losing your erection. Examples include a pelvic fracture, radical pelvic surgery, or penile fracture. As is the case with nerve damage, injuries that disrupt the body from sending the correct signals can result in difficulty maintaining erections. Reduced blood flow due to an injury can also be a culprit. If you’ve sustained an injury recently and are now unable to maintain erections, you should seek medical care to avoid complications. Not to mention, if you have been recently injured in the area, you may not be cleared for sexual activity by your healthcare provider, as it could delay your healing process. 

12. Medication 

Sexual dysfunction is a known side effect of many prescription and over-the-counter medications. While some drugs might lead to a lower libido, others can make it difficult to keep an erection long enough for satisfying sex. Common culprits include (but are not limited to!): 

  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)

  • Blood pressure medications, such as beta-blockers 

  • Stimulants, such as amphetamine (think: Adderall) 

  • Antihistamines, such as diphenhydramine (think: Benadryl)

  • Opioids, such as oxycodone and hydrocodone 

  • Antipsychotics, such as risperidone

  • Antiepileptics, such as gabapentin and topiramate 

13. Hypogonadism / Low Testosterone

Hypogonadism is a condition in which the body produces low (or no) sex hormones. Biological males with hypogonadism often have low testosterone levels and may experience sexual dysfunction as a result of the condition. While low T, as it’s often called, doesn’t always cause ED on its own, it is associated with chronic medical conditions, including heart disease and diabetes, that can affect erectile function. Low testosterone can also impair the ability of medications to help to treat ED.

14. Cardiovascular disease 

By now, you (hopefully) understand that loss of an erection during the excitement phase is often a sign of impacted blood flow. So, it shouldn’t come as a surprise to learn that cardiovascular disease is strongly associated with ED—after all, both are linked to poor blood vessel health. But let’s discuss anyway… 

Cardiovascular disease can make it hard to maintain an erection during sexual intercourse (as well as get one to begin with) due to endothelial dysfunction. One cause of endothelial dysfunction is when blood vessels don’t produce enough nitric oxide for proper vasodilation. In addition to ED, endothelial dysfunction is associated with coronary heart disease, hypertension, and diabetes, all of which are risk factors for ED.  Plus, plaque buildup in the arteries (atherosclerosis) can further restrict circulation, reducing blood flow to the penis and potentially leading you to lose your boner mid, well, boning. 

15. Diabetes 

While it may be best known for its effects on blood sugar control, diabetes can also wreak havoc on sexual dysfunction. Over time, diabetes can damage blood vessels, including those that supply blood to the penis. This can interfere with your ability to get and maintain an erection. The condition can also lead to nerve damage, which, as you probably guessed, can also negatively impact hard-ons.

What to do if you lose an erection during sex 

“If you lose your erection during sex, don’t panic—it’s common and doesn’t necessarily mean there’s a serious problem,” Dr. Houman says, adding that “stressing about it can make it harder to regain an erection.”

Instead, Dr. Houman recommends communicating with your partner about what’s happening, as it can help ease any pressure or embarrassment. (Although, remember, losing the wind in the mast, if you will, isn’t something you should be embarrassed about.) 

Next, he suggests you evaluate the context. Are you fatigued or stressed out? Did you have more than usual to drink? Have you started a new medication? Any of these could be a reason why you’ve lost your erection during sexual intercourse. Also, having a relaxing environment where you don’t feel pressure to perform sexually can help support normal erectile function.

Even if you can’t nail down the exact cause in the moment, you can still take a pause and reset. Dr. Houman suggests shifting focus to non-penetrative activities to reduce performance anxiety. Things like oral sex, using your hands, or using a sex toy can make for a satisfying encounter even if you’ve lost your erection. 

All that said, “if it happens repeatedly, it’s a good idea to schedule a consultation with a specialist to explore possible underlying causes,” Dr. Houman says. 

How to stay hard during sex 

If you’re worried about maintaining your erection during sex, there are some things you can try that might help you stay hard. 

Make lifestyle changes. “Improving your diet, exercising regularly, reducing stress, and getting enough sleep can make a big difference,” Dr. Houman says. Ensuring you’re in a relaxed, happy, and healthy mental state can make it easier to maintain an erection. Consider finding ways to improve your sleep hygiene and improve your diet with foods that boost nitric oxide. 

Limit alcohol and tobacco consumption. If you often have difficulty staying hard after drinking, try skipping the booze and seeing if it makes a difference. If you are struggling to reduce your alcohol intake safely or give up nicotine for good, consult a healthcare provider to help you find resources. The good news is that you may see improvement in ED within days after quitting smoking. 

Consult a therapist or mental health professional. “Seek psychological support if performance anxiety or emotional factors are at play,” Dr. Houman suggests. A therapist or psychiatrist can help you find strategies or medications that make it easier for you to manage anxiety or stress, which in turn can make it easier to maintain an erection. 

Communicate proactively with your partner. “Being open with your partner about concerns can reduce pressure and foster a supportive environment,” he notes. It’s possible that communicating with a partner can reduce your anxiety around the issue, which may make it easier to stay hard. Communicating also may open the door for you and your partner to explore non-penetrative intimacy. 

Try a cock ring. This is essentially a band you wear around the base of your penis to restrict blood flow. It can help maintain your erection and last longer during sex. Since so many causes of lost erections are related to blood flow issues, finding a way to keep the blood where you want it is often a simple approach to the issue. Make sure it is not too tight, as a cock ring that is too tight could potentially damage the penis. 

How to treat ED 

If you find you’re frequently losing an erection during sex, it’s probably time for a medical evaluation. While there are a variety of treatments for ED, the best one will depend on the root cause of your condition. That said, here are some commonly recommended options by healthcare providers (and backed by research): 

Prescription medications. The first line of treatment for ED tends to be phosphodiesterase-5 (PDE-5) inhibitors, a drug class that includes Viagra (sildenafil), Cialis (tadalafil), and vardenafil. PDE-5 inhibitors work in part by relaxing blood vessels and increasing blood flow; they’re shown to be highly effective, with an overall success rate of approximately 76%. Remember that to give these medications a chance, you should work closely with your healthcare provider and adjust the timing and dosage of medication as needed in order to optimize your erectile function and minimize side effects. 

In addition to the aforementioned oral pills, you can find some PDE-5 inhibitors in other formulations. Ro Sparks, for example, is a sublingual (under the tongue) treatment that combines sildenafil and tadalafil (the active ingredients in Viagra and Cialis, respectively) and dissolves under your tongue for fast-acting effects. Another option is Ro’s Daily Rise Gummies, which are once-a-day fruit-flavored gummies containing tadalafil with the goal of increasing sexual spontaneity. 

ED injections. As the name implies, this treatment involves injecting medication into the penis to achieve an erection. While the exact timing depends on the specific medication, PDE5 inhibitors generally take 30–60 minutes to kick in when taken as needed and require arousal. ED injections, on the other hand, typically take 5-20 minutes to produce erections, which tend to last for 30–60 minutes. With injections, you do not need to be aroused to experience an erection. 

Devices and surgery. A penis pump or vacuum erection device is a non-surgical form of treatment consisting of a plastic chamber to which you insert your penis. It’s attached to a hand or battery-powered pump that creates suction to increase blood flow to the penis. These options have limitations such as decreased spontaneity and potential risks, including penile swelling and even potential injury, and should be used with caution. 

Hormone replacement therapy. If low testosterone is to blame for your ED, then hormone treatments, specifically testosterone enhancement (e.g. anastrozole) or testosterone replacement therapy, may be worth discussing with your healthcare provider. This treatment option can increase your testosterone levels if they’re found to be significantly low. It can be administered topically, as an injection, orally, or even as a nasal gel, depending on guidance from your healthcare provider. 

Lifestyle habits. The same tactics of promoting a healthy lifestyle that are mentioned above as ways to stay hard during sex are also commonly recommended for ED. Yup, that means that managing stress levels, limiting alcohol consumption, and quitting drug and tobacco use can all help ameliorate ED. Other key lifestyle changes that double as ED treatment include:  

  • Regularly exercising. Research has found that individuals who exercise regularly, especially with moderate-to-vigorous aerobic workouts, had significantly improved erectile function. What’s more, getting ample physical movement can also boost the production of nitric oxide, potentially increase testosterone levels, and improve circulation—all of which are key to getting and maintaining erections.   

  • Eating a balanced diet. While no one food can fix ED, consuming a variety of nutrient-dense foods, such as lean proteins, healthy fats, and plenty of fresh produce (fruits and veggies), can help lower various risk factors for ED, including type 2 diabetes, high blood pressure, high cholesterol, and obesity. 

  • Prioritizing sleep. Getting 7–9 hours of shut-eye each night can help regulate hormones like testosterone, which play a key role in sexual function. Quality sleep also supports healthy blood flow and reduces stress, both of which are essential for erectile function.

Viagra Important Safety Information: Read more about serious warnings and safety info.

Cialis Important Safety Information: Read more about serious warnings and safety info.

Bottom line

There are plenty of reasons you might lose your erection during sex. If this happens to you only occasionally, it’s probably nothing to worry about. But if it’s happening more frequently, it might be time to consult a healthcare provider. Luckily, there are a ton of treatments and strategies available that can help you maintain your erections and have a fulfilling sex life. 

  • Losing your erection during sexual activity is a sign of ED, but it doesn’t always mean you have the condition. Many sexually active individuals will deal with losing an erection mid-sexy time at some point. If it happens only occasionally, you shouldn’t need to worry. It could be due to fatigue, excessive alcohol consumption, or other factors that don’t necessarily require medical intervention.  

  • Frequently losing an erection during sex could be the result of several different factors, including chronic stress, anxiety, tobacco use, excessive alcohol consumption, poor diet, vascular disease, and certain medications, among others. Consulting a healthcare provider can help you identify the root causes and find an effective treatment option. 

  • Communicate with your partner. Being open with your partner can relieve some of the anxiety you might feel if you lose your erection during sex. If they understand what’s happening, they’ll likely be more open to solutions like using a cock ring or engaging in other forms of sex, like oral sex. 

  • If you do have ED, there are a ton of treatment options available. If you do receive an erectile dysfunction diagnosis, there’s no reason to panic. There are many different treatment options available, ranging from lifestyle changes (think: regularly exercising, eating a nutritious diet, getting ample sleep) to prescription medications like Viagra and Cialis. 

Frequently asked questions (FAQs)

DISCLAIMER

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

  • Acharya, B., Sahu, P. K., Behera, A., et al. (2025). Cannabinoids and the male reproductive system: Implications of endocannabinoid signaling pathways. Maturitas, 192, 108156. doi: 10.1016/j.maturitas.2024.108156. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39602858/

  • Acharya, R. K., Panigrahi, S., Samani, M. J., & Choudhary, A. K. (2022). Prevalence and pattern of sexual dysfunction in male patients with alcohol dependence. Addiction & Health, 14(3), 192–197. doi: 10.34172/ahj.2022.1335. Retrieved from https://pubmed.ncbi.nlm.nih.gov/36544980/

  • Allen, M. S., Wood, A. M., & Sheffield, D. (2023). The Psychology of Erectile Dysfunction. Current Directions in Psychological Science, 32(6), 487–493. doi: 10.1177/09637214231192269. Retrieved from https://journals.sagepub.com/doi/10.1177/09637214231192269

  • Atlantis, E. & Sullivan, T. (2012). Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. Journal of Sexual Medicine, 9(6), 1497-507. doi: 10.1111/j.1743-6109.2012.02709.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22462756/

  • Bauer, S. R., Breyer, B. N., Stampfer, M. J., et al. (2020). Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study. JAMA Network Open, 3(11), e2021701. doi: 10.1001/jamanetworkopen.2020.21701. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33185675/

  • Cao, S., Yin, X., Wang, Y., et al. (2013). Smoking and risk of erectile dysfunction: Systematic review of observational studies with meta-analysis. PloS One, 8(4), e60443. doi: 10.1371/journal.pone.0060443. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060443

  • Celano, C. M., Daunis, D. J., Lokko, H. N., et al. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11), 101. doi: 10.1007/s11920-016-0739-5. Retrieved from https://link.springer.com/article/10.1007/s11920-016-0739-5

  • Corona, G., Rastrelli, G., Filippi, S., et al. (2014). Erectile dysfunction and central obesity: an Italian perspective. Asian Journal of Andrology, 16(4), 581-591. doi:10.4103/1008-682X.126386. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24713832/

  • De Leonardis, F., Colalillo, G., Finazzi Agrò, E., et al. (2022). Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links. Biomedicines, 10(8), 1848. doi: 10.3390/biomedicines10081848. Retrieved from https://www.mdpi.com/2227-9059/10/8/1848

  • Duca, Y., Calogero, A. E., Cannarella, R., et al. (2019). Erectile dysfunction, physical activity and physical exercise: Recommendations for clinical practice. Andrologia, 51(5), e13264. doi: 10.1111/and.13264. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30873650/

  • El-Shahawy, O., Shah, T., Obisesan, O. H., et al. (2022). Association of e-cigarettes with erectile dysfunction: The Population Assessment of Tobacco and Health Study. American Journal of Preventive Medicine, 62(1), 26–38. doi: 10.1016/j.amepre.2021.08.004. Retrieved from https://www.ajpmonline.org/article/S0749-3797(21)00429-3/abstract

  • Fillo, J., Breza, J., Levčíkova, M., et al. (2012). Occurrence of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome in patients with abdominal obesity. Where is a sufficient level of testosterone? International Urology and Nephrology, 44(4), 1113–1120. doi: 10.1007/s11255-012-0132-1. Retrieved from https://link.springer.com/article/10.1007/s11255-012-0132-1

  • Fujita, N., Okamoto, T., Yamamoto, H., et al. (2024). Association between sex hormones and erectile dysfunction in men without hypoandrogenism. Scientific Reports, 14(1), 13433. doi: 10.1038/s41598-024-64339-3. Retrieved from https://www.nature.com/articles/s41598-024-64339-3

  • Goldstein, I., Tseng, L. J., Creanga, D., et al. (2016). Efficacy and Safety of Sildenafil by Age in Men With Erectile Dysfunction. The Journal of Sexual Medicine, 13(5), 852–859. doi: 10.1016/j.jsxm.2016.02.166. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27114196/

  • Hoyland, K., Vasdev, N., & Adshead, J. (2013). The use of vacuum erection devices in erectile dysfunction after radical prostatectomy. Reviews In Urology, 15(2), 67-71. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24082845/

  • Kaplan-Marans, E., Sandozi, A., Martinez, M., et al. (2022). Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Sexual Medicine, 10(5), 100543. doi: 10.1016/j.esxm.2022.100543. Retrieved from https://academic.oup.com/smoa/article/10/5/100543/7041088

  • Khalil, B., Rosani, A., & Warrington, S. J. (2024). Physiology, Catecholamines. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507716/

  • Kovac, J. R., Labbate, C., Ramasamy, R., et al. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10), 1087-1092. doi: 10.1111/and.12393. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25557907/

  • Kumagai, H., Yoshikawa, T., Zempo-Miyaki, A., et al. (2018). Vigorous Physical Activity is Associated with Regular Aerobic Exercise-Induced Increased Serum Testosterone Levels in Overweight/Obese Men. Hormone and Metabolic Research, 50(1), 73-79. doi: 10.1055/s-0043-117497. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28934816/

  • McCabe, M. P. & Connaughton, C. (2016). Sexual dysfunction and relationship stress: how does this association vary for men and women? Current Opinion in Psychology, 13, 81–84. doi: 10.1016/j.copsyc.2016.05.007. Retrieved from https://linkinghub.elsevier.com/retrieve/pii/S2352250X16300537

  • Moon, K. H., Park, S. Y., & Kim, Y. W. (2019). Obesity and erectile dysfunction: From bench to clinical implication. The World Journal of Men's Health, 37(2), 138–147. doi: 10.5534/wjmh.180026. Retrieved from https://wjmh.org/DOIx.php?id=10.5534/wjmh.180026

  • National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Symptoms & Causes of Erectile Dysfunction. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes

  • Nguyen, H. M. T., Gabrielson, A. T., & Hellstrom, W. J. G. (2017). Erectile dysfunction in young men-A review of the prevalence and risk factors. Sexual Medicine Reviews, 5(4), 508–520. Retrieved from https://doi.org/10.1016/j.sxmr.2017.05.004

  • Pizzol, D., Demurtas, J., Stubbs, B., et al. (2019). Relationship between cannabis use and erectile dysfunction: A systematic review and meta-analysis. American Journal of Men's Health, 13(6), 1557988319892464. doi: 10.1177/1557988319892464. Retrieved from https://journals.sagepub.com/doi/10.1177/1557988319892464

  • Rastrelli, G., Corona, G., & Maggi, M. (2020). Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction. Asian Journal of Andrology, 22(3), 265-273. doi: 10.4103/aja.aja_61_19. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31249270/

  • Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2017). Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. British Journal of Sports Medicine, 51(19), 1419–1424. doi: 10.1136/bjsports-2016-096418. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27707739/

  • Sun, L., Yuan, J. L., Chen, Q. C., et al. (2022). Red meat consumption and risk for dyslipidaemia and inflammation: A systematic review and meta-analysis. Frontiers In Cardiovascular Medicine, 9, 996467. doi: 10.3389/fcvm.2022.996467. Retrieved from https://pubmed.ncbi.nlm.nih.gov/36247460/

  • Trapnell, P. D., Meston, C. M., & Gorzalka, B. B. (1997). Spectatoring and the relationship between body image and sexual experience: Self‐focus or self‐valence? The Journal of Sex Research, 34(3), 267-278. doi: 10.1080/00224499709551893. Retrieved from https://labs.la.utexas.edu/mestonlab/files/2014/10/1997-Meston-Trapnell-Gorzalka.pdf

  • Velurajah, R., Brunckhorst, O., Waqar, M., et al. (2021). Erectile dysfunction in patients with anxiety disorders: A systematic review. International Journal of Impotence Research, 34(2), 177–186. doi: 10.1038/s41443-020-00405-4. Retrieved from https://www.nature.com/articles/s41443-020-00405-4

  • Xiong, Y., Zhang, F., Zhang, Y., et al. (2024). Insights into modifiable risk factors of erectile dysfunction, a wide-angled Mendelian Randomization study. Journal of Advanced Research, 58, 149–161. doi: 10.1016/j.jare.2023.05.008. Retrieved from https://www.sciencedirect.com/science/article/pii/S2090123223001479?via%3Dihub

  • Yafi, F. A., Jenkins, L., Albersen, M., et al. (2016). Erectile dysfunction. Nature Reviews. Disease Primers, 2, 16003. doi: 10.1038/nrdp.2016.3. Retrieved from https://www.sciencedirect.com/science/article/pii/S2090123223001479?via%3Dihub

  • Yao, B. C., Meng, L. B., Hao, M. L., et al. (2019). Chronic stress: A critical risk factor for atherosclerosis. The Journal of International Medical Research, 47(4), 1429–1440. doi: 10.1177/0300060519826820. Retrieved from https://journals.sagepub.com/doi/10.1177/0300060519826820

Erectile Dysfunction

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

February 27, 2025

Written by

Jamie Ballard

Fact checked by

Peter Schlegel, MD, FACS and Raagini Yedidi, MD

About the medical reviewers

Peter Schlegel, MD, FACS

Peter Schlegel, MD, FACS, is a Ro Advisor, board-certified urologist, and internationally acclaimed expert in the treatment of male fertility. For nearly 20 years, Dr. Schlegel served as the chair of Urology at New York Presbyterian/Weill Cornell. He now focuses on providing the best patient care possible for urologic conditions through his private practice.

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.

More articles like this