Erections are a cardiovascular event. The arteries involved are narrower than the coronary arteries, which means they show damage earlier — so this symptom is frequently the first visible sign of a vascular problem, several years before anything happens to the heart. That is the single most important thing to know about it, and the reason it is worth an appointment rather than an internet purchase.
How common: Common and increasingly common with age, but never a normal part of ageing in the sense of being nothing to investigate. Occasional difficulty is universal; a consistent change from your own baseline is a signal.
See someone about this if
New erection difficulty is a recognised early marker of cardiovascular disease. Getting blood pressure, glucose, and cholesterol checked is the correct first move, not an optional extra.
Chest pain, breathlessness on exertion, or leg pain when walking alongside this needs prompt medical assessment.
An erection lasting more than four hours is a medical emergency and needs immediate care.
Buying erection medication from an unregulated online seller is genuinely dangerous — counterfeit product is common and the underlying cause goes uninvestigated.
Narrow it down
This page narrows the question; it does not answer it. Everything below is written so that you can walk into an appointment with a date, a pattern, and a specific thing to ask — which is the difference between a consultation that goes somewhere and one that does not.
Do erections still happen on waking or alone?
That suggests the plumbing and nerves are working and points more toward anxiety, context, or a situational cause. If they have also disappeared, a physical cause is more likely and testing is more useful.
Did it come on gradually over months or years?
Gradual onset points toward a vascular or hormonal cause. A sudden change tied to a life event or a new medicine points elsewhere.
21 classes of commonly prescribed medicine are associated with difficulty getting or keeping an erection. Associated does not mean responsible in your case, and it never means stop taking anything — this is a list of things worth raising with whoever prescribed them.
18 conditions on this site list difficulty getting or keeping an erection among their effects. A condition appearing here is not a suggestion that you have it — it is a list of things a clinician can rule in or out, several of which are a single blood test away.
Anxiety disordersCommonly reportedArousal and anxiety compete for the same nervous system.
DiabetesCommonly reportedDamages the small blood vessels and nerves that arousal depends on.
Heart diseaseCommonly reportedFear of the effort is usually a bigger obstacle than the effort.
High blood pressureCommonly reportedDamages the vessels arousal depends on — before any treatment does.
Low testosteroneCommonly reportedTestable, treatable, and frequently caused by something else on this site.
Multiple sclerosisCommonly reportedDirect nerve effects, plus fatigue, plus the medicines — all three at once.
Obstructive sleep apnoeaCommonly reportedMassively under-diagnosed, and it suppresses testosterone directly.
Parkinson's diseaseCommonly reportedMovement, autonomic, and dopamine effects — in both directions.
Peyronie's diseaseCommonly reportedCurvature and pain from scar tissue, with a treatable early window.
Prostate cancer treatmentCommonly reportedErection, ejaculation, and desire all change — and rehabilitation exists.
Raised prolactinCommonly reportedSuppresses desire and arousal, and is measurable with one blood test.
Spinal cord injuryCommonly reportedLevel and completeness determine what remains — and a great deal usually remains.
The most common physical cause, and the one with implications well beyond sex.
High blood pressure, high cholesterol, diabetes, obesity, and smoking, each of which damages the small vessels involved.
Undiagnosed cardiovascular disease, for which this can be an early warning sign.
Sleep apnoea, which contributes through both oxygenation and testosterone.
Hormonal
Less common than vascular causes, and testable rather than guessable.
Low testosterone, including the suppression caused by long-term opioid use and by hormone-blocking cancer treatment.
Thyroid problems and raised prolactin.
Nerves and surgery
Where the signal rather than the supply is the problem.
Diabetes-related nerve damage, multiple sclerosis, spinal injury, and pelvic surgery — prostate surgery in particular.
Radiotherapy to the pelvis.
Anxiety and expectation
Real, common, and frequently layered on top of a physical cause rather than instead of one.
One difficult experience creating the anxiety that produces the next one.
Depression, stress, and relationship strain.
Alcohol, which is the most under-reported single-occasion cause there is.
What helps in the meantime
Treat it as a reason to have a cardiovascular check rather than a reason to avoid a doctor — this is the symptom that gets people assessed years earlier than they otherwise would be.
Alcohol, sleep, and exercise all move this measurably, and all three are free.
Take the pressure off the erection itself: intimacy that does not depend on one is not a consolation prize, and removing the performance demand often improves the erection.
Take these to an appointment
Should my cardiovascular risk be assessed given this symptom?
Could my medicines be contributing, and is a review reasonable?
Would checking testosterone and thyroid be appropriate in my case?
Common questions
What causes erection problems?
Erections are a cardiovascular event. The arteries involved are narrower than the coronary arteries, which means they show damage earlier — so this symptom is frequently the first visible sign of a vascular problem, several years before anything happens to the heart. That is the single most important thing to know about it, and the reason it is worth an appointment rather than an internet purchase. The causes worth ruling out fall into a few groups: blood vessels and metabolism, hormonal, nerves and surgery, anxiety and expectation, and medicines. Most people turn out to have more than one contributing at once.
How common is erection problems?
Common and increasingly common with age, but never a normal part of ageing in the sense of being nothing to investigate. Occasional difficulty is universal; a consistent change from your own baseline is a signal.
Can medication cause erection problems?
Yes — 21 classes of commonly prescribed medicine are associated with it, most frequently anti-androgen medicines, antipsychotic medicines, antiseizure medicines. Never stop, pause, or change a prescribed medicine because of that; take the observation and the date it started to the person who prescribed it, who can weigh a review against what the medicine is doing for you.
When should I see someone about erection problems?
Sooner than most people do. Specifically and without waiting: New erection difficulty is a recognised early marker of cardiovascular disease. Getting blood pressure, glucose, and cholesterol checked is the correct first move, not an optional extra.
What can I do about erection problems myself?
Treat it as a reason to have a cardiovascular check rather than a reason to avoid a doctor — this is the symptom that gets people assessed years earlier than they otherwise would be. Alcohol, sleep, and exercise all move this measurably, and all three are free. Take the pressure off the erection itself: intimacy that does not depend on one is not a consolation prize, and removing the performance demand often improves the erection.
Educational information about why a symptom happens — not a diagnosis, and not a way to work out what is wrong with you. Most of these changes have more than one cause at once, and the causes on this page overlap. Nothing here can examine you, look at your history, or run a test. Pain, bleeding, a lump, or a symptom that is new and unexplained always deserves assessment.