Many men scour the internet for information on how to get erect and stay hard because when you’re having a tough time getting hard and staying hard, it has the potential to be psychologically devastating.
Although this problem is often worse in your own head than it is in reality, it shouldn’t be ignored, especially if you have problems getting erect and staying erect often. You could be dealing with erectile dysfunction (ED).
Erectile dysfunction, sometimes called impotence, is a condition in which you’re unable to get or keep an erection that’s firm enough to have satisfactory sexual intercourse . This means if you have trouble getting hard or staying erect, it’s possible you’re dealing with ED.
If you think you may have erectile dysfunction, you’re not alone. In fact, it’s estimated to affect up to 30 million men within the United States and more than 150 million men across the world . The good news – once you identify the type of ED you’re dealing with there are ways to fix it. Many different things can cause ED, including circulatory problems, taking certain prescription medications, and performance anxiety. Since there are many causes of ED, you’ll also find that there are many effective solutions available today, making it possible to find a treatment that works for you.
If you’re trying to decide which solution will work best for you, considering talking to your doctor about how to get erect and how to stay hard. Your doctor can help you determine the best solution for your unique needs.
The Symptoms of Erectile Dysfunction
Erectile dysfunction, defined as the inability to sustain or achieve an erection that’s hard enough for satisfactory sexual activity, affects nearly every man at one time or another. However, ED is only considered a medical problem when it happens consistently, regularly, over a considerable length of time, and begins affecting a man psychologically and emotionally, harming his sexual activity and self-esteem .
The symptoms of ED include :
- Recurring inability to get an erection. You may get an erection sometimes, but not every time you want to have sexual intercourse.
- Recurring inability to maintain your erection. While you may get an erection, it doesn’t last long enough to have fulfilling sex.
- Inability to get an erection at any time.
The Causes of Erectile Dysfunction
The causes of ED can be classified broadly into physical causes and psychological causes. However, in many cases, it’s a mix of multiple factors causing ED (both physical and psychological), and studies show that mixed ED is the most common type of ED .
Physical Causes – Circulatory Problems
Circulatory problems or vascular disorders are frequently responsible for ED, since both adequate arterial inflow and venous outflow occlusion are essential to getting hard and staying hard . Some circulatory problems known to cause ED include:
Heart Disease – Studies show that approximately 40% of men who have ED also have cardiovascular disease, although most studies show that ED actually precedes the onset of coronary artery disease by two to three years . Although the relationship between heart disease and ED isn’t entirely clear, the two conditions have the same risk factors and studies show men with ED have a 23% increased risk of cardiovascular death and other cardiovascular events.
Clogged Blood Vessels (Atherosclerosis) – Atherosclerosis, a systemic disease in which plaque builds up in your arteries resulting in clogged blood vessels, has been found to contribute to erectile dysfunction . Since getting erect and staying erect requires adequate blood flow into the penis, atherosclerosis is a major cause of ED .
High Blood Pressure – Hypertension, or high blood pressure, is the most common comorbidity associated with ED, and there’s some indication that essential hypertension and ED are essentially the same disorder, although they affect two different organ systems .
High Cholesterol – One study found that the mean LDL cholesterol levels in men with ED were significantly higher than in controls, showing the impact of LDL cholesterol (bad cholesterol) on ED . Other studies have found that cholesterol-lowering medications like atorvastatin (Lipitor) may help improve erectile function in patients who only have high cholesterol as a risk factor for ED .
Physical Causes – Nerve Problems
Neurogenic ED, ED caused by nerve problems or neurogenic disorders, account for between 10-19% of ED cases, and multiple nerve problems/disorders have been associated with ED, including :
Diabetes – In patients with diabetes, the effects of high blood sugar can result in damage to both nerves and blood vessels, which can lead to sexual problems like ED. In fact, studies show that more than half the men with diabetes end up getting ED, although proper diabetes management may help prevent and treat ED that’s caused by diabetes-related nerve damage and circulatory issues.
Parkinson’s Disease – A large-scale observation of men with Parkinson’s disease (PD) found that erectile dysfunction is very high in men with this disease, with two thirds of men with Parkinson’s disease reporting poor or very poor erectile function. However, this observation also found that erectile dysfunction often antedated the disease and may be a significant early predictor of Parkinson’s disease . Another study looked at 75 people with PD who were sexually functioning, and in this study, 68.4% of men reported ED .
Stroke – It’s thought that the disruption of the central network assuring erection may contribute to the increased prevalence and severity of ED after a stroke, although medications added after a stroke or anti-erectile effects of psychological and functional impairment may also contribute . Other studies showed that ejaculatory function, erectile function, and sexual desire were all impaired in patients who had a stroke .
Multiple Sclerosis – Multiple sclerosis has been associated with a higher rate of sexual dysfunction in both men and women. However, the most common complaint of sexual dysfunction in men with MS is ED, with between 50-75% of men studied reporting problems with ED .
Other Nerve Problems – Other conditions that affect nerve pathways include :
- Spinal cord injury
- Multiple system atrophy
- Spina bifida
- Peripheral neurologic impairment after prostate or pelvic surgery
Any of these conditions might be the reason you can’t get erect and stay erect.
Other Physical Problems
Many other physical problems can interfere with getting erect and staying erect, such as:
Peyronie’s Disease – Peyronie’s disease is a disease in which scar tissue known as plaque forms in the penis, most commonly building up on the bottom or top of the penis. The buildup of plaque results in a bend or curve in the penis that can make erections painful. Although the exact cause of the disease is unknown, it may be the result of repeated injuries to the penis, an acute injury to the penis, or an autoimmune disease. ED is very common in men with this disease, and depending on the severity of the disease, getting hard and staying hard may become difficult. In some cases, the disease may result in the inability to have sexual intercourse .
Obesity – Obesity is responsible for more than 300,000 deaths every year within the United States, and recently it has been proven to be an independent risk factor for ED. Around 79% of men with erectile disorders have a BMI of 25 or higher, with men with a BMI of over 30 having three times the risk of sexual dysfunction . Studies have shown that many obese men who have adopted healthy behaviors like weight loss and regular exercise were able to regain sexual activity .
Metabolic Syndrome – Metabolic syndrome is the name for a group of risk factors that increase the risk for heart disease and other health issues. Risk factors include abdominal obesity, high levels of triglycerides, above-normal blood sugar levels, hypertension, and low levels of good cholesterol . ED has been linked to every component of metabolic syndrome . One study looking at the relationship between metabolic syndrome and ED found that every patient in the study who had metabolic syndrome also had ED .
Sleep Disorders – Some evidence points to a link between sleep disorders and ED, and this evidence suggests that either sleep disorders or ED should be considered whenever the other is suspected in adult males . Studies have specifically linked an increased incidence of ED in patients with sleep apnea .
Prostate Cancer – A radical prostatectomy, radiation, and hormone treatment for prostate cancer may all cause ED in some men. Getting erect and staying erect may no longer be possible for some men without the help of man-made methods like medical devices or medications .
Did you know that prostate play feels good and can promote prostate health, so you can get hard easily as you age? It’s true!
Low Testosterone – Approximately one in five men diagnosed with ED have hormonal abnormalities, and ED is associated with low testosterone levels . When low testosterone is suspected of causing ED, testosterone therapy may prove helpful, although it doesn’t always result in the resolution of ED .
Learn how testosterone helps you get a boner in this post.
Poor Oral Health/Chronic Periodontitis – Surprisingly, even your oral health can affect your ability to get erect and stay hard. Experts recently explored the link between chronic periodontitis and ED and found that chronic periodontitis is a risk factor for ED. This means oral health is an important preventive measure for ED and other serious systemic diseases .
Prescription drugs, legal drugs, and illegal drugs may induce ED, making getting hard and staying hard problematic. Drugs associated with ED include:
Certain Prescription Medications – Many different prescription medications have been associated with ED, with multiple analyses showing that tricyclic antidepressants and benzodiazepines are associated with this condition . Blood pressure medications have been most commonly associated with ED . Other drugs that may cause ED include :
- Antihistamines like diphenhydramine (Benadryl), cimetidine (Tagamet), and promethazine (Phenergan)
- Diuretics and high blood pressure medications like atenolol (Tenormin), clonidine (Catapres), furosemide (Lasix), labetalol (Normadyne), prazosin (Minipress), spironolactone (Aldactone), and verapamil (Calan)
- Antidepressants and psychiatric medications like diazepam (Valium), fluoxetine (Prozac), lorazepam (Ativan), and sertraline (Zoloft)
- Medications for Parkinson disease like levodopa (Sinemet) and benztropine (Cogentin)
- Hormonal medications and chemotherapy medicines
- Opiates like methadone, morphine, codeine, and oxycodone (Percodan, Oxycontin)
Illegal Drugs – Although illicit drugs are often viewed as aphrodisiacs, they have been reported to have detrimental effects on sexual function, and one study found when looking at drug abusers using heroin, MDMA, and amphetamine that male illicit drug abusers were more likely to have ED as well as a decrease in sexual desire .
Tobacco Use – One study documented a relationship between erectile dysfunction and tobacco use . Another study that looked at the evidence surrounding the role of smoking in ED found that smoking may increase the likelihood of moderate or complete ED two-fold, although there was some evidence to show that smoking cessation may decrease the risk of ED .
Alcoholism – A look at alcohol-dependent men found that 72% had at least one sexual dysfunction, with the most common dysfunctions including premature ejaculation, low sexual desire, and ED . Heavy drinking increases the risk of sexual dysfunction.
Psychological causes can be involved alone or in combination with physical causes in some cases of ED . However, today it’s thought that only approximately 10% of ED cases have psychological causes . Some of the psychological causes of ED include:
Depression – Depression is often associated with sexual dysfunction in both sexes, and analysis has found there’s a bidirectional association between sexual dysfunction and depression – patients with sexual dysfunction like ED should be screened for depression and men presenting with the symptoms of depression should be assessed for sexual dysfunction . Both depression and anxiety disorders are common in men with ED, although the relationship to sexual dysfunction seems to be complex .
Performance Anxiety – Performance anxiety is a psychological cause of ED, and it’s estimated that fear of sexual failure, along with other psychological factors, may cause between 10-20% of ED cases . Even when there’s a physical cause for ED, the stress and performance anxiety that comes with ED may make the problem worse, resulting in a complex cycle of ED and performance anxiety. Studies have been found anxiety to be a major factor in sexual dysfunction, especially concerning sexual performance . Another study on young military personnel experiencing ED found that preoccupation with body image, especially the genitals, can influence sexual anxiety, resulting in problems with sexual function, such as ED .
Performance and general sexual anxiety are common for both women and men. You might experience it because you’re overly concerned with making your partner orgasm.
Stress – Stress is a major cause of ED that often gets overlooked, and if you’re dealing with difficulties at work, problems in your relationship, or going through other events in your life, you may have a difficult time getting or staying hard . ED can be caused by stress in several ways. You could be distracted by stressful life issues instead of being fully in the moment of sex, which may keep you from getting the sexual stimulation needed for a long-lasting, firm erection. High levels of stress may also affect you in physiological ways, decreasing blood flow to the penis, causing ED. Unfortunately, stress-induced ED can cause a cycle of stress, ED, more stress, and more problems with ED.
Relationship Problems – Relationship problems like conflicts within the family and conflicts within a couple’s relationship also have a link to sexual dysfunction. One study showed that family and couple conflicts had a significant association with ED, as well as depression symptoms and free-floating anxiety . Another small study showed the potential cyclical nature of relationship problems and ED, and while marital distress was linked to sexual dysfunction like ED, ED also was found to play a part in marital discord . Other emotions and relationship problems can also lead to ED, such as :
- Feelings of doubt and failure in your relationship
- Poor communication within your relationship
- Anger, anxiety, fear, or stress in the relationship
- Expecting too much from sexual intercourse, making it a task instead of a pleasure
Low Self-Esteem – Low self-esteem is believed to be a potential psychological cause of ED in men, and even when ED is caused by physical factors, it can cause problems with low self-esteem and stress  that continue the cycle of ED. One study took a look at the self-esteem in men with ED who were treated with the medication sildenafil (Viagra) and found when ED was effectively treated with the drug men saw a significant improvement in self-esteem, sexual relationship satisfaction, and confidence . This study underscores the relationship of self-esteem and other psychosocial factors with erectile function.
Shame/Guilt from Past Experiences – Erectile dysfunction may also result from feelings of guilt, shame, fear or other emotions associated with past sexual experiences in your life. For example, early religious teachings that made you feel like sex is shameful or a sin may leave you feeling ashamed when engaging in any kind of sexual activity. Punishment for masturbation is another negative experience that can affect sexual function in the future. Even a negative sexual experience with a partner can leave you feeling guilty or ashamed, resulting in stress that leads to erectile difficulties .
Infertility – The emotions that come with infertility, may also cause ED. When couples are unable to conceive, it often leaves both partners feeling emotions like grief, panic, despair, and anger, and all of these emotions may have an effect on sexual activity . Multiple studies have discussed the prevalence of ED in men going through infertility , with one study specifically showing that 22% of men enrolled in a study on couples with infertility dealt with some type of erectile dysfunction . Another study on men going through infertility evaluation found that some men may deal with sexual dysfunction, including difficulty with erection, in response to the diagnosis of infertility .
Masturbation Habits – It’s possible that masturbation habits, particularly when masturbation is combined with pornography, may contribute to ED. One analysis took a look at literature and clinical studies and found some evidence that may point to a link between internet pornography use while masturbating and conditioning that may weaken arousal with real-life partners 
Solutions for Erectile Dysfunction
If you’re searching for information on how to get erect and how to stay hard, you’ll find that many different solutions for erectile dysfunction are available, although the treatment you choose should be based upon the cause of your ED. Once ED was first recognized as a real health issue in men, multiple treatment options became available, including options like oral phosphodiesterase-5 (PDE5) inhibitors, vacuum devices, lifestyle modifications, and intracorporal injections . However, all of the treatments have limitations, and their effectiveness varies depending on the root cause of ED, which is why it’s a good idea to work with your doctor to determine the best solution.
Prescription Medications for ED – Oral prescription medications are considered to be the preferred form of treatment for ED over invasive procedures, such as penile injections and surgical intervention  when you want to get hard fast. Your doctor may prescribe you medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Staxyn, Levitra), or avanafil (Stendra) to help you with getting hard and staying hard. These medications all work by relaxing smooth muscles and increase the blood flow to your penis during sexual stimulation .
One of the benefits of taking medicine for ED is that it can help you get an erection fast. But it might not be ideal for spontaneous sex if you don’t have your medicine on you.
It’s important to avoid taking these medications if you take nitrates for a heart condition since the combination of these medications can lead to a sudden drop in your blood pressure. The combination of alpha-blockers with medications that help you get a full erection can also cause a sudden drop in blood pressure, so it’s always important to discuss all the medications you’re taking with your medical professional.
Although these medications can help you to get hard fast and/or keep an erection longer, they can occasionally lead to an uncomfortable hardon for hours at a time. Check your prescription for warnings, side effects and advisements about when to contact your doctor.
Vacuum Pumps and Cock Rings – Vacuum devices for ED have been available commercially since the early 1980s, and they include three parts: a vacuum cylinder, a pump that creates a vacuum, and one or more rings for constriction. Both manually operated and battery-operated pumps are available. After the pump is used for getting hard, then one or more rings (sometimes referred to as cock rings) are placed on the base of the penis to help you stay hard. Rings should never be left on more than 30 minutes .
Vacuum pumps used with cock rings can cause some side effects, especially as you’re getting used to them. Studies have found that once the rings were on the base of the penis blood flow was reduced . Although pain and discomfort are common reasons for dissatisfaction with the use of vacuum pumps, studies have found the overall satisfaction rate with vacuum pumps asa way to get erect and stay erect to be about 68% .
Diet, Exercise, and Other Lifestyle Modifications – Lifestyle modifications like weight loss, avoiding the use of alcohol and illicit drugs, physical activity, and smoking cessation are all recommended for men with ED who want to get hard . Even when other methods of treatment are used, such as prescription medications, adding lifestyle modifications is recommended. Tobacco cessation is highly recommended for smokers since the risk of ED is increased by 51% in smokers . Studies have also been done on weight loss as a treatment for ED, and in one sample of older overweight or obese diabetic men, weight loss did prove somewhat helpful in the maintenance of erectile function .
Penile Injections – Several different medications are available in the form of penile injections, including papaverine, papaverine plus phentolamine, Trimix, and alprostadil, and these injections work by relaxing the smooth muscles and widening blood vessels in your penis to create an erection . One potential side effect of these injections is the development of curvature of the penis, which can interfere with sex and be very painful. Alprostadil is one of the most commonly used injections for ED and studies have shown this treatment to be safe and effective, although fear of penile pain and puncture is often a reason men don’t choose to use this treatment option .
For men who don’t like the idea of injecting a medication into their penis, alprostadil suppositories are available. These suppositories are inserted into the urethra using a prefilled applicator, and an erection usually begins within 8-10 minutes after use and lasts between 30-60 minutes . This might be a better option for men who want to stay erect longer but don’t want an erection that lasts for hours.
Surgical Intervention (vascular surgery, penile implants) – Surgical intervention for ED is usually used as a last resort when other methods of treatment have not worked. The two types of surgery that may be used to get stronger erections or stay harder longer include :
- Implantation of a device designed to make the penis erect (penile implant)
- Rebuilding of arteries in the area to increase the blood flow to the penis
Implanted devices are usually placed by a urologist, and there are two different types of implants, including:
- Malleable implants, which are rods that let you adjust the position of your penis manually
- Inflatable implants, which allow you to use a pump located in the scrotum to make your penis wider and longer
Implanted devices usually come with a high satisfaction rating, within one inflatable penile prosthesis found to have an 83% satisfaction rate  and another device found to have an 85% satisfaction rate .
Penile vascular surgery includes penile arterial revascularization surgeries and penile venous ligation procedures. Although penile venous ligation procedures saw reasonable short-term success rates, the popularity of this surgical intervention has fallen off in recent years due to poor long-term results . The first penile arterial revascularization surgery was performed back in 1973, but there continues to be controversy over the long-term effectiveness of these procedures. Meta-analysis done by the American Urological Association’s Clinical Guidelines Panel declared back in 1996 that neither venous or arterial surgery for ED was justified for routine performance .
Psychological Counseling – If emotional or psychological issues are affecting your ED, then psychological counseling may prove helpful. A counselor can teach you methods to reduce stress and anxiety related to sex . In some cases, you may be asked to bring your partner to sessions so your partner can learn how best to support you. Studies have also found evidence to support the use of men’s group therapy as an effective treatment for ED . Another study found that sex therapy offers a reliable, effective treatment option with good long-term results for psychogenic ED .
Testosterone Replacement Therapy – Since testosterone is known to correlate with erectile function and studies have shown a correlation between low serum testosterone and decreased erectile function, testosterone replacement therapy is sometimes used to treat ED . Transdermal gel via patches or other gel applications have been reported to improve desire, enjoyment, sexual motivation, and overall sexual performance and there was also an increase in the percentage of men who reported full erections and greater satisfaction with their erections . However, other studies have concluded that testosterone replacement therapy may be a better therapy alternative when used along with PDE-5 inhibitors like Viagra for ED in patients with low testosterone .
Hormone therapy may not just help you maintain your erection. It can also mitigate libido loss due to low testosterone.
Acupuncture – Acupuncture is increasingly being used as an alternative treatment for patients with ED, although a systematic review of acupuncture concluded that there isn’t enough available evidence to support the idea that acupuncture can improve ED on its own . A small pilot study found that 15% of patients saw an improvement in the quality of erection and 31% reported an increase in sexual activity, although it’s difficult to draw definite conclusions on the effectiveness of acupuncture from this pilot study . More studies on acupuncture and ED are needed, but it may be worth trying along with other treatments for ED.
Kegel Exercises – In normal erectile function, the pelvic floor muscles are active, so it has been hypothesized that weak pelvic floor muscles may be a cause of ED. One study compared the efficacy of manometric biofeedback and pelvic floor muscle exercises with lifestyle changes in men with ED. In this randomized controlled trial, men in the intervention group saw a significant increase in erectile function at three months, and at six months there was further improvement, with 40% of men achieving normal erectile function and 34.5% seeing improvements in erectile function . This study suggests that the use of pelvic floor exercises may be an excellent first-line approach to treating men who want long-term resolution of ED.
Kegels may contribute to penis strengthening that makes it easier to keep an erection longer naturally.
Treatments’ to Avoid For Getting and Keeping An Erection
Radio commercials, online banner ads, and even television commercials often offer “magic pills” and “dietary supplements” marketed as incredible treatments to treat ED and enhance sexual performance. You might be tempted to follow these tips on getting hard and staying hard; however, according to the FDA, many of these products actually contain undisclosed drug ingredients, and they may include combinations of undisclosed ingredients or extremely high doses of ingredients, which are both potentially dangerous to your health . In fact, FDA testing has found that some of these “magic pills” available without a prescription actually contain sildenafil (Viagra), the active ingredient in the ED medication Viagra, and dosage amounts have been high enough to be dangerous for some patients. Unknowingly taking the prescription ingredients found in these pills can also cause dangerous interactions with some medications .
It’s also important to beware of supplements sold that contain “natural” ingredients. Ginseng, maca, and horny goat weed are a few of the over-the-counter dietary supplements that are sold with the claims that they’ll improve male sexual health and treat sexual dysfunction. However, there’s not a lot of evidence to back up these claims. In fact, manufacturers don’t even need to submit evidence of their purity , and it’s difficult to know how much of the active ingredient you’re actually getting when you purchase dietary supplements.
Erectile dysfunction can be caused by both physical and psychological causes, and in many cases, it’s a combination of physical and psychological factors at the root of the problem that must be addressed if you want to know how to maintain an erection. However, as you better understand the cause of ED, you’ll find that many different solutions are available that can help you in your journey to discovering how to get hard and stay hard when engaging in sex with your partner. You can overcome ED, it’s just essential to make sure you only try safe, proven solutions, and it’s always a good idea to discuss this issue with your doctor so you can choose the most effective treatment together.