A Guide to Maintaining an Erection

Being able to get an erection, but not maintain it, can be frustrating. You might feel like you cannot last as long as you or a partner would like, or like there’s a timer counting down as soon as sexual activity starts.

Here are a few tips for understanding some possible underlying causes, along with some solutions that could help.

One-off problems

There are several reasons why you might find it difficult to keep an erection during sex. Most people find that they face this question at some point in their lives.

Most of the time, this is absolutely nothing to worry about. Losing an erection is very often due to common, everyday factors like:

• stress
• tiredness
• anxiety – e.g. ‘first night nerves’
• drinking too much alcohol
• the side effects of a drug you’re taking

Some people will experience this much more often than others.

Signs of underlying health problems

If you regularly lose your erection during sex, it could be a sign of an underlying health condition. This could be a physical or an emotional health condition, and may need treatment in the form of medication or lifestyle changes.

The main physical reasons you might lose your erection during sex are:

• high cholesterol or high blood pressure
• blood flow issues (a narrowing of the blood vessels in your penis)
• a physical issue with the shape of your penis, like Peyronie's disease
• side effects of a prescription medication you’re taking
• premature ejaculation
• hormone problems

It can also be caused by psychological reasons:

• Stress
• Performance anxiety
• Emotional or mood problems
• Not having sexual desire, or not being aroused

Erectile dysfunction is the condition where you repeatedly struggle to get or keep an erection. It's very common, and isn’t lifelong.

Most of the time, ED is easily treated with medication or counselling. If you’re concerned about losing your erections during sex, talk to your doctor for advice.

Some solutions for keeping an erection work better than others, depending on the causes. As with any health condition, it helps if your treatment is agreed with a doctor.

Physical causes

The main erectile dysfunction (ED) treatments include:

• medications called PDE-5 inhibitors – Viagra or Viagra Connect (sildenafil), Cialis (tadalafil), Levitra (vardenafil), or Spedra (avanafil)
• medications to help lower your blood pressure
• statins, to help lower your cholesterol levels
• hormone replacement therapy (HRT) if the cause is low testosterone
• changing your current medication (if your ED is a side effect)

Psychological causes

• ED treatments can include:
• Cognitive behavioural therapy (CBT)
• Couples’ counselling, if you have a regular partner
• Practising techniques to reduce stress and anxiety, like meditation, mindfulness, or yoga
• Lifestyle changes

At the same time as getting treatment for physical or psychological causes, it can be helpful to make some lifestyle changes:

• Losing weight, if you’re overweight
• Eating a balanced, healthy diet
• Quitting smoking
• Exercising regularly
• Getting enough sleep every night
• Cutting back on alcohol. Try to stick to less than 14 units a week
• Taking a break from cycling, if you cycle more than 3 hours a week

You’ll know if you particularly struggle with any of these. But any changes you can make can help give you the best possible chance of treating your ED.

In many cases, yes. Viagra (or sildenafil) is proven to be an effective medical treatment for a lot of erectile dysfunction cases. The other available licensed drugs have also been shown to work.

But, medication like Viagra won’t be suitable for everyone.

You cannot use Viagra if you:

• are allergic to its ingredients
• have, or have had, a serious heart or liver problem
• have recently had a heart attack or a stroke
• have low blood pressure

The easiest way to tell whether or not a medication like Viagra is suitable for you is to get assessed by your online doctor or GP. If they think it could help you, and that it’s safe for you to take, they’ll give you a prescription.

No, not necessarily. It’s possible, and very common, for people to lose erections even when they’re fully aroused and want to continue having sex with a partner.

It’s possible that your relationship is playing a part. For example, if you’re not feeling safe, comfortable or attracted to your partner, this could make it more difficult to get or keep an erection.

Or, if you're having relationship or emotional problems that have been causing you or your partner high stress, this could also be the cause.

If you’re able to talk to your partner about your concerns, this could really help. Good communication is important for a healthy sexual relationship.

A lot of people find that couples’ counselling or stress management techniques are right for them, and help them to resolve the issue of erection loss.

If you can stay hard when you masturbate but not during sex, this could be because of a number of different reasons.

Masturbation and sex are different

You’re much more likely to get nervous about having sex with a partner than about masturbating by yourself. It could help to talk to your partner about how you’re feeling, take things slowly, and try to stay relaxed.

This situation is more common if you're younger

You’re more likely to experience the physical causes of losing erections as you get older.

So, for younger men, it's more likely to be psychological causes. But if you cannot stay erect whether you're masturbating or having sex, then it's more likely to have a physical cause.

Do I need to change the way I masturbate?

Not necessarily, but you could try and see if it works for you. If you always (or very regularly) masturbate to porn, it could make it harder for you to orgasm in other situations. You could try masturbating without porn, or cut down on masturbating generally, and see if it helps you maintain your erection during sex. You might still find one of the treatments listed above is a better solution.