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Understanding ED and how to manage it

Understanding ED and how to manage it

Knowing how to get hard. How to get stronger erections.

These might be things you didn’t think you’d have to worry about. Before, erections probably just happened for you. And you’ve never had to question why.

That is, until they stopped happening.

Maybe you want harder erections, or maybe you just want to know how to get an erection full stop.

Daniel Atkinson
Medically reviewed by
Daniel Atkinson, GP Clinical lead

Erections are complicated and problems with them are common, so struggling to get it up is nothing to be ashamed of. But erectile dysfunction (ED) can often be the symptom of certain lifestyle choices or a broader health problem. Things like exercise, a healthy diet and avoiding too much alcohol can all help you get harder erections.

Table of contents
Reviewed on Jul 09, 2024. by Dr Daniel Atkinson GP Clinical lead Registered with GMC (No. 4624794) Next review due on Jul 09, 2027.
Daniel

Last updated on Jul 09, 2024.

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It’s important to remember that an official diagnosis, understanding the root cause (whether vascular, psychological, or hormonal) of your ED, and choosing a treatment pathway must be done in consultation with a medical professional.

The role of lifestyle factors in managing ED

In some cases, making positive lifestyle changes can help support a healthy blood flow and vascular health, which is linked to ED. This can mean changing regular habits and introducing new ones.

Can exercise help improve ED?

The benefits of exercise are wide-ranging and well known, but here’s a quick recap:

Can support heart health and the vascular system;
Helps maintain a healthy weight range;
Reduces the risk of several serious illnesses including Type 2 diabetes, stroke and cancer;
Supports mental health and mood;
Improves energy levels.

That’s just to name a few, there are plenty of reasons to exercise regularly. (Hundreds more.)

Medical guidelines generally recommend around 150 minutes of moderate to vigorous exercise a week is enough to lower serious risk and keep you fit.

And because erections rely on healthy blood flow and a well-functioning vascular system, regular exercise can play an important role in managing ED.

Cardio and erections

Cardio, otherwise known as aerobic exercise, is a physical activity that raises the heart and breathing rate. In the gym, you might have heard of ‘cardio’ machines. Examples include the treadmill, elliptical and cycling machines.

But you don’t need to go to the gym for a good cardio workout. Other examples include brisk walking, jogging and running. You can ask your doctor if your erectile dysfunction symptoms can benefit over time from these simple cardio exercises (as well as from many others).

Regular cardio over time helps your overall cardiovascular function and health improve, and it also helps to increase blood flow to the penile tissue and muscles, namely the corpus cavernosum.

This is because erections depend on good vascular health and blood flow. Research shows that men with higher levels of physical activity report fewer symptoms of impotence.

It’s also well known that regular aerobic exercise improves mental health and overall mood.[4] This is because the body produces endorphins when you exercise. This, too, could be of benefit to erectile dysfunction — particularly when it’s caused by psychological factors like anxiety or depression. However, if you suspect that your ED is related to psychological factors, seek medical advice. It’s possible that your doctor will determine that exercise alone is not enough, and that psychological therapy may be of benefit.

Strength training and erections

So we’ve covered cardio, but what about strength exercises?

You can think of exercise as two sides of one coin. It’s important that we strike a good balance between aerobic exercise and strength exercise, or resistance training.

Strength exercises are those which target the muscles and build strength and endurance. It’s often associated with weights, but can be defined in three ways:

  • Calisthenics: Calisthenic exercise helps build muscle and target key areas, without depending on anything except your own body weight. Examples include pull-ups, push-ups and chin-ups.
  • Isometrics: Isometric exercises involve static contraction of muscle groups without visible movement in the angle of a joint. Examples include the plank and glute bridges.
  • Plyometrics: Plyometric exercise, also known as jump training, happens when the muscles exert high force in short bursts of time. Examples include skipping and jump squats.

These exercises and resistance training groups are designed to build muscle and endurance, but most of them will also raise the heart rate and breathing. This can help with ED, because – that’s right – good erections depend on good blood flow and circulation.

Can yoga and meditation help with erections?

Yoga is an ancient form of low-intensity exercise which focuses on strength, stretching and breathing. It’s long been claimed that yoga benefits mental health and mood.

Meditation ‘focuses one's mind for a period of time, in silence or with the aid of chanting, for religious or spiritual purposes or as a method of relaxation.’

But how effective are these techniques, and can they help with erectile dysfunction? Yoga will require some form of physical exertion, which will help with circulation and blood flow (especially when performed regularly). This, in turn, can help with the symptoms of impotence.

But what about meditation for erectile dysfunction? Well, it’s less about the physical and more about the mental. This is because a lot of meditation is about (through practice) letting go of worry and stress. It’s about becoming comfortable with yourself and your mind.

This might not sound like your thing, but there is some evidence that meditation can help with ED. However, because psychological causes vary, these practices are typically integrated alongside formal psychological therapies or medical treatments. So make sure to always ask the advice of a healthcare professional when dealing with conditions such as erectile dysfunction.

The impact of nutrition on erectile function

We get told from an early age how important food is (eat your greens, an apple a day keeps the doctor away, carrots help you see in the dark and so on).

While some of these phrases are exaggerated, they all have roots in truth. Fruit and vegetables are one of the most important food groups, and as part of a balanced diet, they can have a number of far-ranging benefits.

The reason for this is because different food groups, and the varying foods within those groups, contain different vitamins and minerals which all have varied jobs in the body. For example, milk contains calcium, which benefits the teeth and bones.

Eating a healthy diet reduces the risk of developing many chronic diseases, such as heart disease, stroke and cancer. A diet that is high in saturated fats and sugars can damage the blood vessels and have a knock-on effect on your erections.

But are there any foods that are actually good for ED?

There aren’t any foods that are specifically known to treat ED. However, eating a balanced diet will help you to stay generally healthy; and being generally healthy reduces your risk of getting ED. A balanced diet typically includes fruit, vegetables, whole grains, and lean proteins in quantities that are enough to provide essential vitamins and minerals that support the vascular system.

The role of alcohol, nicotine, and substance use

Recreational drugs, smoking and alcohol consumption all have the ability to cause serious, long-term damage to the body and impact the ability to get or maintain an erection.

Recreational drugs can include illegal drugs, but also unprescribed or misused medication. Drug misuse can impact the blood vessels and vascular function, and also impact sexual desire and libido.

Nicotine, also a drug, has a similar effect. Smoking can decrease libido. Nicotine is a vasoconstrictor, meaning it temporarily narrows blood vessels. Over time, smoking contributes to long-term cardiovascular damage. This, in turn, can cause problems with erections.

Drinking alcohol also carries risks, especially if you drink too much over time. Alcohol interferes with the ability to get an erection for a number of reasons in the long and short term.

Erections and recreational drugs

Drug use can be dangerous in many ways, particularly when someone is addicted to them. But taking drugs recreationally can also impact erections and cause ED.

Drugs negatively impact erectile function for a number of reasons.

For example, drugs like cocaine and speed which induce a stimulating effect in the brain can also cause the blood vessels to narrow and become too constricted. Erectile dysfunction can also become more severe if these types of drugs are misused over long periods of time.

Certain prescribed pharmacological drug classes which are sometimes misused or taken recreationally, may also reduce libido and sexual desire.

Erections and smoking

It’s well known that smoking is incredibly dangerous and addictive. Nicotine use increases the risk of several cancers, heart disease, heart attack, stroke, damaged blood vessels, pneumonia, COPD and many other conditions.

But if that wasn’t enough to make you think twice about smoking, it also increases the chances of developing erectile dysfunction. Why?

Because cigarettes contain a lot of chemicals which have no business being inside the human body. Examples include carbon monoxide, hydrogen cyanide and arsenic. A lot of these harmful chemicals can damage the blood vessels which pump blood around the body, and to the penis, sometimes permanently. Nicotine also has an instant effect in reducing blood flow and constricting the blood vessels.

But that isn’t all. If you developed a serious, chronic health condition from smoking — like cardiovascular disease or heart disease — this can have a knock-on effect for your erections.

Medical guidelines typically recommend avoiding smoking altogether.

Erections and alcohol

Alcohol misuse can carry a lot of risks — including for your erections. In fact, the popular consensus among experts is that no single level of alcohol consumption can be classified as “without risk.”

Consistent heavy drinking can increase the risk of a number of health conditions. These can include blood pressure problems, diabetes, heart disease, stroke, liver disease and digestive problems.

Of the physical causes of ED, there is a strong correlation between ED and cardiovascular diseases, with about 40% of men with ED having hypertension and 42% have high cholesterol. One-third of ED patients also have diabetes. And for all three of these conditions, excessive drinking increases their risk. Ask your doctor for advise on how to best manage ED if you also suffer from any of these conditions.

But alcohol can also have short-term effects on the ability to get an erection, namely because of how it reacts in the body and affects the central nervous system. It’s well known that a heavy drinking session can decrease your chances of having a successful erection. This is because it’s a central nervous system depressant, and it impacts the brain’s ability to send chemical messages where they need to go (in this instance, to the penis).

So even if you don’t have a persistent problem with ED, it’s better to stay within sensible limits if you’re hoping to have sex later on. Discuss what amount of alcohol is considered low-risk for your health with a medical professional.

Can sleep quality affect erectile function?

According to Statistics Canada, 25% of people suffer with sleep problems and sleep deprivation.

A lack of sleep can be dangerous for a number of reasons. In the short term, it can cause you to feel tired, groggy, grumpy and stressed. In the long term, it can increase the risk of several health conditions including obesity, coronary heart disease and diabetes, and even lower life expectancy.

The short term effects of sleep deprivation that affect your mood may also interfere with your ability to get an erection, just because you won’t feel like it. You may feel tired, stressed or without energy.

The long term effects of sleep deprivation can also damage, sometimes permanently, the vascular system and blood vessels. This can make getting or keeping an erection much more difficult.

How to increase the duration and quality of erections?

There isn’t a one-size-fits-all method, but usually getting regular exercise, with a balance of aerobic and strength exercise, avoiding recreational drugs and smoking, and sticking to the “low-risk” alcohol consumption guidelines, helps protect the blood vessels responsible for a successful erection.

Erections happen because, in times of arousal, blood rushes to the penis and fills two muscular chambers known as the corpus cavernosum. Keeping an erection means that once the penis is filled with blood, the muscles at the base can constrict well enough to keep it there, ensuring you stay hard.

To evaluate the severity of erectile dysfunction, healthcare professionals sometimes use a validated clinical questionnaire called the International Index of Erectile Dysfunction (IIED) to help them determine the most appropriate management plan.

The importance of stimulation

If you’ve ever wondered how you get an erection ensuring you live a healthy lifestyle is only part of what needs to happen. You also need to be aroused.

When you’re turned on, the brain sends chemical signals to the penis. The blood vessels in the penis will dilate, allowing for blood to flow in. Once filled, the vessels at the base constrict which traps the blood, keeping you hard.

If you’re struggling with arousal, it can help to:

  • make sure you feel comfortable and engaged
  • remember that if you’re with a sexual partner, trust is key
  • remove anything that might be distracting you
  • make sure you give foreplay enough time
  • talk to your sexual partner if you’re feeling anxious about sex.

Refractory period and erections

Why does ejaculating make your erections weaker? Why is it so difficult to stay hard, or erect, after coming?

Answer: the refractory period, which is defined as the period directly following an orgasm where the person is no longer sexually responsive. It’s more common in men, whereas in women it’s an area of more complex clinical focus. In men, the period can be thought of in two stages.

  • Stage 1: Following an orgasm, it is physiologically impossible to get an erection or ejaculate again.
  • Stage 2: A psychological refractory period may also occur, where the man feels fulfilled and no longer interested in sex.

How long does it take to get an erection again after ejaculating?

The refractory period is different for all men. Sometimes you may feel ready to go again in just a couple of minutes, but sometimes it can last hours or even days.

Longer refractory periods get more common with age, but other things can factor into how long they last, including cardiovascular health. There are also recognized non-drug intervention that a clinician might suggest, like certain exercises or training techniques that can reduce the refractory period, such as pelvic floor muscle training (PFMT).

It may also be worth speaking to a doctor or sexual health expert if you feel your refractory period is too long.

When is it ‘ED’ and when should I get help?

care-iconBecause ED can be tied to underlying physical or psychological factors, it should always be assessed by a professional. But if you’ve already tried implementing positive lifestyle changes, like:

  • eating well
  • reducing alcohol intake
  • avoiding recreational drugs
  • quitting smoking
  • getting at least six to eight hours of sleep a night.

and you’re still having problems with erections, you likely need to have another discussion with your doctor to understand what options are right for you.

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