An erection problem is the inability to get or maintain an erection that is firm enough for a man to have intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse before you are ready. If the condition persists, the medical term is erectile dysfunction.

Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man's self esteem and harm his relationship with his partner, and thus requires treatment.

If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.

In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as "don't worry" or "just relax and it will take care of itself." Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.

One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.

In most men, erection difficulties do not affect their sex drive.

Premature ejaculation (when orgasm comes on too quickly) is not the same as impotence. Together with your partner, you should seek counseling for this problem, which is usually due to psychological factors.

Male infertility is also quite different from impotence. A man who is unable to maintain an erection may be very capable of producing sperm that could fertilize an egg. An infertile man is usually able to maintain an erection, but he may be unable to father a child due to problems with sperm count or other factors.

An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can become a problem. Common causes include:

• Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor circulation, low testosterone, depression, spinal cord injury, nerve damage (for example, from prostate surgery), or neurologic disorders (like multiple sclerosis or Parkinson's disease)
• Certain medications such as blood pressure medication (especially beta-blockers), heart medication (such as digoxin), some peptic ulcer medications, sleeping pills, and antidepressants
• Nicotine, alcohol, or cocaine
• Stress, fear, anxiety, or anger
• Unrealistic sexual expectations, which make sex a task rather than a pleasure
• Poor communication with your partner
• A "vicious cycle" of doubt, failure, or negative communication that reinforces the erection problems

Erection problems tend to become more common as you age, but it can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.

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