Why Can't I Get or Keep an Erection?

Like the stock market and foreign car engines, erections are mysterious things that seem to have a mind of their own. When they don't happen, it can be disappointing, at the very least.

Decreased blood flow, typically because vessels that supply blood to the penis have narrowed, is often the cause of erectile dysfunction (ED) in older men.

Emotional issues are more commonly at the root of it for younger men.

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It happens to most men from time to time. But if it happens to you more than half the time you have sex, talk to your doctor.

Is the Problem All in My Head?

Probably not. Most cases of ED are caused by physical problems alone or in combination with emotional ones.

Just about any medical condition that affects your nerves or blood vessels could hurt your ability to have erections.

High blood pressure, heart disease, multiple sclerosis, kidney disease, and diabetes can all lead to ED. In fact, over 50% of men with diabetes find themselves in that situation.

Hormonal issues such as low testosterone levels can also factor in, more often for older men. Prostate cancer treatments including surgery and radiation may be the culprit.

If you have erections in the morning or while sleeping, the problem probably isn't physical. Stress, anxiety, and depression can cause ED, too.

Talk to your doctor about your symptoms. They may want to run some tests to help figure out what's going on.

Can I Blame My Medicines?

Maybe. Several types of medications, like blood pressure drugs (especially beta-blockers) and certain antidepressants, can make it tough to get an erection.

If you think your medicine may be causing your problem, don't just stop taking it. Talk to your doctor. You may need to switch to something different or consider taking an ED medication, too.

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Could My Lifestyle Play a Role?

Absolutely. Being overweight, getting too little exercise, and smoking all can work against the good blood flow that is key to erections.

For some men, a little alcohol may help take the edge off. Yet too much, as Shakespeare wrote, "provokes the desire, but it takes away the performance."

Some “causes” you may have heard about are just myths: Bike riding and tight underwear don’t cause erectile dysfunction.

How About My Age?

Aging doesn't cause ED, but the problem is more common in older men. It may take longer to get an erection, and you may need more touching and foreplay.

About 4% of guys in their 50s and almost 17% in their 60s are unable to get erections, according to the National Institutes of Health.

About half of men older than 75 are affected.

Treatments can help men of any age.

What Can I Do?

Experts agree: If you smoke, stop. Get your blood pressure, cholesterol, and blood sugar levels under control. Then talk to your doctor about your options.

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ED medications -- sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn) -- can often help whether your problem is performance anxiety or poor blood flow.

Self-injections, vacuum devices, and squeeze pumps implanted under the skin are other options to boost your response.

If your testosterone is low, replacement therapy may help, though it won't necessarily solve the ED.

Counseling can help you work through any relationship or emotional troubles you may be facing.

Keep your partner informed about your erection problems and treatment. Impotence affects both of you.

Will Insurance Cover ED Treatment?

If you have a documented medical condition that’s causing your ED, insurance will usually cover at least some of it.

Sex therapy and medications that have not been approved by the FDA, however, are generally not covered.

Ask your insurance provider if the treatment you’re considering will be covered.

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