What’s (Not) Up: Why You Might Be Struggling With Erections

One of the most common things people with penises come to sex therapy for is difficulty gaining and/or maintaining erections. 

Our first response to this is often to think there’s something on a physical or hormonal level that’s causing us to struggle with getting erections, and sometimes this is the case. Often however, erection issues can be caused by more psychological and/or relational factors that are creating a block when it comes to sex. 

What we see in the media in regards to penis-owning people, is that we should be able to get hard and perform sexually at the drop of a hat at any given moment if anything slightly sexy is happening, if we have an erotic thought, or if the opportunity for sex arises. In reality, the majority of us don’t experience arousal in this instantaneous manner. When our experience doesn’t match what we’ve been told is “normal functioning” for a penis-owning person, then we think something must be wrong with us. 

It can be deeply frustrating, and the worry that we might not be able to get an erection can then cause more anxiety around sex in general, creating a cycle of worry and disappointment that distances us from sex and our bodies more and more over time. 

If you’re struggling with erections, you’re not broken. This article serves as a bit of a guide to figuring out what might be happening for you, by approaching erection concerns from a comprehensive, full body perspective. 

Where To Start

When first starting to look at why you might be struggling to gain or maintain erections, the best place to begin is by considering how our systems are operating on a foundational level. 

Firstly, we can consider any medications or existing medical conditions that might be limiting our ability to get erections. If you’re currently on any medications, experiencing chronic pain, or navigating any other form of medical condition, reflect on when your erection issues began in relation to taking on new medications or undergoing medical procedures. If you see some sort of relationship here, speak to your doctor about how this might be impacting your ability to gain/maintain erections. 

If you’re undergoing gender-affirming hormone therapy, or any other form of hormone dosage, this will have a large impact on how you experience arousal and sexuality. People with penises who are taking Estrogen will experience a decrease in erections, or experience their erections as softer, less intense, and less predictable. This does not mean erotic sensation won’t still occur, and you will still be able to experience orgasm, it will just start to look and feel different along the way. This is normal, and a beautiful sign of your changing body. Use this as an opportunity to explore your new access points to pleasure!

If you’re erections issues aren’t appearing to be caused by any form of medical experience, we can consider whether you’re getting nocturnal erections and waking erections, meaning erections during the night or when you wake up. This is a sign that your circulatory system is operating properly and the blood is being flushed through during the night. If you’re not getting nocturnal and/or waking erections, this might be a sign to consult a doctor.

If you’re getting nocturnal and waking erections, so we know systems are functioning, then we can consider whether you’re able to get erections during masturbation or solo touch. If you’re able to get erections when you’re alone, but not with a partner or partners, then this often indicates that your erection struggles might be connected to some form of relational or emotional block, or some form of performance anxiety. If you’re not able to get erections when you’re alone, we might like to consider exploring some other forms of masturbation and self arousal, to explore what your body is really wanting by uncovering your unique experience of arousal. 

If you’re getting nocturnal and waking erections, and you’re able to get erections alone, and sometimes able to get erections with a partner or partners, then we might consider what types of experiences, or types of sex, are leading to your erection, and what’s not working. Essentially, what are the patterns here? What types of sex, or partnered dynamics, are working for you, and what experiences are feeling blocked? Are there any themes connected to when you’re getting erections and when it’s not happening?

Once we have an understanding of where we’re at and what’s happening, where patterns might be and where we currently are becoming erect, we can start to explore some of the larger picture. 

Anxiety and Sex

If you’re able to get erections when you’re alone but not with a partner or partners, this often indicates that you might be experiencing some form of fear or anxiety around partnered sex. 

There are an endless number of reasons why we might be experiencing anxiety around sex, and the causes of this fear or anxiety will be unique to each individual. Often the most efficient way to learn what might be causing this blockage for you is to consult a sex therapist to dig deeper into your experience of sex and sexuality. 

Though the source of our fear and/or anxiety will be unique to each of us, the uniting factor is that it almost always comes back to our nervous system in some way. 

Your Nervous System and Your Erection

When we’re experiencing fear and/or anxiety in relation to partnered sex, what’s happening is our body is operating from a stress response on a nervous system level. 

Regardless of where the fear or anxiety might be coming from, when the body is operating from a stress response, what is happening is that the Sympathetic Nervous System is taking on a dominant role in our body. Engaging in sex from a place of sympathetic dominance in our nervous system is often a very difficult task, because when our bodies are in this state, they are actually physically blocking access to arousal, and therefore erection, on purpose. 

Your Sympathetic Nervous System

The sympathetic nervous system is the part of our nervous system that comes online when the body perceives a threat. When our nervous system evolved in early humans, its primary purpose was keeping us alive during a time when humans were more often getting chased by lions. This is why we refer the sympathetic nervous system as “fight or flight mode,” because it was literally developed so we would have the ability to either fight the threat, or to run away to safety. It was designed to keep us alive. 

This is also the part of the nervous system that we often intentionally access to “get our blood pumping” in the form of fitness training classes or other high intensity physical activity. Think about what sort of music you’d listen to if you wanted to pump yourself up; most likely something with a base and an up-beat vibe to get yourself moving. The main goal of the sympathetic nervous system is firing your body up to get things done, fast, so we target this with stimuli that align with these action-based goals when desired. 

The sympathetic nervous system offers us this “act fast” mode by restricting certain bodily functions to prioritize immediate need for action. The best way to understand this is to imagine anything that might be useful to help you if you were, in fact, being chased by a lion. When the sympathetic nervous system is dominant, heart-rate increases (to move faster), pupils dilate (to focus), and blood flows to our arms and legs (to help us fight or run). 

By contrast then, any bodily function that is not necessary if you’re being chased by a lion is put on hold. Things like digestion, salivation, and sexual desire/arousal. Have you ever received stressful news and suddenly your mouth goes dry, or realized how hungry you are only after a workout? This is because the stress response is putting unnecessary functions on hold to prioritize responding to the threat, or immediate action, as it is designed to do. 

The trouble however, is that today’s society is literally built to target this part of our nervous system, so we often end up in somewhat of a perpetual state of stress, between stressful jobs, stressful sidewalks and shopping centers and train stations, and high intensity fitness classes, rushing between social engagements and trying to squeeze 8 hours of sleep in. 

Today’s humans are also experiencing threats more often on an intrapersonal level than in the form of angry lions, so even if we’re not actually in physical danger, but we might be experiencing general anxiety from any form of interpersonal dynamics, our nervous system still functions in the same basic way; there’s a lion, react!

When Sex Is The Threat

When we’re feeling stress, fear or anxiety in relation to sex then, our body perceives sex as the threat, turns on the alarm signals, and goes into the stress response mode, in order to keep us safe. 

If you’re being chased by a lion, realistically the last thing you need to worry about is stopping for sex, so your body removes sexual function from the priority list in order to keep you safe. On a physiological level, as mentioned above, when you’re operating from a stress response your body is pumping blood away from your core and out to your arms and legs, so as the blood is actively getting pumped away from your penis, you can understand why it might be difficult to get an erection. 

Regulating The Nervous System

On the flip side of all of this, our Parasympathetic Nervous System is the yin to the stress response’s yang, meaning that this is the part of the nervous system responsible for cooling things down and performing regular resting-state functions such as digestion and salivation. 

To access sex and arousal, we have to be operating from a place of relative balance between these two systems; the sympathetic and the parasympathetic nervous systems. 

This balance is referred to as the Social Engagement state, because it’s from this place of balance where we’re most easily able to engage with the world securely, bodily functions run smoothly, and sexual desire is more accessible. 

So, if we’re feeling fear and/or anxiety in relation to sex, what happens is that sex, or our partners, or even our own bodies, actually become the threat that our nervous system is working to protect us from. Alarm bells go on, fight or flight kicks in, blood rushes away from the penis, erections become difficult. 

In order to work towards the ability to gain and/or maintain erections then, we actually have to work to regulate our nervous system back down to a place of balance in our nervous systems. 

Your Routine and Your Nervous System

If you’re somebody who experiences anxiety and/or restlessness in general life, or perhaps you’re usually operating under stress in general life, then even if there’s not conscious anxiety specifically related to sex, your overall state of stress and/or anxiety might be blocking your ability to gain erections. 

As mentioned, not only is our society constructed to target the sympathetic nervous system in order to keep us moving and producing from a capitalistic standpoint, but often we’re actively targeting this stress response in our own bodies, to perform in environments like fitness classes and other high intensity exercise regimes, to match the high intensity demands of the rest of our lives. 

Exercising is absolutely a wonderful thing, don’t get me wrong, but many of us go from high stress jobs into high stress fitness sessions, come home, eat fast and watch high stress action or crime shows/movies or video games, get into bed, and then wake up to a high stress alarm, and repeat our cycle. 

After long enough operating in this cycle, we don’t actually allow our bodies any opportunity to come out of the stress response. 

When it comes to sex then, regardless of how much we want to be able to connect with our partners and slow down during sex, our bodies actually don’t know how to slow down enough to access our desire and arousal when we try to. 

This lack of ability to slow down can cause erection issues initially, which then creates stress around sex because the worry that you won’t be able to become erect is now present, which adds to the existing erection difficulties, becoming a frustrating cycle. 

The goal then, is to target the parasympathetic nervous system to come back online, to minimize the stress associated with sex, and to slow down in general life, so the body can relax into desire a little more.  

Regulating Back To Arousal

Regardless of where the stress and/or anxiety is originating, our goal in reconnecting to our arousal and our erection is to minimize the stress associated with sex and target the parasympathetic nervous system, to regulate the body back down from the stress response to a place of social engagement. 

Some ways to minimize stress and erection anxiety:

Some ways to regulate your nervous system:

If you resonate at all with being someone who often feels in a state of stress or anxiety in general life or in your routine, it can be helpful to start regulating your nervous system before sex is even on the table. Some ways to do this are:

• Start doing one thing at once as much as possible. We’re often doing multiple things; listening to podcasts while we walk, texting while we’re watching TV, scrolling socials while we poop, emailing with music playing while we eat lunch. Slow down. Do one thing at once, intentionally. See how this slows your heart rate in general. 
• Simple breath work techniques to help regulate such as focusing on lengthening your exhale when you breathe, box breathing, or taking audible sighs when you exhale can be ways to help slow the heart rate relatively quickly
• If you’re a high intensity fitness person, try incorporating more stretching, more yoga, or more recovery-focused movement sessions into your week. Even if that means a walk rather than a run one day of the week, or a little wiggle in the morning, see if there are ways you can incorporate slower, more mindful movement into your routine. Your recovery is just as important to your fitness regime as your endurance. 
• Try listening to slower, more chilled-out music, or sitting in silence, while you cook or go about your day. This naturally slows us down in relation to higher BPM choices. 

The above suggestions are things that work for some people, but might not work for everyone. The key is to find ways to loosen up and unwind prior to sex, so our bodies can access this relative state of regulation when engaging in sex. 

Also, if after trying some of these practices you’re finding yourself becoming more able to feel relaxed, and are accessing more pleasure during sex, consider that the deepening of pleasure might be enough whether or not you’re able to get erections. If everyone is having a good time, your erection doesn’t have to limit your pleasure.