What Senior Men Can Do When They Can’t Get Hard

Like most men, I’ve had my share of difficulties with erections. Sometimes in a sexual encounter, everything works great as I hope it would, and other times nothing happens. It is normal for men to have occasional erection difficulties. As I have grown older, the erection problems have happened more often. It’s frustrating and can undermine my sexual confidence.

In the past, the word “impotence” was commonly used to describe erection difficulties. Now the phrase “erectile dysfunction,” or ED for short, is common. We’ve all seen the TV ads for medications designed to help ED; remember the ad picturing a couple in separate bathtubs? No, that never made any sense to me either. Why were they in separate tubs in an ad abut sex?

ED is frequently defined as when a man regularly finds it difficult to attain or keep an erection firm enough to have sexual intercourse. You may have ED if you have these symptoms regularly:

• Trouble getting an erection
• Difficulty maintaining an erection during sexual activities
• Reduced interest in sex
  

Causes of ED

Although men like to think that our erections should always be ready on demand, that’s not reality. There are several reasons why we have difficulty getting hard when we want to get hard. Some of these are medical reasons, and some of them are psychological reasons.

One cause of erection issues is simply growing older. It’s common knowledge that as men age, they tend to reduce their ability to quickly gain and maintain an erection. On the other hand, it would be a mistake to dismiss all erection problems as a function of age, and therefore not treatable. There may be an underlying physical or psychological cause that is treatable and might improve the symptoms.

There are medical and psychological causes for ED

Too often men don’t receive help for ED because they are afraid to talk about it to their parents, friends, or doctors. Our sexual performance is wrapped up with our ego and our sense of being a man. It’s embarrassing and threatening to talk to others when we’re having sexual issues.

1. Medical Causes

See your doctor if you have ongoing difficulty getting and staying hard. Occasional difficulties are normal and not a cause for concern, but an ongoing difficulty might indicate a more serious medical issue. “Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.” Mayo Clinic website.

The solution to ED starts with a willingness to talk about it with professionals. Don’t worry, they’ve heard it all before.

Even though it’s difficult to talk about such a personal subject, it’s important to consult a doctor. A medical professional can rule out medical causes, or identify an issue and recommend treatment.

After visiting my doctor and taking a blood test, I learned I had an unusually low level of testosterone. She prescribed a testosterone cream that I apply each day. It’s made a big difference in my ability to get and keep erections, and my desire for sex.

A doctor can identify and treat a physical problem causing ED

a. Medical Causes of ED

The Mayo Clinic lists these possible physical causes of ED:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Being overweight, especially if you’re obese
• Certain prescription medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain, or prostate conditions
• Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
• Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord
• Low testosterone
  

b. ED Prescription Medications can Often Help

If your doctor diagnoses a physical cause, they can recommend a course of treatment. It’s possible your doctor may prescribe one of the medications developed to increase blood flow to your penis to help treat ED. You might need to try several to find out which works best for you. These include:

• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis

Fortunately, there are medications readily avialable to help you get and keep an erection

I’m not the kind of person who takes a pill for every ache or pain, but I’m thankful I have an ongoing prescription for sildenafil (Viagra). While I don’t need it all the time, it’s nice to have it on hand when I want to guarantee that I’ll be able to perform. It helps me to get and stay hard when I might not be able to do so on my own. Having it available significantly lowers my “performance anxiety” stress, and leads to positive experiences to build on instead of negative ones.

2. Psychological Causes

There are a lot of different psychological reasons why men don’t have erections. Occasionally our penis refuses to get hard because we’re not comfortable or feeling nervous or anxious in the situation. The first thing we should do when having erection difficulties, is to stop and ask, “Am I comfortable in this situation?” Perhaps your penis is simply reacting to the stressful circumstances you’re in.

a. Talk to your Partner about the Need for Direct Stimulation

When we were younger, all we had to do was think about sex to instantly become rock-hard. Now, it might require direct stimulation of our penis to achieve an erection. It can make a big difference to receive direct stimulation from our partners when we want to have an erection. Even though you might be uncomfortable doing so, I recommend you talk to your partner about your physical changes and your need for direct physical stimulation.

Don’t be afraid to ask your partner for direct stimulation of your penis to help with erection

Too often when a man starts having frequent erection problems, he becomes frustrated and embarrassed with repeated failures. Instead of talking with his partner about it, he avoids future failures by withdrawing and stopping having sex with her. She doesn’t know why and assumes he doesn’t desire her anymore. This leads to her feeling hurt and withdrawing herself from him emotionally. Now he’s unhappy, and she’s unhappy, and they are both suffering, mainly because he hasn’t communicated his sexual changes and need for help.

b. How to Overcome Performance Anxiety

Not having an erection when we want to can make us question our sexual confidence. We become anxious and worry that it will happen again. Unfortunately, that performance anxiety can easily become a self-fulfilling prophecy and prevent us from gaining an erection the next time. The more times we experience failure, the worse it becomes.

Don’t worry about getting hard; focus on how your body is feeling.

The most effective way to prevent the vicious circle of performance anxiety is to not take our sexual performance so seriously. “It is essential to recognize that an inability to perform from time to time does not mean that a person is unable to have sex. It may mean that they were stressed or facing anxiety at that time. At another time, when the stress is not present, they will be able to enjoy sex as before.” Jon Johnson, writing in Medical News Today.

Try some positive self-talk and not over-think a one-time event. During sex, focus on how your body is feeling at the moment and not the question, “Will I be hard when I want to be hard?”

c. Get the Psychological Help You Need

According to Johnson, there are many psychological causes that can trigger performance anxiety:

• Anxiety
• Depression
• Stress
• Low self-confidence
• Low self-esteem
• Relationship difficulties
• Sleep issues
  

Sometimes erection problem symptoms will stop on their own when the psychological circumstances improve, but not always. You might need the help of a professional, such as an individual or couples’ counselor, or a sex therapist.

There are Options Even When You Can’t Get Hard

What do you do if you investigate all the possible physical and psychological causes for erection problems, seek help to try to improve, and you still can’t get hard or stay hard? In that case, it doesn’t mean that sex is over, it means you need to redefine what sex is.

There are lots of pleasurable sex acts besides penis-in-vagina sex.

Most people define sex as primarily penis in vagina (PIV) intercourse. But that’s an overly restrictive definition. “Sex is about everything —the look you give someone across a wine glass before you take them home, their arm around your waist … the way they kiss, the way they touch. Sex is all the things you do with someone before intercourse, and the stuff you do afterward. Sex isn’t a few moments of PIV; it’s the whole package.” Georgie Wolf, writing in her book “The Art of the Hook-Up.”

Don’t give up on sex just because you can’t get hard!

There are many kinds of sexual activities that people find very pleasurable and fulfilling. Sexual activities that we normally call foreplay such as kissing, touching, and stroking each other’s body can all be exciting and enjoyable. Oral sex can be pleasurable for both women and men, even if a man can’t obtain an erection. Sexual toys can be used (such as those that vibrate) to bring pleasure and stimulation to men and women.

I encourage you to not give up on sex just because you can’t have an erection. Explore the other options open to you and continue to enjoy sexual pleasure.

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