Why Am I Not Getting Hard? Understanding & Solutions for Erectile Dysfunction

Can't achieve or maintain an erection? You're not alone.

Erectile Dysfunction (ED) is more common than you might think. It affects millions of men in India and around the world. According to the highly prevalent Massachusetts Male Aging Study, about 52% of all men experience ED in their lifetime. So, don't panic! Most cases of ED are treatable, and often, simple lifestyle changes can make a big difference.

In this article, we'll break down the causes of ED and explore solutions based on an interview with Bangalore-based sexologist, psychiatrist, and neuropsychiatrist Dr. Ravi Prakash. Dr. Prakash has over 10 years of experience helping patients across India overcome sexual health concerns.


Question: What is Erectile Dysfunction (ED)?

Answer: ED is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. It's often caused by reduced blood flow to the penis, but the underlying reasons can be complex: they can be physical, physiological, related to lifestyle factors, or a mix of all. My patients often come in distress and ask for a clear answer and simple solution. But we have to be careful: we need to understand the cause to solve the problem effectively. 

I always first try to understand their medical history, any underlying or genetic conditions, sexual history, relationship dynamics and many additional aspects. As a professional sexologist, I ask them about their lifestyles, the type of profession of education they’re currently pursuing and its subsequent effects, their diets and a whole lot more. These questions are crucial to identify the causes of their erectile dysfunction. 


Question: How to recognize Erectile Dysfunction symptoms? 

Answer: Erectile dysfunction is characterized by one of these two issues:

  • You are unable to achieve an erection.
  • You can achieve an erection but despite arousal, are unable to maintain it mid-sex.

If this happens once in a blue moon, nothing to worry about. But if any of these two signs happens consistently, I would advise consulting a sexologist.


Question: Is Erectile Dysfunction Reversible?

Answer: Definitely! Take a young patient of mine. He loves cycling. When he started to face erectile dysfunction symptoms, he came to me really worried, explaining how this would affect his relationship. And guess what: after talking to him, we understood that the shape of his bike seat and his seating position were causing significant pressure on the perineum—the area between the genitals and anus. That led to temporary nerve damage and reduced blood flow to the penis. A couple of lifestyle (and biking equipment) changes, and voilà!

This is the reason I insist on establishing the correct diagnosis. Sometimes, pills would be irrelevant. Sometimes, therapy is needed. Sometimes, just a good conversation. And sometimes, just a different bike seat. As a sexologist, my job is also to find out how to help. 


Question: What are the common Causes of Erectile Dysfunction?

Answer: Well, there are many possible causes and three general categories: 

  • Reduced Libido: This can be due to hormonal imbalances, stress, relationship issues, or mental health conditions like anxiety and depression.
  • Physical Factors: Vascular conditions, neurological diseases (like diabetes or spinal cord injuries), penile trauma, and chronic illnesses can lead to Erectile Dysfunction.
  • Lifestyle Choices: Excessive smoking, drinking, obesity, and a sedentary lifestyle can lead to erectile dysfunction. Such lifestyle choices are usually the source of erectile dysfunctions amongst young people. Of course, such lifestyle choices are likely to trigger erectile dysfunction at every stage of your life. 

Question: How can I recover from Erectile Dysfunction? 

Answer: In any case, I encourage patients to maintain balanced diets, exercise regularly, and watch their alcohol/smoking consumption. Being from Bangalore, I see too many cases where alcohol excesses affect libido and penile functioning. Pelvic floor exercises, also called Kegel exercises may speed up the whole process because they have a direct impact and help erection to last longer.

In some cases, and if injuries or underlying conditions are involved, it’s a mix of lifestyle factors and medical interventions. Sildenafil (Vaigra) is the most common drug that patients ask for. Antihypertensives help manage cholesterol and blood pressure (BP).

Occasionally, some cases demand medical therapy, such as testosterone replacement therapy, or surgery, like penile implants. Both options are seldom needed and tend to be very safe. 


Question: I have erectile dysfunction. Should I tell my partner? 

Answer: When erectile dysfunction is caused by performance anxiety, negative thought patterns or unresolved relationship issues, I often recommend intimacy coaches. Couple therapy and mindfulness training is always recommended to increase emotional connection between them, which leads to a more satisfying sex life.



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Take Control of Your Sexual Health

If you're concerned about ED, don't hesitate to seek professional help. You can book an online consultation with Dr. Ravi Prakash or visit him in person. Remember, prioritizing your sexual health is an act of self-care. Explore Libertee's collection of vibrators and massagers to enhance your journey to pleasure and well-being. Subscribe to our newsletter and get the latest on sexual wellness. Libertee, out!

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