Insufficient Penile Erection: Causes and Solutions

Insufficient congestion / Erection

Hello, I would like to inquire about issues related to penile erection and engorgement.
My personal situation is that I feel my hardness is insufficient, and it softens quickly.
When I want to engage in sexual intercourse, it starts off hard, and during foreplay, such as oral sex and body licking, everything feels normal, and I don't feel bored or unexcited.
However, my penis suddenly becomes less hard.
I can sense that it feels like there is insufficient engorgement, but I don't feel that it is due to a lack of stimulation.
After finishing foreplay, when both parties intend to proceed to intercourse, I find that I lack the hardness needed to put on a condom, or I can put it on, but it just doesn't feel right; it doesn't have that normal firm feeling that I can control.
This situation has been occurring for about two years.
I am currently 26 years old and work out more than four times a week, incorporating both cardio and weight training, including HIIT exercises, with my heart rate reaching 160-170.
Each workout lasts over an hour, and my daily diet includes one kiwi and one banana, along with boiled meals, vegetables, fruits, and plenty of water, so I am generally well-nourished.
My body fat is around 11-12%, and I have a six-pack, so I am not overweight.
I also experience morning erections daily, which can sometimes be very firm, while at other times they are semi-soft.
When I have a very firm morning erection, it is the condition I desire (which was also the case two or three years ago during intercourse).
Occasionally, I do experience erections during the day, and at those times, the hardness is also what I desire for sexual activity.
However, when it comes to actual intercourse, I find it difficult to achieve the desired state.
During masturbation, there are times when I cannot reach the level of hardness I want; it tends to be somewhat soft and somewhat hard, and I feel that if I stop stimulating my penis, it will soften immediately.
I also experience semi-hardness and ejaculate.
I have considered the possibility of psychological barriers causing this, but I have experimented many times in a completely relaxed state without thinking about it and engaged in intercourse, yet it did not go as smoothly as expected.
I really want to know what the underlying cause of this issue is.
I do smoke (approximately for seven years), but I have tried quitting for three months to see if there was any improvement, and there was none.
Currently, I smoke about one cigarette a day, and sometimes I only smoke once every three or four days.
I do not drink alcohol or chew betel nut, and I typically masturbate about once a week, with no other bad habits.

Lin Xiansheng, 20~29 year old female. Ask Date: 2018/08/14

Dr. Chen Jiansheng reply Urology

It may still be largely psychological factors.
You can first try medications like Viagra to help build confidence.

Reply Date: 2018/08/14

More Info

Understanding insufficient penile erection, also known as erectile dysfunction (ED), can be a complex issue that involves both physiological and psychological factors. Based on your description, it seems that you are experiencing difficulties with maintaining an adequate erection during sexual activity, despite having normal erections at other times, such as during morning erections or while engaging in foreplay.

Causes of Insufficient Penile Erection
1. Physiological Factors:
- Blood Flow Issues: Erections are primarily caused by increased blood flow to the penis. If there are any issues with blood vessels or circulation, this can lead to insufficient blood flow, resulting in weaker erections. Conditions such as atherosclerosis (hardening of the arteries) can impede blood flow.

- Hormonal Imbalances: Testosterone plays a crucial role in sexual function. Low testosterone levels can lead to decreased libido and erectile issues. It’s important to have hormone levels checked if you suspect this might be a factor.

- Nerve Damage: Conditions such as diabetes or neurological disorders can affect the nerves that signal the blood vessels in the penis to dilate, which is necessary for an erection.

2. Psychological Factors:
- Anxiety and Stress: Performance anxiety can significantly impact your ability to maintain an erection. Even if you feel relaxed, subconscious worries about sexual performance can lead to difficulties.

- Depression: Mental health issues can affect libido and sexual performance. If you have been feeling down or anxious, this could contribute to your symptoms.

3. Lifestyle Factors:
- Smoking: While you mentioned that you smoke infrequently, smoking is known to affect blood circulation and can contribute to erectile dysfunction over time. Even light smoking can have negative effects.

- Diet and Exercise: Although you maintain a healthy diet and exercise regularly, it’s important to ensure that your diet is rich in nutrients that support vascular health, such as omega-3 fatty acids, antioxidants, and vitamins.

Solutions and Recommendations
1. Consult a Healthcare Professional: It’s crucial to discuss your symptoms with a healthcare provider. They can conduct a thorough evaluation, including blood tests to check hormone levels and assess cardiovascular health.
2. Lifestyle Modifications:
- Quit Smoking: If you haven’t already, consider quitting smoking entirely. This can improve your overall vascular health and potentially enhance erectile function.

- Dietary Adjustments: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Foods that improve blood flow, such as dark chocolate, nuts, and fish, can be beneficial.

- Regular Exercise: Continue your exercise routine, as physical activity is beneficial for cardiovascular health and can improve erectile function.

3. Psychological Support: If you suspect that anxiety or stress is playing a role, consider speaking with a therapist or counselor who specializes in sexual health. Cognitive-behavioral therapy (CBT) can be effective in addressing performance anxiety.

4. Medical Treatments: If lifestyle changes and psychological support do not resolve the issue, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis) may be prescribed to help improve blood flow to the penis.

5. Avoid Self-Diagnosis: While it’s good to be informed, avoid jumping to conclusions about your condition. Each individual’s situation is unique, and a healthcare professional can provide tailored advice and treatment options.

In conclusion, insufficient penile erection can stem from a variety of causes, including physiological, psychological, and lifestyle factors. It’s essential to approach this issue holistically and seek professional guidance to identify the underlying causes and appropriate treatment options. Remember, you are not alone in this, and many men experience similar challenges at different points in their lives.

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