How To Get Hard Naturally And Hold Your Erection Longer

Plenty of men go looking online for answers on how to get erect and stay hard, and it's easy to see why — struggling to get hard or stay that way can take a real toll on your confidence.

While the problem is frequently more of a mental spiral than the reality warrants, that doesn't mean it should be brushed off, particularly if getting or keeping an erection is a recurring struggle. What you might be facing is erectile dysfunction (ED).

Erectile dysfunction — also called impotence — describes an inability to achieve or hold an erection firm enough for satisfying sex [1]. So if getting hard or staying hard has become a repeated struggle, ED could well be the reason.

If ED sounds like what you're dealing with, you're far from alone — estimates put the number at up to 30 million men in the U.S. alone, and over 150 million worldwide [2]. Here's the encouraging part: once you pinpoint which type of ED you're up against, there are real paths to fixing it. Causes range widely — circulation issues, side effects from certain medications, performance anxiety — and because the causes vary so much, so do the solutions, meaning there's a good chance something out there will work for you specifically.

If you're weighing your options, it's worth bringing up how to get and stay erect with your doctor directly. They're in the best position to match a solution to your specific situation.

Recognizing the Symptoms of Erectile Dysfunction

Erectile dysfunction — the inability to reach or maintain an erection firm enough for satisfying sex — touches nearly every man at some point in his life. It only becomes a clinical concern, though, when it's persistent, happens regularly over time, and starts taking a psychological and emotional toll that affects both sexual activity and self-worth [3].

Signs of ED include [1]:

• Repeatedly struggling to get an erection at all — sometimes it happens, sometimes it doesn't.
• Getting an erection but being unable to hold onto it long enough for satisfying sex.
• Never being able to get an erection under any circumstances.

What Causes Erectile Dysfunction

ED generally falls into two buckets: physical causes and psychological ones. Most of the time, though, it's a blend of both, and research indicates that this combined form is actually the most typical presentation of ED [4].

Physical Causes — Circulation Issues

Since getting and staying hard depends on both healthy arterial blood flow in and proper venous blood retention, circulatory and vascular problems are a leading physical cause of ED [4]. Circulatory conditions linked to ED include:

Heart Disease — Research shows roughly 40% of men with ED also have cardiovascular disease, and in most cases, ED symptoms actually show up two to three years before a coronary artery disease diagnosis [5][6]. The exact mechanism connecting the two conditions isn't fully understood, but they share risk factors, and men with ED face a 23% higher risk of cardiovascular death and related events[7][8].

Clogged Blood Vessels (Atherosclerosis) — Atherosclerosis — plaque buildup that narrows the arteries — has been linked to erectile dysfunction [9]. Because a firm erection requires strong blood flow into the penis, atherosclerosis stands out as a significant driver of ED [10].

High Blood Pressure — Hypertension is the single most frequent condition paired with ED, and some researchers even suggest that essential hypertension and ED might be two expressions of the same underlying disorder, just affecting different organ systems [5].

High Cholesterol — Research has found that men with ED tend to have notably higher LDL ("bad") cholesterol levels than men without it [11]. Separately, cholesterol medications such as atorvastatin (Lipitor) have shown promise in improving erectile function for men whose only ED risk factor is elevated cholesterol [12].

Physical Causes — Nerve-Related Issues

Neurogenic ED — cases rooted in nerve damage or disorders — makes up somewhere between 10-19% of cases, with several nerve-related conditions tied to the problem, including [4]:

Diabetes — Elevated blood sugar in diabetic patients can damage both nerves and blood vessels, contributing to sexual issues including ED. More than half of men with diabetes eventually develop ED, though managing the condition well can help prevent or treat ED tied to diabetes-related nerve and vascular damage[13].

Parkinson's Disease — A wide-scale study of men with Parkinson's disease (PD) found erectile dysfunction to be strikingly common, with two-thirds reporting poor or very poor erectile function. Interestingly, the same research suggested ED often shows up before PD itself, potentially serving as an early warning sign [14]. A separate study of 75 sexually active men with PD found 68.4% reported ED [15].

Stroke — Disrupted neural pathways controlling erection are thought to play a role in the higher rate and severity of ED following a stroke, though post-stroke medications and the psychological toll of the event may also contribute [16]. Other research found impairments across ejaculation, erectile function, and sexual desire in stroke patients [17].

Multiple Sclerosis — MS correlates with elevated rates of sexual dysfunction in both men and women, with ED as the leading complaint among men — 50-75% of men studied reported ED-related issues [18].

Other Nerve-Related Conditions — Additional conditions that disrupt nerve pathways include [19]:

• Spinal cord injury
• Epilepsy
• Multiple system atrophy
• Spina bifida
• Peripheral nerve impairment following prostate or pelvic surgery

Any one of these could explain persistent difficulty getting and staying erect.

Additional Physical Contributors

A range of other physical conditions can get in the way of getting and staying erect, such as:

Peyronie's Disease — This condition involves scar tissue (plaque) forming inside the penis, usually along its top or bottom, which creates a bend or curve that can make erections painful. The precise cause remains unclear, but it may stem from repeated or acute penile injury, or an autoimmune response. ED is extremely common among men with this condition, and depending on severity, getting and keeping an erection can become genuinely difficult — in some cases, intercourse becomes impossible altogether [20].

Obesity — Obesity contributes to more than 300,000 U.S. deaths annually and has been established as an independent ED risk factor. About 79% of men with erectile issues have a BMI of 25 or above, and a BMI above 30 triples the risk of sexual dysfunction [21]. Research shows that obese men who commit to healthy habits like weight loss and regular exercise often regain sexual function [22].

Metabolic Syndrome — This umbrella term covers a cluster of risk factors for heart disease and other conditions — abdominal fat, elevated triglycerides, above-normal blood sugar, hypertension, and low "good" cholesterol [23]. Every component of metabolic syndrome has been tied to ED [24], and one study found that literally every participant with metabolic syndrome also had ED [25].

Sleep Disorders — Some research points toward a connection between sleep disorders and ED, suggesting either condition should prompt a check for the other in adult men [26]. Sleep apnea in particular has been linked to a higher incidence of ED [27].

Prostate Cancer — Radical prostatectomy, radiation, and hormone treatment for prostate cancer can each trigger ED. For some men, getting and staying hard afterward may only be achievable with medical devices or medication [28].

Here's something you might not know: prostate stimulation feels good and can actually support prostate health, helping you get hard more easily as you age. Check out this guide to prostate massage.

Low Testosterone — About one in five men with an ED diagnosis also has a hormonal imbalance, and low testosterone specifically has been linked to the condition [29]. Testosterone therapy can help in cases where low T is the suspected culprit, though it doesn't guarantee ED resolves completely [30].

Curious how testosterone factors into getting an erection? Read more here.

Poor Oral Health/Chronic Periodontitis — Oddly enough, your dental health may matter here too. Researchers examining the link between chronic periodontitis and ED found periodontitis to be a genuine risk factor — a reminder that oral hygiene has ripple effects across other serious health conditions, not just ED [31].

Legal, Illegal, and Prescription Drugs

Whether prescribed, over-the-counter, or illicit, certain substances can trigger ED and make getting and staying hard harder to achieve. Substances linked to ED include:

Certain Prescription Medications — A wide range of prescription drugs have been connected to ED, with multiple analyses pointing to tricyclic antidepressants and benzodiazepines in particular [32]. Blood pressure medications carry the strongest association with ED overall [33]. Other medications tied to ED include [34]:

• Antihistamines like diphenhydramine (Benadryl), cimetidine (Tagamet), and promethazine (Phenergan)
• Diuretics and blood pressure drugs like atenolol (Tenormin), clonidine (Catapres), furosemide (Lasix), labetalol (Normadyne), prazosin (Minipress), spironolactone (Aldactone), and verapamil (Calan)
• Antidepressants and psychiatric drugs like diazepam (Valium), fluoxetine (Prozac), lorazepam (Ativan), and sertraline (Zoloft)
• Parkinson's medications like levodopa (Sinemet) and benztropine (Cogentin)
• Hormonal medications and chemotherapy drugs
• Opiates such as methadone, morphine, codeine, and oxycodone (Percodan, Oxycontin)

Illegal Drugs — Despite their reputation as aphrodisiacs, illicit substances tend to hurt sexual function rather than help it — one study of men abusing heroin, MDMA, and amphetamines found higher rates of both ED and diminished sexual desire [35].

Tobacco Use — Research has documented a clear connection between smoking and ED [36]. A separate review found smoking may roughly double the odds of moderate-to-complete ED, though quitting appeared to lower that risk over time [37].

Alcoholism — In a study of alcohol-dependent men, 72% reported at least one form of sexual dysfunction, with premature ejaculation, low desire, and ED topping the list [38]. Heavy drinking raises the risk of sexual dysfunction in general.

Psychological Causes

ED can stem from psychological factors alone or layered on top of physical ones [39], though current thinking puts the share of purely psychological ED cases at around only 10% [40]. Psychological contributors include:

Depression — Depression and sexual dysfunction frequently go hand in hand for both sexes, and research shows the relationship runs both directions — men with ED should be screened for depression, and men reporting depression symptoms should be evaluated for sexual dysfunction [41]. Depression and anxiety disorders are both common among men with ED, though the underlying relationship is complicated [42].

Performance Anxiety — Fear of sexual failure and related psychological factors are believed to drive somewhere between 10-20% of ED cases [43]. Even when there's a clear physical trigger for ED, the stress that comes with the condition can compound it, creating a loop of anxiety feeding ED and ED feeding more anxiety. Anxiety has repeatedly shown up as a major factor in sexual dysfunction, especially around performance specifically [44]. One study of young military personnel with ED found that preoccupation with body image — particularly genital appearance — can drive sexual anxiety and, in turn, erection problems [45].

Both men and women commonly deal with performance-related sexual anxiety. For men, it might stem from an intense focus on making a partner orgasm — for more on that, see this post.

Looking for ways to manage it? This post about sexual anxiety covers strategies to quiet the anxiety and stay hard during sex.

Stress — Stress is a commonly overlooked driver of ED. Work pressure, relationship strain, or other major life events can all interfere with your ability to get or stay hard [46]. Stress can undermine erections in a few different ways — it can pull your attention away from the moment, preventing the stimulation needed for a firm, lasting erection, and it can also physically reduce blood flow to the penis. Unfortunately, this can spiral into a feedback loop of stress causing ED, which causes more stress, which worsens the ED further.

Relationship Problems — Tension within a family or between partners has also been linked to sexual dysfunction. One study found a meaningful connection between family or couple conflict and ED, along with depressive symptoms and generalized anxiety [47]. A smaller study pointed to a two-way relationship — marital strain contributed to sexual dysfunction like ED, and ED in turn fueled marital discord [48]. Other relational and emotional triggers for ED include [49]:

• Doubt or a sense of failure within the relationship
• Breakdowns in communication between partners
• Anger, anxiety, fear, or general stress in the relationship
• Placing too much pressure on sex, turning it into an obligation rather than something enjoyable

Low Self-Esteem — Diminished self-esteem is considered a possible psychological driver of ED, and even when the root cause is physical, ED itself can chip away at confidence and add stress [43], perpetuating the cycle. One study looked at self-esteem in men with ED treated using sildenafil (Viagra) and found that once ED was effectively managed, self-esteem, relationship satisfaction, and overall confidence all improved significantly [50]. That finding highlights just how tightly self-esteem and other psychosocial elements are woven into erectile function.

Shame or Guilt from Past Experiences — ED can also trace back to guilt, shame, fear, or other emotional residue from earlier sexual experiences. Religious upbringing that framed sex as sinful or shameful, for instance, can leave lingering discomfort around any sexual activity later in life. Being punished for masturbating as a kid is another example of an experience that can echo into adult sexual function. Even a single bad sexual experience with a partner can generate guilt or shame that snowballs into stress-related erectile issues [46].

Infertility — The emotional weight of infertility can also contribute to ED. Couples struggling to conceive often experience grief, panic, despair, and anger — all of which can spill over into sexual function [51]. Several studies have documented how common ED is among men navigating infertility [52], including one that found 22% of men in an infertility study experienced some form of ED [53]. Another study of men undergoing infertility evaluation found that some develop sexual dysfunction, including erection difficulties, as a response to the diagnosis itself [54].

Masturbation Habits — There's some indication that masturbation habits — especially when paired heavily with pornography — could contribute to ED. A review of existing literature and clinical research found evidence suggesting that masturbating to internet porn may condition arousal in a way that weakens responsiveness to real-life partners [55].

Solutions for Erectile Dysfunction

If you're researching how to get and stay erect, you'll find no shortage of ED treatment options — though the right one for you depends heavily on what's actually causing it. Since ED was first recognized as a genuine medical condition, treatment has expanded to include oral phosphodiesterase-5 (PDE5) inhibitors, vacuum devices, lifestyle changes, and intracorporal injections [4]. Every option has trade-offs, and effectiveness depends on the underlying cause, so partnering with your doctor to find the right fit is worthwhile.

Prescription Medications for ED — Oral medications are generally the go-to treatment ahead of more invasive options like injections or surgery [56] when the goal is getting hard quickly. Doctors commonly prescribe sildenafil (Viagra), tadalafil (Cialis), vardenafil (Staxyn, Levitra), or avanafil (Stendra) to support getting and staying hard. All of them work by relaxing smooth muscle tissue and boosting blood flow to the penis during arousal [57].

One upside of ED medication is a fast erection response. The downside is that spontaneous sex becomes tricky if you don't have the pill on hand.

Avoid these medications entirely if you take nitrates for heart problems — combining the two can cause a dangerous, sudden blood pressure drop. The same risk applies when combining alpha-blockers with erection medications, so always run your full medication list by your doctor.

While these drugs can help you get hard quickly and stay that way, they can occasionally cause a prolonged, uncomfortable erection lasting hours. Always review your prescription's warnings and side-effect information, and know when it's time to call your doctor.

Find out more about lasting longer in bed.

Vacuum Pumps and Cock Rings — Vacuum devices for ED have been on the market since the early 1980s and consist of three components: a vacuum cylinder, a pump to create suction, and one or more constriction rings. Both manual and battery-powered pumps exist. Once the pump has produced an erection, a ring (sometimes called a cock ring) is placed at the base of the penis to help maintain it — but rings should never stay on for more than 30 minutes [58].

Side effects can occur while adjusting to vacuum pumps and rings. Research has shown blood flow decreases once a ring is fitted at the base [59]. Pain and discomfort are common complaints, but overall satisfaction with vacuum pumps as an ED solution still lands around 68% [60].

Diet, Exercise, and Other Lifestyle Changes — Losing weight, cutting out alcohol and illicit drugs, staying physically active, and quitting smoking are all recommended lifestyle changes for men with ED who want to get hard [4]. Even alongside medication, these habits are worth pairing in. Quitting smoking matters in particular, since smokers face a 51% higher risk of ED [61]. Weight loss has also been studied as a treatment path — in one group of older, overweight or obese diabetic men, shedding weight noticeably helped preserve erectile function [62].

Related: 12 best sex positions for overweight men and women.

Penile Injections — Several injectable medications exist for ED, including papaverine, papaverine combined with phentolamine, Trimix, and alprostadil — each working by relaxing smooth muscle and widening blood vessels in the penis to trigger an erection [2]. A possible side effect is penile curvature, which can be painful and interfere with sex. Alprostadil is the most widely used of these injections, and research supports its safety and effectiveness, though fear of pain or the injection process itself often keeps men from trying it [4].

For men who'd rather skip the needle, alprostadil suppositories are an alternative — inserted into the urethra with a prefilled applicator, they typically trigger an erection within 8-10 minutes that lasts 30-60 minutes [57]. That timing might suit men who want a strong erection without one that persists for hours.

Surgical Intervention (Vascular Surgery, Penile Implants) — Surgery is generally reserved as a last resort once other treatments have failed. The two main surgical approaches used to achieve or maintain erections are [57]:

• Implanting a device engineered to make the penis erect (penile implant)
• Reconstructing arteries in the area to boost blood flow to the penis

Implants are typically placed by a urologist, and there are two categories:

• Malleable implants — rods that let you manually position the penis
• Inflatable implants — a scrotum-based pump lets you inflate the penis wider and longer

Satisfaction rates for implants tend to run high — one inflatable prosthesis reported an 83% satisfaction rate [63] and another device came in at 85% [64].

Penile vascular surgery covers both arterial revascularization and venous ligation procedures. Venous ligation initially showed decent short-term results, but its popularity has declined due to disappointing long-term outcomes [65]. The first arterial revascularization surgery dates back to 1973, and debate over its long-term value continues. The American Urological Association's Clinical Guidelines Panel concluded back in 1996 that neither venous nor arterial surgery should be routinely used for ED [66].

Psychological Counseling — When emotional or psychological factors are driving your ED, counseling can genuinely help. A therapist can teach techniques for managing sex-related stress and anxiety [57]. Sometimes your partner may be invited into sessions too, so they understand how best to support you. Research has also found men's group therapy to be effective for ED [67], and another study found sex therapy delivers reliable, lasting results for psychogenic ED [68].

Testosterone Replacement Therapy — Given the established link between testosterone levels and erectile function, and research connecting low serum testosterone to reduced erectile capacity, testosterone replacement therapy is sometimes prescribed for ED [69]. Transdermal gels and patches have been shown to boost desire, sexual enjoyment, motivation, and overall performance, along with an uptick in men reporting full, satisfying erections [70]. That said, other research suggests testosterone therapy may work best as a complement to PDE-5 inhibitors like Viagra, rather than a standalone treatment, for men with both ED and low testosterone [71].

Hormone therapy's benefits aren't limited to erections either — it can also help offset libido loss tied to low testosterone.

Looking for ways to boost your partner's libido? Check out this post on making a woman horny or this one about turning girls on.

Acupuncture — Acupuncture is gaining traction as an alternative ED treatment, though a systematic review concluded there isn't yet strong enough evidence that it improves ED on its own [72]. A small pilot study found 15% of participants saw improved erection quality and 31% reported more sexual activity, though the sample size makes it hard to draw firm conclusions [73]. More research is needed, but it could be worth trying alongside other treatments.

Kegel Exercises — Since the pelvic floor muscles play an active role in normal erectile function, researchers have theorized that weak pelvic floor muscles could contribute to ED. One study compared biofeedback and pelvic floor exercises against lifestyle changes alone in men with ED. In this randomized controlled trial, the intervention group saw meaningful gains in erectile function by three months, with further improvement by six months — 40% reached normal erectile function and 34.5% saw partial improvement [74]. This points to pelvic floor exercises as a strong first-line option for men seeking a lasting fix for ED.

Kegels may also strengthen the muscles involved in maintaining an erection naturally over the long term.

Related: 4 Kegel Exercises That Will Supercharge Your Sex Life!

'Treatments' Worth Avoiding for Getting and Keeping an Erection

Radio spots, banner ads, and even TV commercials frequently push "magic pills" and "dietary supplements" claiming to fix ED and boost sexual performance. It's tempting to try these shortcuts for getting and staying hard — but the FDA warns that unproven sexual-enhancement products may contain undisclosed drug ingredients capable of dangerously interacting with prescription medications and crashing blood pressure [75].

FDA testing has actually found sildenafil (Viagra's active ingredient) hidden in some of these prescription-free "magic pills," sometimes at doses high enough to be dangerous. Taking these prescription ingredients unknowingly can also trigger harmful interactions with other medications you're on [76].

Watch out for "natural" supplements too. Ginseng, maca, and horny goat weed are frequently marketed as male sexual health boosters and ED treatments, but the supporting evidence is thin. Manufacturers aren't even required to prove the purity of what's in the bottle [77], so there's no guarantee of how much active ingredient, if any, you're actually getting.

ED can stem from physical causes, psychological ones, or — most commonly — some mix of the two, and understanding your own root cause is key to learning how to maintain an erection reliably. Once you know what's driving it, though, you'll find a wide menu of solutions available to help you get and stay hard with your partner. ED is very much beatable — just stick to safe, evidence-backed approaches, and loop your doctor in so you can land on the most effective plan together.

Resources

It's completely normal for some erections to feel firmer than others according to Dr. Paul Joannides.

This article on The Telegraph offers guidance for women whose partners struggle to stay erect.

Curious about a woman's perspective on erectile dysfunction? Read this post.

WebMD also has a partner's guide to ED.

Take a look at these informative infographics about erectile dysfunction from Superdrug Online Doctor.

Getting Hard and Maintaining Your Erection FAQ

FAQ #1 – Is a single instance of erectile dysfunction something to worry about?

Struggling to get hard once or twice isn't cause for alarm — it happens to virtually everyone occasionally. ED as a diagnosis requires an inability to get or keep an erection sufficient for sex more than half the time [78]. Don't let an isolated incident spiral into worry, since anxiety and stress themselves are common ED triggers.

FAQ #2 – Does erectile dysfunction just come with getting older?

Research confirms ED becomes more common with age, affecting 52% of men between 40 and 70, with rates climbing further past 70 [79]. Age becomes a notable risk factor around 50 and up, though ED certainly isn't limited to older men [80]. Older men may also find it harder to reach the same firmness younger men do.

A firmer erection can also appear larger.

Related: How to Make Your Penis Bigger

FAQ #3 – Should I see a doctor if I suspect I have erectile dysfunction?

If persistent ED is disrupting your sex life and causing you emotional distress, it's time to talk to a doctor [81]. Many men avoid the conversation simply because the subject feels awkward to bring up — actually saying "why can't I get hard?" out loud isn't easy. Harvard Health offers a few tips for approaching the topic with your doctor [81]:

• Settle on phrasing that feels natural to you — a simple icebreaker can make the conversation easier to start.
• Jot down your questions ahead of time in case nerves make you forget them in the moment.
• Track your symptoms, since your doctor will likely have specific follow-up questions.

Doctors have genuinely heard far stranger things than "I can't stay hard." Being upfront can also help your doctor catch related issues, like prostate concerns, and recommend the right treatment.

FAQ #4 – How do doctors diagnose erectile dysfunction?

Diagnosing ED typically involves a combination of steps, including [82]:

• A review of your sexual and general health history
• A physical exam to check for underlying issues
• Lab work such as urine tests, cholesterol panels, blood counts, or testosterone levels
• Penile ultrasound to assess blood flow
• A psychosocial evaluation to rule in or out psychological contributors

FAQ #5 – Can you orgasm without getting an erection?

Yes — an erection isn't a requirement for orgasm or ejaculation. Even with no erection or only a partial one, orgasm through sexual stimulation is still very possible. As long as normal skin sensation in the penis remains intact, orgasm can happen regardless of erection status [28].

FAQ #6 – Should I bring up erectile dysfunction with my partner, and how?

If a fulfilling relationship matters to you, having the ED conversation with your partner is worthwhile — it's genuinely the first step toward a solution [83]:

Since talking about sex openly can feel uncomfortable, this advice for discussing sex with your partner is worth a look first.

Opening up might reveal your partner is far less fixated on your erection than you assumed. It can also open the door to pleasing her in other ways — like eating pussy (tips here) or fingering her (learn how to finger a woman) — which takes some of the pressure off your penis entirely.

Find out how to pleasure your woman.

You might also decide together that sex toys are a great option for penetration, and some can even help her squirt.

Read More: How to Make a Girl Squirt

FAQ #7 – Could too much porn be contributing to my erectile dysfunction?

There's evidence connecting sexual dysfunction like ED to frequent masturbation paired with internet pornography. It appears porn use can sometimes condition the body to respond only to that specific stimulus, though a three-week break from internet porn was shown to reduce sexual dysfunction symptoms [55].

FAQ #8 – What if nothing I try seems to work?

If you've worked through multiple approaches to staying hard without success, it's easy to fear your sex life is finished — but that's not the case. You still have options for sexual intimacy with a partner. Remember that an erection isn't required for orgasm, so pleasurable stimulation and orgasm remain very much on the table [28]. Shifting focus toward pleasing your partner shows care and commitment, and can help preserve a fulfilling relationship even while you keep working on solutions [84].

October 11, 2020