Not being able to get or maintain an erection (known as erectile dysfunction) is not uncommon. It can be hugely frustrating and have an impact on how you feel about yourself. Erectile dysfunction can have many causes, some physical and some psychological. 

Why can't I get hard?
Stress, anxiety, depression, hormone levels, smoking, recreational drugs and alcohol are all known to play a part [1]. Some prescribed drugs – like Prozac and Seroxat, used to treat depression – can also decrease your desire to have sex [2]. There are also some erection problems that can be caused by HIV, or the side effects of certain anti-HIV drugs [3]. If your erection problems are psychological, it can become a vicious circle; the more you worry about your erection, the less likely you are to be able to get one. It can help to have some distraction, so encourage your partner to focus on something other than your cock for a while – kissing or nipple play might help to get you back in action.

Medical conditions such as diabetes, high cholesterol and high blood pressure can also cause erectile dysfunction. It is important that you get screened for these conditions, especially if you are over the age of 40. Apart from erectile dysfunction, they can also cause more serious health conditions such as heart disease or strokes.

Viagra and other drugs
Erection problems can usually be sorted out, possibly through counselling or the use of drugs like Viagra or Cialis and your doctor can talk to you about these options. Alternatively, the Dr Thom website offers anonymous online assessments by NHS-certified doctors free of charge which can determine if you need medical treatments like Viagra. If the assessment suggests that you need treatments, you can purchase these online and get them delivered in discreet packaging to your door. By quoting the GMFA code number '187BBA9' when checking out, Dr Thom will give 5% of the price of the purchased product to GMFA – and this will help us to keep this website (which currently receives no funding) running.

Erectile dysfunction drugs should not be taken with recreational drugs like poppers, cocaine and ecstasy, as the combination puts a lot of pressure on your heart and can increase the risk of heart attack.

What else can I use?
Cockrings can also be used to help maintain a hard-on. A cockring is a rubber or metal ring or leather or rubber strap that fits around the cock and balls and restricts the blood flow out of the cock. They can help you get a hard-on and help you stay hard for longer. They can easily be bought online or at sex shops. Leather or rubber straps are safer to use, as they are easier to remove, especially if you have not used a cock-ring before. 

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References:
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1 Permpongkosol S, Kongkakand A, Ratana-Olarn K, Tantiwong A, Tantiwongse K, and the Thai Erectile Dysfunction Epidemiological Study Group. Increased prevalence of erectile dysfunction (ED): results of the second epidemiological study on sexual activity and prevalence of ED in Thai males. The Aging Male, 2008;11(3):128-133.
2 Csoka AB, Bahrick AS, Mehtonen O-P. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. Journal of Sexual Medicine, 2008;5:227-233
3 Collazos J. Sexual dysfunction in the highly active antiretroviral therapy era. AIDS Reviews, 2007;9:237-245.