What is an erection?

When a man has an erection blood flows to the penis, which makes it hard. Many men have erection problems (erectile dysfunction, impotence) as they get older. Some of these problems include:

• trouble getting an erection
• the penis isn’t as hard as it used to be with an erection
• erections don’t last as long as they used to

Men can still have orgasms, even if they don’t have an erection. During sexual touching or stimulation, a man can still have an orgasm, even if the penis isn’t hard enough for intercourse. It’s normal for men to have difficulty with erections on occasion. Erectile dysfunction gets more common as men get older.

What causes erection problems?

Erection problems can be caused by:

• blood vessel problems
• nerve problems
• heart disease​
• diabetes
• smoking
• cancer treatments involving the pelvis (e.g., pelvic radiation therapy, pelvic surgery)
• depression, anxiety, or stress
• drinking too much alcohol

Chemotherapy can also affect the ability to have an erection because it can affect sexual desire. If this happens, sexual touching might be needed before an erection can happen. If you’re having trouble with interest in sex or erectile function, think about erections in a different way—as a response to sexual touch. Erections may happen with sexual touching instead of on their own when you think about or feel the urge to have sex.

Difference between orgasm and ejaculation?

Orgasm is different than ejaculation. For most men, they happen at the same time. Many people think orgasm and ejaculation are the same thing, but they aren’t. A man can have an orgasm without ejaculating. For most men, they ejaculate when they orgasm, which causes fluid to come out of the penis.

Sometimes after surgery or pelvic radiation, some of the nerves are damaged and some of the nerves aren’t. Even if nerves are damaged, a man can have an orgasm without having an erection. This is because the nerves that help a man feel pleasure are different than the nerves that cause an erection.

If the prostate has been removed, a man can still have an orgasm, but he won’t ejaculate. The prostate gland makes the liquid part of semen. If it’s removed during surgery or damaged by radiation, men have dry orgasms. Some men say that the quality of the orgasm is different, but many men say it’s just as enjoyable. If a man doesn’t ejaculate, he’s infertile.

If I have trouble with erections, are there treatments?

There are many ways to treat erectile problems including:

• vacuum erection devices
• erection medicine
• penile injections
• penile prostheses

Enjoying Sex without a Firm Erection

Many couples keep having sex, even if the man can’t get a firm erection. People can still have orgasms with caressing, oral sex, or other types of stimulation. Think about getting a sex toy (e.g., vibrator). A vibrator works well if you’re tired or if you get tired using your hands to stimulate your partner. You can also lie facing your partner and rub your genitals against each other or use a vibrator between you. Make sure to use a good lubricant to make it feel good and decrease pain from friction.

Many people think that penis-in-vagina sex or sex with penetration are the only ways to have sex. But, most couples use touching and caressing as part of their routine. When couples can’t have intercourse because of erection problems, many give up on sex, but others continue to have sex in other ways. Think about trying something new.

There is no risk when learning to enjoy sex without a firm erection. Some people may feel this option goes against their religious beliefs or values. If this is a concern for you, talk to your healthcare provider.

Tips for Having Sex without a Firm Erection

• Try different ways to caress each other that you haven’t tried before. Try things more than once if they don’t work well the first time.
• Make sure you understand your partner’s body, and where and how they like to be touched.
• Most women like to have the clitoris touched and caressed. Talk to your partner about what you like. Be open to trying new kinds of touch.
• If you or your partner has a hard time reaching orgasm, think about using a vibrator when you have sex.
• Add in new ways to increase your excitement like thinking about a sexual fantasy or reading an erotic story to each other.
• Use a lubricant when stimulating the penis by hand or with a vibrator.
• Think about masturbating (on your own or with your partner). This can help you know how you like being touched best. Sometimes, this can change after surgery or cancer treatment. Talk about how you like to be touched with your partner. Also, anything that increases the blood flow to the penis helps keep the tissue healthy, including masturbation.​​