Erectile dysfunction (ED) may happen gradually, so a person may still be able to get hard in the early stages. The duration, strength, and frequency of erections may decrease gradually with ED.

Many people experience trouble getting an erection from time to time, but if it happens more than 25% of the time, it may be ED.

While ED may disrupt how often a person gets an erection, it does not mean they cannot get hard.

This article looks at how ED affects erections and how doctors diagnose and treat it.

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The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that ED starts gradually. At first, a person may get an erection sometimes, but not every time they want to have sex.

Sometimes, the person’s erection may not last long enough or be hard enough for penetrative sex or climax.

People may experience ED to varying degrees, with only a few people having difficulty getting hard. Many people experience the symptoms intermittently but often enough to be bothersome.

If the cause of ED is psychological — such as stress or concerns involving intimacy — a person may still get hard but have difficulty getting an erection in certain circumstances. For example, they may get an erection at night but not for sexual intercourse.

If difficulties with erections start happening more often, a person with ED might be concerned with how long their erections can last or with how their partner feels about their sexual actions. These feelings can also worsen ED symptoms.

People may experience ED to varying degrees. The first symptom may be experiencing temporary difficulty getting an erection.

For example, a person may have ED if they experience:

  • difficulty getting an erection sometimes but not every time they want to have sex
  • an erection, but it does not last long enough for sex
  • trouble getting an erection at any time

ED may affect a person’s quality of life and be a symptom of an underlying condition. Thus, people may want to consider contacting a doctor if they suspect ED.

Doctors will look for both physical and psychological causes of ED. They may recommend blood tests to check for:

Once a doctor identifies an underlying condition, they can offer various treatments.

The NIDDK says that lifestyle changes, such as reducing or stopping alcohol use and smoking, and increasing physical exercise, can improve a person’s erectile function.

Other treatments include:

  • Oral medication: ED medications include sildenafil (Viagra) and tadalafil (Cialis). These work by increasing the blood flow to the penis during stimulation, increasing the likelihood of a lasting erection.
  • ED injections: Injecting alprostadil directly into the penis before sex is an option for those who cannot take oral medications or whose previous treatments are ineffective for them. The injections cause the penis to fill up with blood and become erect.
  • Penis pumps: These are vacuum pumps that pull blood into the penis. The person can then use a special band to hold the erection during sex.
  • Surgery: Doctors may recommend penile implants if all other treatments are ineffective for them. The person can then inflate the implant when they wish to have sex.
  • Therapy: Counseling can help individuals or people in relationships work through any psychological concerns that may cause ED.

If a person has ED because of an underlying condition, treatment can prevent it from worsening.

The Urology Care Foundation (UCF) states that professionals often associate ED with blocked arteries and other cardiovascular conditions that need treatment to avoid complications. ED can also signify that a person’s diabetes results in nerve damage that can benefit from treatment to prevent further complications.

Getting ED treatment may affect a person’s relationships, lessening additional stress and anxiety.

The NIDDK acknowledges that how a person treats their ED is up to personal choice but recommends counseling to reduce a person’s fear and anxiety.

With the many treatment options available, the UCF says many people can experience sexual intimacy in a way that works for them. They can maintain a hard enough erection to climax or orgasm.

Some people find that the symptoms disappear completely over time, while others may continue to benefit from their treatment.

This section answers some frequently asked questions about erectile dysfunction.

Can a man with ED still come?

Yes, a person with ED can still ejaculate. However, it may not happen as regularly or reliably as previously.

Doctors may diagnose people with ED if they have a difficult time getting an erection 25% of the time.

Additionally, the NIDDK states that a person with ED may get an erection sometimes but not every time they want to have sex. In these cases, a person may complete sexual intercourse.

Because of this, a person with ED may complete sexual intercourse sometimes but not all the time.

Can you suddenly get erectile dysfunction?

Anyone can experience unexpected episodes of ED at any time, but it is a gradual process.

If ED occurs suddenly, it may be a side effect of taking medication or a psychological episode. The NIDDK says that some medications, including antidepressants and blood pressure medications, can cause ED.

How do you get hard and stay hard with ED?

Feeling sexually excited can be an important part of getting and staying hard. People with ED may take longer to experience arousal or need treatments to help them get erections.

Vacuum pumps and penile injections can give instant results, while oral medications may take more than an hour to have an effect.

People with erectile dysfunction can still get hard and experience orgasm. However, it may not be as frequent as a person previously experienced.

Underlying conditions, such as diabetes or cardiovascular disease, can contribute to a person’s ED.

Many different treatments are available, and many people find one that allows them to return to their previous levels of sexual satisfaction.