Erectile Difficulties: It’s Not Always What You Think

Erectile difficulties are far more common than most people imagine. Nearly 20% of men over 20 will experience some form of ED at some point in their lives.

I don’t use the term erectile dysfunction—I prefer erectile difficulties because it’s more accurate and less pathologizing. A penis isn’t a machine you flip on. Erections are a complex process, and difficulties can come from multiple overlapping contributors:

• Cardiovascular

• Hormonal

• Nerve-related

• Muscular

• Psychological

• Social and relational

Yes, sometimes a pill helps. But most of the time, it’s more nuanced than that.

A Team Approach Works Best

In my practice, I find that a multidisciplinary lens is key. That may include a urologist or sexual medicine physician, a sex therapist, and a pelvic floor therapist or sex counselor. No one professional holds all the answers—and you shouldn’t have to piece it together alone.

Start With the Basics

Most people benefit from shoring up the foundations first:

1. Cardiovascular exercise
Most erectile difficulties have a vascular component. If blood flow isn’t optimal in your body, it often shows up first in your penis. Consistent movement makes a meaningful difference.

2. Sleep
Poor sleep is linked with lower testosterone, and deep sleep is essential for healthy hormonal rhythms. Remember: testosterone alone doesn’t create an erection, but it’s part of the larger system.

3. Nutrition
You know that sluggish feeling after a week of eating mostly processed foods? Your penis feels it, too. The Mediterranean diet is associated with improved erectile function, but perfection isn’t required. Small shifts still help.

Digging Into the Specifics

The Pelvic Floor
Your pelvic floor helps support the blood flow that creates and maintains an erection. When it’s not moving well, often because it’s overactive or stuck “on,” that can interfere with erections.

If you just tried to do a kegel while reading that…stop.

For most people with erectile difficulties, releasing and restoring movement to the pelvic floor is far more effective than squeezing. Pelvic floor training should expand your options, not tighten everything down.

The Nervous System & Arousal
Erections can appear at unexpected times because sometimes they’re simply a reflexive physiological response. But during partnered or intentional sex, you need two key ingredients:

• A psychological cue - you actually want what’s happening.

• A relatively calm nervous system - anxiety makes the erection pathway less efficient.

Worrying about “getting it up” or “keeping it up” can create the exact conditions that make erections harder. It’s an exhausting loop, and you’re not alone if you’ve been stuck in it.

Pressure, Masculinity & Pleasure

Many men carry immense pressure around erections - how hard, how long, how reliable. Some link their masculinity or worth to what their penis can or can’t do. When I ask clients what they actually enjoy, many have no idea.

Your penis has so many pathways to pleasure, and so many ways to please a partner, regardless of firmness or duration. Expanding your sexual menu, redefining what “counts,” and exploring pleasure without performance pressure can open doors you didn’t know were there.

You Don’t Have to Carry This Alone

Most men with erectile difficulties feel isolated. They often haven’t told friends, and sometimes haven’t even shared it with their partners. That’s a heavy load to carry privately.

This is why working with someone who can listen, assess, and create a plan just for you can be life-changing.

Ready for Support?

If you want a practical starting point you can use today, head to https://groovephwellness.com/erectile-difficulties/ and they will send you the free guide:

When You Start Strong and End Soft

It walks you through a gentle in-the-moment reset - no shame, no pressure.

You can also learn more about my program Men Thriving, created specifically for men navigating pelvic pain, sexual health concerns, and erectile difficulties.

It’s okay to ask for help - especially if you’re ready for things to feel different.

Author: Laura Ross PT, DPT, PRPC, CSC