What causes a weak erection? Having a weak erection means being unable to achieve or maintain sufficient penile firmness for satisfactory sexual intercourse. It is neither a rare occurrence nor an inevitable sign of ageing. It can happen inconsistently — sometimes the erection is firm, at other times less so — leading to frustration, anxiety, and insecurity.
This decline in vigour can have a profound impact on a man’s psychological and physical well-being, as well as on the dynamics of a couple’s relationship. Intimacy may become a source of stress rather than pleasure, and self-esteem can suffer.
Many men, out of embarrassment, tend to downplay the issue, hoping it will resolve on its own. However, a weak erection is often an early warning sign of underlying medical conditions, particularly those affecting the cardiovascular system. For this reason, a specialist assessment with an experienced andrologist such as Prof. Fabio Castiglione can provide comprehensive answers to the question: what causes a weak erection.
What causes a weak erection? The main causes: a complete and clear map!
The reasons behind a weak erection are multiple and often interconnected. Understanding them is essential to identify the most effective therapy.
Vascular Causes
The penis is a vascular organ. To achieve a stiff erection, you need optimal blood supply. Any condition that damages blood vessels can compromise this mechanism.
- Atherosclerosis: The hardening and narrowing of the arteries, often caused by high cholesterol, reduces blood flow to the penis.
- Hypertension (high blood pressure): Damages the walls of the arteries, making them less elastic and impairing the vasodilation required for an erection.
- Diabetes: Long-term high blood sugar levels damage both blood vessels (micro- and macroangiopathy) and nerves (neuropathy) involved in the erectile process.
- Dyslipidaemia: Abnormal levels of fats in the blood (cholesterol and triglycerides) contribute to the formation of atherosclerotic plaques.
Hormonal causes
Hormones play a crucial role in regulating sex drive and erectile function.
- Hypogonadism (low testosterone): A testosterone deficiency can reduce libido and contribute to a less vigorous erection.
- Thyroid dysfunction: Both hyperthyroidism and hypothyroidism can interfere with sexual function.
- Hyperprolactinemia: High levels of prolactin can suppress testosterone production and cause erectile dysfunction.
Neurological causes
The signal for an erection originates in the brain and travels through the spinal cord to the nerves of the penis.
- Neurodegenerative diseases: Multiple sclerosis, Parkinson’s disease.
- Spinal injuries or pelvic surgery: Procedures for prostate or rectal cancer can damage the erectile nerves.
- Peripheral neuropathies: Often associated with diabetes or chronic alcoholism.
Psychological and Relational Causes
The mind is the most important sexual organ.
- Performance anxiety: The fear of failure can create a vicious cycle that inhibits erection.
- Chronic stress and depression: These can alter neurotransmitters and hormones linked to sexual function.
- Excessive consumption of pornography: This may lead to desensitisation and the development of unrealistic expectations.
- Relationship problems: Unresolved conflict or poor communication can diminish desire and arousal.
Medications and Substances
Many commonly used medications can cause erectile dysfunction as a side effect.
- Antidepressants (especially SSRIs).
- Certain antihypertensive drugs and diuretics.
- Anti-androgen medications (used in the treatment of prostate cancer).
- Alcohol, cigarette smoking and recreational drugs: all of these can impair vascular and neurological function.
Anatomical causes
Peyronie’s disease (Induratio Penis Plastica): The formation of fibrous plaques in the penis causes curvature, pain, and loss of stiffness.
Penile or pelvic trauma.
Lifestyle and Metabolic Factors
- Overweight and obesity: They increase systemic inflammation, reduce testosterone, and worsen vascular health.
- Sedentary lifestyle: An independent risk factor for erectile dysfunction.
- Obstructive sleep apnea: Reduces nighttime oxygen levels and alters hormonal balances.
Giving a definite answer to the question: “what causes a weak erection” is the first step to solving it. Book a specialist visit to London with Prof. Castiglione by calling +447830398165.
The Correct Diagnosis before Treatment: Why it’s Essential
Avoiding self-diagnosis and “do-it-yourself” solutions is essential. A specialist assessment makes it possible to identify the exact cause of the problem and, consequently, the most suitable therapy.
At Prof. Castiglione’s clinic, the diagnostic pathway includes:
- Complete medical history: Detailed discussion of the patient’s medical, sexual, and psychological history, including review of all ongoing drug therapies.
- Validated questionnaires: The International Index of Erectile Function (IIEF-5) provides an objective score of the severity of the disorder.
- Blood tests: Total and free testosterone levels, thyroid hormones (TSH), prolactin, blood sugar and lipid profile are checked.
- Dynamic penile echocolorDoppler: This test is the gold standard for evaluating the vascular component. After the injection of a vasoactive drug, ultrasound allows the blood flow in the arteries of the penis to be measured in real time, identifying any venous leaks or insufficient arterial supply.
Depending on the clinical picture, it may be necessary to involve other specialists such as the cardiologist, endocrinologist or psychosexologist, in a multidisciplinary approach coordinated by Prof. Castiglione.
How to take action: 2025 solutions from fastest to longest
Once the cause has been defined, you can choose from a range of treatment options, often combinable with each other for an optimal result.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil)
- How they work: They increase blood flow to the penis in response to sexual stimulation. They do not cause an automatic erection.
- Timing: Fast action (30-60 minutes). There are on-demand formulations (to be taken as needed) and low daily dosage (for continuous coverage).
- Caution: Contraindicated in patients taking nitrates for heart problems.
VED (Vacuum Erection Device) Devices
- How they work: A cylinder creates a vacuum around the penis, drawing blood. An elastic ring is then placed at the base to maintain an erection.
- Timing: Effective immediately, but the ring should not be kept for more than 30 minutes.
- Pros and cons: Non-pharmacological solution, but may not be spontaneous.
Intracavernosal injections (ICIs)
- How they work: Micro-injections of vasoactive drugs (e.g. alprostadil) directly into the penis.
- Timing: Powerful erection in 5-15 minutes, independent of stimulation.
- Pros and Cons: Highly effective even when pills fail. They require medical training for self-administration and carry a small risk of priapism (prolonged erection) and fibrosis.
Low-intensity shock waves (Li-ESWT)
- How they work: Low-energy acoustic pulses stimulate the formation of new blood vessels (neoangiogenesis) and improve endothelial function.
- Timing: It is a curative therapy, not symptomatic. The benefits become apparent gradually over a few weeks.
Pshocks (PRP + Shock Waves)
- How it works: This is the advanced regenerative approach proposed by Prof. Castiglione. It combines the action of shock waves (Li-ESWT) with injections of PRP (Platelet Rich Plasma), a concentrate of growth factors obtained from the patient’s own blood. This synergy enhances tissue and vascular regeneration.
- Timing: The goal is a lasting improvement in natural erectile function, with appreciable results in 6-12 weeks. It is ideal for patients with vascular or mixed causes.
Prosthetic surgery
- How it works: Implantation of penile prostheses (malleable or three-component hydraulic) for cases refractory to all other therapies.
- Results: Definitive solution that guarantees excellent rigidity and a very high satisfaction rate for the patient and the partner.
Don’t let frustration take over. Ask yourself “what causes a weak erection?” and take action. Call +447830398165 to discover the most innovative solutions offered by Prof. Castiglione in London.
A lifestyle that supports rigidity
Therapies are most effective if supported by a healthy lifestyle. What is good for the heart, is also good for the erection.
- Exercise: At least 150 minutes of moderate aerobic activity (brisk walking, running, cycling) per week.
- Diet: The Mediterranean diet, rich in fruits, vegetables, fish and healthy fats, has been shown to improve erectile function.
- Weight control: Losing even just 5-10% of your body weight can make a big difference.
- Stop smoking and reduce alcohol: Two of the most powerful enemies of vascular health.
- Sleep quality: Sleeping 7-8 hours per night is essential for hormonal and cardiovascular health.
Frequently Asked Questions (FAQs)
How can I fix a weak erection?
The solution starts with a precise diagnosis. An andrologist will evaluate the causes (vascular, hormonal, psychological) and set up a personalized treatment plan, which can include oral medications, regenerative therapies such as shock waves or Pshocks, up to definitive solutions such as prostheses.
Why isn’t my erection fully hard?
The most common causes are an insufficient arterial blood supply (often linked to cardiovascular risk factors such as smoking, diabetes, hypertension) or a “venous escape”, in which blood cannot get trapped in the corpora cavernosa. A dynamic penile echocolorDoppler can clarify the exact cause.
How to improve erection hardness?
In the short term, drugs such as sildenafil or intracavernosal injections are very effective. In the long term, improving lifestyle (diet, exercise) and undergoing regenerative therapies such as shockwaves and the Pshocks protocol can restore the natural vascular function of the penis, leading to spontaneous and harder erections.
Why does my partner lose an erection during intercourse?
It can depend on physical causes (e.g. veno-occlusive escape) or psychological (performance anxiety). It is important to approach the topic with empathy and without judgment, encouraging him to consult a specialist. The problem is almost always solvable and the support of the partner is essential.
Safety first
Be wary of so-called “miracle” supplements or drugs purchased online from unauthorised sites. These products may be ineffective, contain dangerous ingredients, or interact with other therapies. Taking erection medications in particular requires medical supervision, especially if you have heart conditions or are taking medications such as nitrates. A preventive cardiology consultation may sometimes be necessary to ensure maximum safety.
Conclusions: Recovering rigidity and trust is possible
A weak erection is not an ineluctable fate, but a medical condition with precise causes and effective solutions. Today, thanks to an advanced diagnostic approach and a therapeutic arsenal ranging from on-demand drugs to innovative regenerative strategies, it is possible to recover satisfactory and long-lasting penile rigidity.
The key to success lies in a personalized specialist assessment. Understanding the source of the problem makes it possible to combine fast-acting interventions for immediate relief with long-term strategies, such as the Pshocks protocol, which aim to restore and improve natural erectile function. Don’t let embarrassment stop you from rediscovering the pleasure of serene and fulfilling intimacy. The path to regaining vigor and confidence begins with a simple phone call.