Erectile dysfunction (ED) is a common condition and the proportion of men who experience ED dramatically increases with age.1 The failure to obtain an erection or poor erectile function can be an incredibly distressing experience. Yet, many tend not to realise that this phenomenon is inevitable at some point in life and doesn’t necessarily mean clinical ED is present.
What is ED?
ED is defined as the persistent inability to attain and/or maintain an erection that is sufficient for sexual performance.2 The keyword within this definition is ‘persistent’. If you occasionally experience a failed erection, it's likely nothing to worry about.3 If it happens more often, then ED could be present; if so, visiting a healthcare professional is strongly recommended.4
Who's at risk of ED?
Certain conditions are strongly associated with ED, such as cardiovascular disease, obesity and diabetes, metabolic syndrome, depression, and other mental health disorders.2 Some of these conditions may well be the cause of ED while others may act as a risk factor. For example, cardiovascular disease is one cause through the build-up of fatty substances called plaque within the arteries that transport blood to the penis, causing obstruction and reduced blood flow.2
What can cause episodic ED events/occasional failed erections?
Alcohol intake is a well-established risk factor for sexual issues and is strongly associated with poor erectile function.5 Episodes of failed erections in men who consume large amounts of alcohol are routine, especially in men who consume more than three standard units of alcohol (12 g ethanol) daily.6 Though reasons as to why alcohol strongly influences erections and sexual issues are not fully understood; it’s thought that its interaction with key arousal signals from the hypothalamus within the brain is one potential explanation.7
The risk of a failed erection can increase with tiredness, which can soon become a vicious cycle causing more stress, even worse sleep, and lowered sexual arousal. Many physicians have anecdotally observed the relationship between poor sleep and decreased libido in patients.8 Unfortunately, a lack of high-quality data makes it difficult to fully understand the true impact tiredness can have on sexual arousal and erections.
In one attempt to understand why tiredness impairs erectile function, researchers sleep-deprived rats for a 72-hour duration while taking blood samples to see what, if any, changes would occur as a result. Noticeably, several interesting observations were discovered. For one, erectile function declined, as did levels of nitric oxide, a gas responsible for the initial relaxation of the penis, a critical step in the initiation of an erection. In addition, testosterone, a hormone thought to strongly influence erections, also declined.9
These findings should be interpreted with caution as it’s uncommon to observe such prolonged periods of sleep deprivation in humans. Nonetheless, this research does hint at the possible reasons behind impaired erectile function in tired men. However, whether the effect is as extreme as observed in this study is unknown, and further research is needed.
While tiredness can cause poor erectile function, it may also be a cause of clinical ED too, with those suffering from sleep disorders at a greater risk of persistent and clinical ED.10
How do I know if I have ED?
Unfortunately, there is no set timeframe for poor erectile function to be classed as clinical ED. As guideline recommendations emphasise the persistent nature of poor erectile function in ED, it’s important to be self-aware and monitor how consistent the failed erections are. Some suggest the condition needs to persist for six months to be ED – yet this seems to be an arbitrary estimation.11 With the well-established links between ED and conditions such as cardiovascular disease, if you experience poor erectile function consistently for more than a couple of weeks, it’s sensible to visit your healthcare professional to obtain a correct diagnosis and receive the appropriate treatment if necessary. 4
Take home points
- While factors such as alcohol and tiredness can cause poor erectile function, chronic alcohol intake and tiredness may cause clinical ED
- If poor erectile function persists for more than a couple of weeks, it’s important to visit a healthcare professional to receive the appropriate diagnosis and if necessary, treatment
- Feldman HA, et al. Journal of Urology 1994;151(1), 54–61.
- Hacket G, et al. J Seks Med 2018;15:430–457.
- NHS. Erectile dysfunction (impotence) available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/. Date accessed: September 2022.
- NHS Inform. Erectile dysfunction (impotence) available at: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence. Date accessed: September 2022.
- Arackal B, et al. Indian J Psychiatry 2007;49(2):109–112.
- Mirone V, et al. Eur Urol. 2004;45:87–91.
- Prabhakaran, et al. Indian J Psychiatry 2018;60(1):71–77.
- Everyday health. Situational Erectile Dysfunction: Should You Worry? Available at: https://www.everydayhealth.com/erectile-dysfunction/situational-erectile-dysfunction-should-you-worry.aspx. Date accessed October 2022.
- Lee DS, et al. J Seks Med 2019;15:15–16.
- Lin H, et al. Int J Clin Practice 2015;69(8),846–852.
- Sooriyamoorthy T, et al. Erectile Dysfunction. [Updated 2022 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/?report=classic.