Why do erections fade too quickly?
An erection that repeatedly fades before or during sex, rather than now and then, fits the definition of erectile dysfunction, the persistent inability to get and keep an erection firm enough for satisfactory sex. Losing the erection soon after ejaculation is normal. Treatments work well, and alprostadil injections are effective in more than 70% of men.
How is a fading erection different from premature ejaculation?
An erection that fades during arousal or intercourse, before ejaculation, points to erectile dysfunction. Losing the erection after ejaculation is normal, and some men who notice this have premature ejaculation rather than erectile dysfunction.
Both problems often occur together. A significant proportion of men with erectile dysfunction also have premature ejaculation, and performance anxiety about erections can make premature ejaculation worse.
"High levels of performance anxiety related to ED may worsen PE, with a risk of misdiagnosing PE instead of the underlying ED." Source 1, p. 59
For this reason, the two are told apart before treatment. The history records whether premature ejaculation is lifelong or acquired and whether it happens with a specific partner or in all situations.
What causes erections to fade?
Erectile dysfunction has physical causes, such as problems with blood vessels, hormones and nerves, and psychological causes, and most cases involve both. The medical history records the rigidity and duration of erections during sex and in the morning, which helps show the pattern.
Low testosterone is one recognised cause, and men with low testosterone who do not respond to PDE5 inhibitor tablets may respond better after testosterone treatment. Relationship factors and mental health problems such as anxiety and depression are also linked with erectile difficulties.
Which first steps help an erection last?
Lifestyle changes and control of risk factors are recommended before, or at the same time as, treatment, and physical activity, weight loss and treatment of heart risk factors may improve sexual function. PDE5 inhibitor tablets are the first-line medicine.
When tablets seem not to work, the prescription and the way they are taken are checked first. High-fat meals can delay absorption of some tablets, men may wait too short or too long before sex, and explaining the dose, timing and the need for sexual stimulation often restores the effect. Cognitive behavioural therapy (CBT) combined with medical treatment is recommended when psychological factors play a part.
How well do injections and vacuum devices work?
Vacuum devices produce erections satisfactory for intercourse in up to 90% of men, whatever the cause, although satisfaction ranges from 27% to 94% and long-term use falls to 50% to 64% after two years. Common side effects include pain, difficulty ejaculating, small bruises and numbness.
Injections of alprostadil into the penis are effective in more than 70% of men, with satisfaction of 87% to 93.5% in patients and 86% to 90.3% in partners, and the erection appears within 5 to 15 minutes. A three-drug mixture called Trimix reaches 92% effectiveness but has never been licensed for erectile dysfunction, and men learn the injection technique in a training session first.
When is a penile implant considered?
A penile implant is recommended when other treatments fail or when the patient prefers it. Once in place, it gives an erection that lasts as long as the man wants. Infection and mechanical failure are the two main complications, and infection affects 2% to 3% of first implants in low-risk men at high-volume centres.
Satisfaction after implant surgery reaches 92% to 100% in men and 91% to 95% in partners with appropriate counselling, one of the highest rates of any treatment. An implant is best regarded as irreversible, so it is discussed in detail before surgery.