Erection problems don't just affect men - they can also have a real impact on a partner and a relationship as well. And they're more common than you may think. It's estimated that half of all men between the ages of 40 and 70 suffer from erectile dysfunction (ED) to some degree - with this rising to 7 in 10 men aged 70 and above.
What are erection problems?
An erection problem is the inability to sustain an erection which is good enough for a man to achieve penetration or orgasm, explains Dr Anand Patel, GP and specialist in sexual function.
"Some people are able to masturbate with a relatively soft penis and still achieve orgasm, but it may well not be good enough for penetration. It also depends on what kind of sex you're having, because if it's oral sex it's very different to vaginal sex, which is again different to anal sex, so it is very much the individual case," he says.
The impact of erection problems in a relationship
"Men can often feel quite frustrated about not being able to achieve an erection and it can be very demasculinising - the fact that they may see this as a symbol of their fertility and manliness and they're not able to achieve it on demand," says Patel.
"There are also external pressures like pornography or people writing about having better sex for longer in the media. Often the reality is that if you're stressed, have had a busy day, have eaten late and the kids are screaming and then you try to have sex, it's just not going to happen."
Female partners can worry that they're not attractive enough or that their husband is having an affair and can't get an erection because he is having sex elsewhere, explains Patel. But this is unlikely to be the cause.
"And sometimes a woman may be concerned that her partner is addicted to porn - which can be an issue and can occasionally be the case where you can't get an erection in real life."
However, again, there are other more likely explanations. You can find out more about the psychological and physical causes of erection problems in our leaflet.
Talking with your partner about erectile problems
Of course, erection problems can be a difficult issue for couples to discuss - but talking openly can often be the best way of resolving stress and identifying underlying causes. Talking about what's going on is a much better approach than pretending erectile problems aren't happening or just avoiding sex without giving a reason.
"I think the best thing to do is communicate openly - and recognise that your relationship and sex life aren't always going to be perfect and being relaxed about that. Ideally, you'll have a healthy relationship that allows you to talk," says Patel.
"Realise that this isn't going to be forever and perhaps examine your lifestyle together, which is such a big factor for erectile problems."
He suggests talking about whether there are things in your life that you can change - this could be eating better, stopping smoking, exercising more or reducing stress levels. Or, perhaps you need to just find time for each other, where you're not focused on kids, pets or work.
Change the way you think about sex
There are plenty of ways that you can be intimate together without having to have a strong erection. Focus on creating closeness rather than on penetration.
Patel says: "There’s lots of sex you can have that doesn't involve penetration and you can achieve orgasm without penetrating. So, think about sex more broadly. Increase your sexual script and have sex in slightly different ways. Having sex in different rooms, for example, can be enough or having sex in the morning rather than the evening when your testosterone is higher can also help."
When should you get help?
"If you have persisting difficulty with erections or you have had issues for longer than two to three months, get checked out by your GP," explains Patel.
They will be able to provide you with a health check, as ED can be a sign of underlying health conditions (such as heart disease), and also suggest a wide range of treatments.
If erection problems continue to be a barrier in your relationship, it may be worth speaking to a psychosexual therapist who can help identify where the difficulties lie.