Erectile Dysfunction:
Causes, Treatment and the Role of Exercises

Erectile dysfunction means regularly having trouble getting or keeping an erection firm enough for sex. Physical health, medication, stress and performance anxiety can all play a part, and a clinician can help you work out which apply to you. Keep It Hard, a program in The Coach app, gives you guided pelvic floor exercises, relaxation and practices for performance anxiety to use alongside medical care.

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What is erectile dysfunction?

Occasional erection problems are common and can come with tiredness, stress or alcohol. Erectile dysfunction symptoms are different: the trouble getting or keeping an erection keeps coming back. Noticing that pattern helps a clinician, but the pattern alone doesn’t show the cause.

  1. One bad night, or the first night with someone new. Nerves can make it harder to get or stay aroused. One difficult night isn’t a diagnosis.
  2. A run of difficulties that started with another change. New medication, stress, or changes in your health or habits may be part of it. Tell a clinician when it started, and don’t stop a prescribed medicine on your own.
  3. Losing it once midway and getting it back. Erections naturally vary during sex. One episode can’t tell you whether the cause is physical or psychological.

“Why can’t I get hard?” and “why can’t I stay hard?” describe two different difficulties: getting an erection and keeping one. Either way, a useful next step is to notice when it happens and to get help if it keeps coming back.

Physical and psychological factors: what to discuss with a clinician

Physical and psychological factors often overlap. These three questions help you prepare for an appointment, though they can’t sort out the cause without an assessment.

  1. Does it happen in every situation, or only some? Say whether it happens on your own, with a partner, or both. Getting erections in some situations doesn’t rule out a physical cause.
  2. Did it start gradually or suddenly? Note when you first noticed the change and whether it comes and goes. Either pattern can have more than one explanation.
  3. Is there something new alongside it? Mention new medication, health conditions, injuries or surgery. These details help the clinician decide what to investigate.

Psychological erectile dysfunction can involve anxiety, stress or relationship difficulties. Physical factors may also be present, and worrying about erections can add to the problem. An assessment helps you work out what kind of help to look for.

See a doctor if erection problems persist, happen in every situation, or come with pain or other symptoms. They may review your health and medication, examine you and suggest tests if needed.

What causes erectile dysfunction?

There’s no single main cause of erectile dysfunction. These five groups cover the common contributing factors, and more than one can apply at the same time.

01Cause
Blood flow. Cardiovascular disease, high blood pressure, raised cholesterol and diabetes can affect circulation. How well your pelvic floor muscles work can also affect firmness.
02Cause
Nerves. Diabetes, neurological conditions, spinal injuries and pelvic surgery can affect the nerves involved in erections. A doctor needs to assess these.
03Cause
Hormones. Low testosterone and thyroid conditions can contribute. A clinician can tell you whether hormone tests make sense for your symptoms.
04Cause
Medication and habits. Some medicines, recreational drugs and heavy drinking can affect erections. Smoking and inactivity can also contribute. If you think a medicine is involved, talk to the doctor who prescribed it.
05Cause
Anxiety. Worrying about whether you’ll stay hard can make it harder to stay aroused. Learning to manage that worry may help, alongside care for any physical factors.

Erectile dysfunction symptoms and patterns to notice

Worth a doctor’s visit

You can’t get an erection in any situation, even on your own
It started around a new prescription, a diagnosis, an injury or surgery
You already know about diabetes, blood pressure or cholesterol
There’s pain involved, or a change in shape

Patterns that may involve stress or anxiety

It works in some situations and not in others
It followed one bad experience, and now you’re braced for the next
Nothing else changed — no new medication, no new diagnosis
It varies with stress or pressure

Medical care, healthy habits and support for anxiety can all play a role. The right combination depends on the cause.

What can help with erectile dysfunction

Erectile dysfunction treatment depends on the cause. Medical care and practical changes often work together, and these four steps cover both.

  1. Have the physical causes checked and treated. A clinician can assess circulation, hormones, other conditions and medication. Treatment may include medicine, counselling or other options suited to your situation.
  2. Support your health with everyday habits. Regular activity, avoiding smoking, limiting alcohol and looking after your sleep can support general and sexual health. Ask for support with changes that are difficult to make alone.
  3. Practise muscle control and relaxation. Pelvic floor exercises, relaxation and practices for performance anxiety work on both the muscles and the worry. Keep It Hard puts them into a daily routine; it doesn’t replace medical care.
  4. Reduce pressure around intimacy. Talk with your partner and explore touch without making penetration or a firm erection the goal. You don’t need to force yourself to have sex. If avoidance or anxiety is getting you down, a therapist can help.

You can start the healthy habits today, with or without an app. For the exercises, a guided plan tells you what to do each day and helps you keep it up.

What an exercise program for erectile dysfunction involves

Keep It Hard gives you guided practices for each day, about 10 to 20 minutes in total. It doesn’t replace an assessment or treatment.

Step 01

Answer a few questions

A few questions set your starting point. They don’t diagnose the cause of ED.

Step 02

Follow the guided practices

Short lessons and guided practices for pelvic floor control, relaxation and performance anxiety, all in one daily plan.

Step 03

Review how you feel

From time to time the app asks how things are going. Don’t expect change overnight. Stop any exercise that hurts, and get advice if difficulties persist or get worse.

Build a guided exercise routine

If you want to know how to improve erections, the right exercises and help with anxiety can be part of the answer. Keep It Hard puts both into a daily plan, and a few questions give you a starting point.

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Can erectile dysfunction be reversed?

There’s no one answer to how to fix erectile dysfunction: how to cure ED depends on what’s causing it, and so does the care that helps.

Treatable isn’t the same as cured.

Many causes can be treated or managed, and that can improve erections. But no one can promise a permanent cure for erectile dysfunction for everyone.

Progress doesn’t follow one timeline.

Look at how comfort, confidence and erections change over weeks. You don’t need to treat every time you have sex as a test.

You can ask for help now.

If worry leads you to avoid intimacy, talk about it with your partner or a therapist. Getting support is more useful than forcing yourself to perform or waiting for the fear to disappear.

Age is one factor to consider.

Erection difficulties become more common with age, but they are not something you have to accept without help. Health conditions and medication are worth reviewing at any age.

Find the right place to start

Answer a few questions to get a plan with guided exercises and relaxation. If erection problems persist, see a doctor as well.

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What users reported after four weeks

From a survey of The Coach users after their first four weeks. These are personal experiences; individual results vary.

58%
Felt more in control during sex
55%
Said sex became much more satisfying
39%
Reported a higher libido
41%
Had sex more often

What men say about the program

Reviews from the App Store, Google Play and Trustpilot:

“I started using the coach in the first week of January, 2026 and by the 2nd week I’d already started seeing improvement in my erection.”

Elpaolo

“I have erectile dysfunction due to a few medical conditions. I believe that training my pelvic floor muscles with this app will beat my ED.”

Martin11997722

“The lessons and exercises have helped me tremendously. I am much more confident both within myself and also with my appearance. Intimate moments are not so anxious as before.”

Mark Rushby

“I take medication as a last resort, so when I saw the natural approach I thought I would give it a try. I am happy for the results I have gotten and I appreciate the tips and advice.”

Jeff Debruin

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Find your first guided practice

Everyone’s situation is different. Answer a few questions to get your own plan.

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The experts behind The Coach

Urologists, men’s health physiotherapists and sex therapists helped build the programs. That’s also why we tell you plainly when something needs a doctor rather than an app.

Gerard Greene

Specialist men’s health physiotherapist and senior lecturer at Coventry University.

Dr. Susie Gronski

Licensed physical therapist, certified sexuality counselor, and founder of a men’s pelvic health clinic.

Natalie Goldberg

Certified sex and family therapist dedicated to improving intimate relationships and personal well-being.

Dr. Amy Pearlman

Board-certified urologist specializing in male sexual wellness, performance, and hormonal health.

Dr. Justin Houman

MD, UCLA-trained urologist and male reproductive specialist focusing on sexual health.

Cameron Fraser

Certified sexologist and tantric yoga teacher who coaches men on sexual wellness and performance.

Ben Greenfield

13-time Ironman triathlete, bestselling author, and recognized expert in health, fitness, and performance.

Dr. Gary Shlifer

DO, board-certified internal medicine physician specializing in preventative care, nutrition, and anti-aging.

Questions about erectile dysfunction

Is it normal at my age?

It becomes more common with age, but it’s not something you just have to accept. Health conditions, medication and stress can play a part at any age, and a clinician can help find which causes of erectile dysfunction apply to you.

I still get erections some mornings — what does that tell me?

Morning erections give a clinician useful information, but they don’t rule out physical causes or count as a diagnosis on their own. Mention it if you’re getting them less often. For more about morning erections, see our guide to getting morning wood back.

Could this be a sign of something else?

Yes. Erection difficulties can be linked to cardiovascular disease, diabetes, medication or other health factors. That’s why it’s worth seeing a doctor when problems persist. One symptom doesn’t prove you have any particular condition.

Is there a simple trick to cure ED?

No. There’s no simple trick to cure ED, and how to fix ED depends on the cause. Medical care, healthy habits, help with anxiety and the right exercises can all play a part.

Do natural remedies or lifestyle changes help?

Yes, healthy habits can help. If you want to know how to get harder erections naturally, regular activity, avoiding smoking and cutting down on heavy drinking are useful steps. They don’t replace care for an underlying condition. Ask a clinician or pharmacist before using supplements for ED.

Can I do anything about it without medication?

Yes. Our Keep It Hard program gives you guided pelvic floor exercises, relaxation and practices for performance anxiety to use alongside medical care. Decide with a clinician how to treat erectile dysfunction medically, including whether medication suits you.

How long before anything changes?

There’s no fixed timeline. It depends on the cause, your health and how well the exercises suit you, and it won’t happen overnight. Get advice if symptoms persist or get worse.

What if an exercise causes pain?

Stop the exercise and get advice if pain persists or comes back. More contractions aren’t always better, especially with a tense pelvic floor. A pelvic health professional can tell you which practices suit you.

What do I get in the app?

Keep It Hard combines guided pelvic floor exercises, relaxation and practices for performance anxiety in a daily plan. Short video, audio and text lessons explain what to do. Allow about ten to twenty minutes a day.

Do I need equipment, pills or a partner?

No special equipment is needed, and the solo practices don’t need a partner. Some later lessons are for you and a partner, and the main touch practice also has a solo version. The program doesn’t involve pills and doesn’t replace prescribed medication or medical care.

More programs from The Coach

Keep It Hard

Stay hard without the pills.

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Last Longer

Real arousal control in eight weeks.

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Overall Health

Boost your testosterone and get your energy back.

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Man’s Guide to Sexting

Mental foreplay, one message at a time.

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Take a practical next step

Build a routine with guided exercises and relaxation, for about ten to twenty minutes a day. Get medical advice when symptoms call for it.

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