How erections work

An erection occurs when the blood flow to the penis increases, causing it to change shape and size.

There are three stages to an erection:

• Soft or flaccid penis: This is the penis’s “normal” state, and it occurs when there is no sexual arousal or stimulation via sight, touch, or fantasizing. During this phase, blood flow to and from the penis is equal.
• Swollen penis: Sexual stimulation causes the brain and nerves to change the blood vessels and other tissue of the penis so that more blood flows into the penis than flows out. The penis starts to swell during this phase.
• Erect penis: The penis becomes erect as visual, imaginary, or touch stimulation continues. The brain and nerves continue to send more blood to the penis and restrict blood flow from it. The penis becomes fully erect, allowing manual stimulation or vaginal, anal, or oral sex to occur.

A variety of physical or psychological issues can prevent an erection from occurring or lasting long enough for sexual activity.

It is also possible that the penis will become erect for no known reason. An erection can occur at awkward times during the day.

In these cases, a person can take certain steps, such as readjusting their pants or shirt, to hide the erection and try taking their mind off their penis. If these steps fail, they can visit the bathroom until the erection passes.

How long should sex and erections last?

There is no universal set time for the length of sexual activities or how long a penis should remain erect. Typically, an average erection may last from a few minutes to roughly half an hour. However, this can vary significantly due to the many factors that can affect erection duration.

It is also worth noting that a person does not need an erection to achieve orgasm.

People may worry that they are on either end of the spectrum and that their erection lasts either too long or not long enough.

In some cases, a person may have difficulty getting an erection, having a firm erection, or maintaining one long enough for satisfactory sex. Physical or psychological factors can contribute to erectile dysfunction (ED) or premature ejaculation (PE).

In other cases, a person may have a prolonged erection unrelated to sexual activity or interest, which is known as priapism. Medications, drugs, and injury can cause priapism, which can be a serious condition due to the risk of permanent tissue damage.

Factors that affect erections

A variety of factors can temporarily cause erection problems. These include:

• fatigue
• alcohol or recreational drug use
• distractions
• feelings of self-consciousness
• tension
• being uncomfortable with a partner

In addition to temporary causes of erection trouble, medical issues can also cause short- or long-term ED.

For example, after receiving treatment for prostate cancer, some people may develop ED. However, it is still possible for these individuals to regain full sexual function.

Erectile dysfunction

ED affects as many as 30 million people with a penis. ED occurs when a person is unable to get or keep an erection long enough for sexual activity.

According to the Urology Care Foundation, ED occurs when erection troubles are an ongoing issue. Several factors, such as stress or relationship issues, can worsen ED. Some common causes of ED include:

• age over 50 years
• high blood pressure or blood sugar levels
• smoking
• cardiovascular issues
• obesity
• lack of exercise
• high cholesterol levels
• recreational drug or alcohol use

Several treatments are available for ED, including medications, physical interventions, and, potentially, surgery.

Premature ejaculation

PE is a form of sexual dysfunction that may prevent people from having satisfactory sex. Various factors can cause PE. These include psychological causes, such as anxiety or inexperience, and medical causes, such as drug use or health conditions.

PE may resolve by itself, or it may require treatment options that will vary due to the underlying cause. These can include therapy, topical drugs, or using different sexual methods.

Priapism

Priapism is a prolonged erection unrelated to sexual arousal that is also often painful. Certain medications, such as ED drugs, blood thinners, antidepressants, and some blood pressure drugs, can cause priapism.

It is important for someone who has had an erection for 4 hours or more to seek immediate emergency care. Tissue damage can begin 4–6 hours after erection onset. Any damage to the sensitive penile tissue may be permanent and nonreversible.

Treatments to help reduce a prolonged erection include:

• medication to decrease blood flow
• aspiration to drain blood from the penis
• surgery to restore normal blood flow to the penis

When to see a doctor

In some cases, a person may not need to see their doctor for erection troubles. Temporary problems, such as stress or relationship issues, may cause erection difficulties but do not necessarily require a visit to the doctor.

However, a person should talk to their doctor if they frequently have an issue with achieving an erection. Their doctor may be able to help them identify a root cause, such as medication or emotional issues. The doctor can also provide treatment to help the person get an erection.

If a person has a prolonged erection that is unrelated to sexual activity and lasts more than a few hours, they should seek immediate medical help.

Summary

Erections are usually necessary for many types of sexual activity involving a person with a penis. Erections typically start during arousal and normally go away when arousal stops or following ejaculation.

Factors such as stress, alcohol, and medication can affect a person’s ability to achieve and maintain an erection. If a person has continual trouble with getting an erection, they should talk to their doctor because they may have ED.

A person should also see their doctor if they have an erection that lasts much longer than the sexual activity. Priapism can result in permanent damage if a person does not receive treatment.