You have no problem getting an erection—and keeping it up until you and your partner are both satisfied. But even if your penis is humming along just fine now, there could still be some issues lurking beneath the surface.
That’s right: Even if you’re getting an erection with no problem now, you still may be well on your way to erectile dysfunction.
Penis problems generally don’t just pop up out of the blue, though. In many cases—especially if we’re talking about a physical cause of erectile dysfunction, rather than a mental one—there are certain signs that can serve as a harbinger that issues may be brewing.
Sometimes, a minor erection issue could be a sign that you’re headed towards disaster in the sack. It could also be your body’s way of telling you that you have another, more serious concern to deal with, explains S. Adam Ramin, M.D., medical director of Urology Cancer Specialists in Los Angeles.
So no penis problem should be ignored. Here, 8 unexpected signs that can point to erectile dysfunction down the line—and what you should do if you notice them.
Erectile dysfunction sign: You haven’t woken up with morning wood in a while
Nighttime and early morning erections have nothing to do with feeling aroused: They happen because your brain releases less noradrenaline—a hormone that keeps erections from happening nonstop—during sleep.
Having frequent morning wood is a good thing, since it indicates the blood vessels that allow blood to flow to your penis are healthy, says Dr. Ramin.
If you start noticing that you’re waking up with an erection less often than usual, that could mean that those blood vessels aren’t working as well as they should—making it harder for blood to flow into your penis to become erect, Dr. Ramin says. That means the same issue impeding your morning wood might eventually rear up in the bedroom, when you’re actually trying to get hard.
Now, there’s no magic number that means you could be in trouble. It’s any amount that’s different than your normal that raises the red flag.
Erectile dysfunction sign: You don’t think about sex as much as you used to
If the stuff that usually gets you going just isn’t working anymore, there’s a good chance that your testosterone levels are lower than normal.
Testosterone is the main hormone responsible for your sex drive, explains New York-based urologist and sex expert David Shusterman, M.D. If it plummets, your desire to get going in the say may, too.
And if you’re not really in the mood, getting hard will be next to impossible.
Along with a lack of sexy thoughts, you may also notice some other signs of low testosterone, like fatigue or mood changes, difficulty building muscle, or even developing a gut.
Erectile dysfunction sign: Your cholesterol or blood pressure reading came back high
The results from your annual physical’s lab work might hint that your erection is in danger. Two of the most common tells? High cholesterol and high blood pressure.
High total cholesterol is anything 240 milligrams per deciliter (mg/dL) or higher, and recent guidelines have just lowered the threshold for high blood pressure to 130/80 millimeters of mercury (mm Hg) or above. (One high BP reading probably isn’t a big deal. But more than two to three elevated readings over time likely means you have high blood pressure.)
Both high cholesterol and high blood pressure can damage your blood vessels, causing them to lose their elasticity. This makes it harder for the vessels to expand so more blood can flow into your penis, says Dr. Ramin.
That in turn can make getting hard more difficult. “If the vessels can’t dilate, there won’t be enough blood flow to cause an erection,” he says.
Erectile dysfunction sign: You started a new prescription medication
Antidepressants and high blood pressure meds are particular culprits, says Dr. Ramin.
Antidepressants like SSRIs (like Prozac or Paxil) and SNRIs (like Effexa XR and Cymbalta) make it harder for hormones and chemical signals that make you feel aroused, like norepinephrine, to reach the brain, explains Dr. Ramin. And that lowered libido can make it harder to get an erection. Typically, you’d start to notice these symptoms within a couple weeks of starting the meds.
Blood pressure meds, of course, work to lower your blood pressure. That’s a good thing for your overall health, but it can be a bad for your sex life. Lower BP means less blood flow to the arteries in your penis, which could mean trouble getting hard, Dr. Ramin says.
Erectile dysfunction sign: Your gums are swollen, tender, or bleed easily
Gums that are swollen, painful, or bleed when you brush or floss are likely signs of gum disease. That doesn’t cause ED directly, but it can set off a chain of events that could create problems for your package, Dr. Shusterman explains.
That’s because gum disease can lead to inflammation throughout your body, which can damage your blood vessels. And if your blood vessels aren’t functioning properly, it’ll be tougher for blood to flow into your penis and make you hard.
Erectile dysfunction sign: You don’t get as hard as you used to—or you have trouble staying that way
You’re still getting hard enough for sex. But your penis still might be signaling an issue if you notice any kind of change to your erection—in fact, this can be the early stage of ED.
“It’s usually a slow, progressive problem,” Dr. Ramin says. “Initially, a patient might notice that his erections are not as firm, or that he isn’t able to maintain his erections for as long as before.”
There’s no cutoff level for how soft or short an erection has to be to signify a problem, though. It’s just about changes from your own personal norm, says Dr. Ramin. It’s probably not a big deal if it only happens once. But if you notice it happening frequently and you can’t think of a mental reason why you’d be having trouble getting hard (like you’ve been extra exhausted or stressed), that might be pointing to a bigger issue.
Erectile dysfunction sign: You’re suffering in the sleep department
No matter what’s stealing your shuteye, lack of sleep can lead to problems in the boner department. That may be especially true if you have sleep apnea, a sleep disorder where your breathing pauses frequently throughout the night.
Nearly 70 percent of guys who have sleep apnea also have ED, according to the International Society for Sexual Medicine.
Sleep deprivation causes testosterone levels to plummet and can make you feel more stressed or anxious, Dr. Shusterman explains. And all of those things can kill your libido and make it harder to get an erection.
Erectile dysfunction sign: You have kidney disease
Guys with kidney disease may also develop problems maintaining erections. That’s because medical conditions like these also impact hormone levels, blood circulation, and energy, according to the National Kidney Foundation. Or some guys lose interest in sex because because of the emotional and physical changes these conditions may cause. However, men may regain their interested with time as they treat the initial kidney problems. But that’s not to say that all men with kidney problems will go on to experience ED. Taking prescribed medication, communicating with your doctor, and speaking with a psychologist can help guys maintain a healthy sex life.
Psychological factors of erectile dysfunction
Most men will experience ED at some point. In fact, 70 percent of guys will be impacted by the time they’re 70, according to the Cleveland Clinic. Guys are often too embarrassed to speak with their doctors, but there’s no need to hide their problems, says urologist Dr. Jamin Brahmbhatt.
“Men have said to me they often feel like less of a man because they are unable to get an erection,” he tells Men’s Health. “At that moment I usually tell them that their ability to admit to the problem is the best they can do as a man.”
Usually patients are less anxious after talking through their problems and learning they’re not alone, he says. But left untreated, ED can severely impact a guy’s self-esteem and even relationships.
“There can be a breakdown in communication, and I’ve seen couples’ problems in the bedroom lead to problems elsewhere in their relationship,” Dr. Brahmbhatt explains. “Men can avoid this by just manning up and talking about the problem!”
What to do if you notice erectile issues
You should speak with your doctor the moment your erections start to seem unusual, recommends Dr. Ramin.
Sometimes the fix might be straightforward, like adjusting your meds if you take prescriptions that are messing with your ability to get hard. If it turns out that the problem stems from an underlying health issue, diagnosing and treating it could be the key to getting your erections back to normal. That could involve tests to measure things like your blood pressure, cholesterol, or testosterone levels.
Either way, your doctor might also be able to offer help in the short term to keep your sex life from tanking—like prescribing an ED med like Cialis, Viagra or Levitra. (For everything you need to know about ED, check out The Men’s Health Guide to Erectile Dysfunction).