How to get hard and stay hard

The lifestyle changes that can make all the difference when you're suffering from erectile disorders.

If you’re not satisfied with your erection, you could be suffering from an erectile disorder. But don’t worry, there are plenty of things you can do to manage symptoms and treat disorders early on to return to healthy erections.


How erections work

When you’re sexually aroused, the sensory nerves leading to the brain begin to fire, signaling the penis muscles to relax. This increases blood flow to the male sex organ. As blood creates pressure in the penis, it expands and becomes erect. An erection ends when the penis muscles contract and blood flows back out of the organ. The whole process is governed by important chemicals in the body and brain, namely nitric oxide and phosphodiesterases. Nitric oxide signals the muscles in the blood vessels to relax and widen whilst phosphodiesterases inhibit the erection.

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What is erectile dysfunction

Erectile dysfunction describes the inability to get or maintain an erection. Common reasons for the condition include psychological (e.g. depression, anxiety) and neurological causes (e.g. Alzheimer’s, Parkinson’s disease), cardiovascular conditions (e.g. atherosclerosis), diabetes, obesity, and high blood pressure. Certain medications, smoking, and heavy alcohol consumption are also associated with impotence.


Medications to treat erectile dysfunction include Viagra, Cialis, and Levitra as well as several generic versions of the drugs. They act by blocking the phosphodiesterases so that the penis stays erect for longer.


What is erectile dissatisfaction

Erectile dissatisfaction is often confused for a more serious dysfunction, but they are not the same. Men who suffer from erectile dissatisfaction may find it harder to keep an erection; they could be disrupted more easily by noises or distracting thoughts. Alternatively, they may find that they can no longer become erect by mental stimulation but need hands-on help. This tends to be a natural process that often occurs in men over the age of 50, but psychological issues such as anxiety and depression may exacerbate erectile dissatisfaction.


Before you jump to conclusions or rush off to the pharmacy, there are lifestyle changes that have been scientifically proven to correct erectile issues.


The lifestyle changes that make the biggest difference


Sleep well

According to research by the American Urological Association, men who sleep badly are more likely to have erectile dysfunction. Researchers found that with decreasing sleep quality, erectile dysfunction increased. There may be several reasons for this including a decline in testosterone levels. Chronic sleep disruptions are also linked to health issues and may increase the risk of stroke or heart disease.


If you’re experiencing sleep issues, you can try a few things to get a good night’s rest. First, ensure that your bedroom is dark and quiet. Meditation before bedtime has been shown to promote rest and a sense of calm. It’s also a good idea to avoid caffeine or alcohol before bed. They are known diuretics and you may find yourself waking up in the middle of the night to urinate.


Eat healthily

Obesity and diabetes are known risk factors of erectile dysfunction. The majority (79%) of men with erectile disorders have a BMI of 25 or higher, and eight million cases of erectile dysfunction in the US are linked to obesity and diabetes. With increasing BMI, the risk of a hormonal imbalance increases; production of testosterone becomes hampered. Excess fat also damages the cells lining the penis which restricts blood flow through the organ. Physical inactivity and psychological issues associated with obesity may make it harder for men to engage in pleasurable sexual experiences.


Eating a healthy and balanced diet free from processed foods can help minimize the risk of developing a serious medical condition. The Massachusetts Male Aging Study found that eating healthy foods was associated with fewer incidences of erectile dysfunction. If you’re trying to lose weight, opt for fresh foods, cut excess sugar and focus on sustainable dietary changes.


Exercise regularly

Another great way to boost your body’s natural healing mechanisms is through exercise. Research by the University of Copenhagen found that exercise keeps the blood vessels more elastic which boosts blood flow to the penis. Physical activity also promotes the production of nitric oxide which relaxes the muscles of the blood vessels. But how much should you exercise to notice an effect? The science suggests that 40 minutes four times a week can improve erectile dysfunction within six months.


Cardio and aerobic activities also strengthen the heart which keeps the arteries from being clogged up. If you’re just starting out, go for a walk to boost your health. Fitness trackers on smartphones make it easy to monitor how many steps you’ve taken. Current recommendations are in the region of 7,500 to 10,000 steps per day.


Cut stress

Too much stress can have negative effects on the body and the mind. Chronic stress not only affects the immune system but is also associated with heart disease. In addition, stress disrupts the hormone balance of the body. During stressful events, the body produces more epinephrine (the adrenaline hormone), which promotes muscle tension – the exact opposite of what you need during an erection. When you’re anxious or stressed it may thus become harder for your smooth muscle to relax and erectile dysfunction is the consequence.


You can cut stress by practicing relaxation techniques or meditation. If you suffer from anxiety or depression, it may be worth visiting a therapist to address any unexplored issues.  



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  2. Cartledge, J., Minhas, S., & Eardley, I. (2001). The role of nitric oxide in penile erection. Expert Opinion on Pharmacotherapy, 2/1: 95-107. DOI:
  3. Yafi, F., Jenkins, L., Albersen, M., Corona, G., Isidori, A., Goldfarb, S., & Maggi, M. et al. (2016). Erectile dysfunction. Nature Reviews Disease Primers, 2/1. DOI:
  4. Tam, L. (2019). Why erectile dysfunction does not mean the end of your sex life. South China Morning Post. Retrieved September 15, 2019, from <>
  5. Research Connects Poor Sleep Quality and Nocturia with Erectile Dysfunction, Low Testosterone and Increased Risk of Death - May 20, 2018. (2019). American Urological Association MediaRoom. Retrieved September 15, 2019, from <>
  6. Nagendra, R., Maruthai, N., & Kutty, B. (2012). Meditation and Its Regulatory Role on Sleep. Frontiers in Neurology, 3. DOI:
  7. Skrypnik, D., Bogda?ski, P., & Musialik, K. (2019). Obesity--significant risk factor for erectile dysfunction in men. Pol Merkur Lekarski, 36/212: 137-41.
  8. Feldman, H., Goldstein, I., Hatzichristou, D., Krane, R., & McKinlay, J. (1994). Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151/1: 54-61. DOI:
  9. Gerbild, H., Larsen, C., Graugaard, C., & Areskoug Josefsson, K. (2018). Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sexual Medicine, 6/2: 75-89. DOI:
  10. Lee, I., Shiroma, E., Kamada, M., Bassett, D., Matthews, C., & Buring, J. (2019). Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Internal Medicine, 179/8: 1105. DOI:
  11. Salleh M. R. (2008). Life event, stress and illness. The Malaysian journal of medical sciences : MJMS, 15(4), 9–18.
  12. Trussell, J., Kunselman, A., & Legro, R. (2010). Epinephrine is associated with both erectile dysfunction and lower urinary tract symptoms. Fertility and Sterility, 93/3: 837-842. DOI:

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