In some men, they can achieve an erection but it rapidly fades.
It tends to be worse when lying on their back during sex and slightly better when standing.
This can be a symptom of venous leak.
The penis is basically similar to a tyre with two inner tubes.
Blood goes in (instead of air) and inflates it and valves shut to keep the blood in. This maintains the erection until orgasm when the valves open and the erection subsides.
In some men, like with varicose veins, it is just bad luck. In others, it can be the result of Prostate surgery.
We refer patients for vascular survey with ultrasound to confirm this.
Where feasible, this can be treated by closing the leaking valves under imaging. Patients may still require some form of erectile medication.
We have had great success over the years.