Why Do I Have Erectile Dysfunction When Standing?

Many men notice they can get or keep an erection while lying down, but it becomes difficult or impossible when they stand. This issue can be frustrating, but it’s also very telling. The position of your body affects blood flow, nerve communication, and muscle coordination in the pelvis—all key factors for erectile health. Understanding why this happens is the first step toward finding the right solution.

Blood Flow and Gravity

When standing, gravity makes it harder for blood to stay within the erectile tissues. A firm erection depends on blood entering and being trapped inside the penis. If the muscles or veins in the pelvis are not functioning properly, blood may leak out too quickly when you’re upright. Vascular issues, venous insufficiency, or pelvic congestion can all make this worse.

Pelvic Floor Muscle Imbalance

Your pelvic floor muscles are responsible for controlling pressure and trapping blood to maintain an erection. When you lie down, these muscles work under less stress, but when you stand, they must stabilize your pelvis and core at the same time. If they are too tight, they can restrict circulation. If they are weak, they can fail to keep blood in the penis. In either case, poor muscle coordination can lead to erectile dysfunction when standing.

Posture and Pelvic Alignment

Your posture influences how blood and nerve signals travel to the penis. An anterior pelvic tilt, for example, can shorten the hip flexors and tighten the lower back while stretching the pelvic floor, which disrupts the pudendal nerve. This nerve is critical for arousal and sensation. Over time, poor posture can reduce blood flow and communication between the brain and pelvic muscles, making it harder to stay erect in standing positions.

Nerve Compression or Tension

The pudendal nerve, genitofemoral nerve, and other branches of the autonomic nervous system play a central role in erectile function. Standing can increase pressure on these nerves if there’s muscle tension in the glutes, adductors, or pelvic floor. Men who spend long hours sitting or who have pelvic injuries often develop restrictions that worsen when they shift to an upright posture.

The Role of Stress and the Nervous System

Chronic stress activates the sympathetic nervous system—the body’s fight-or-flight response. This diverts blood away from the genitals and into larger muscles used for survival. Some men unconsciously hold tension in their core and pelvis when standing, which keeps the pelvic floor tight and overactive. Calming the nervous system and restoring balanced breathing can have a major impact on erectile function.

Hard Flaccid and Standing ED

A condition known as hard flaccid can also cause erectile difficulties, especially when standing. It involves chronic tightness in the pelvic floor and restricted blood flow to the penis, leading to a semi-rigid or tense flaccid state. Posture and gravity often make symptoms worse. Addressing muscle tone, fascial restriction, and nerve irritation can significantly reduce these symptoms over time.

How Pelvic Floor Therapy Can Help

Pelvic floor physical therapy addresses both the muscular and nervous system components of erectile dysfunction. Treatment may include:

• Evaluation of pelvic muscle strength, coordination, and tone

• Manual techniques to release tension and improve blood flow

• Nerve mobilization and fascial work to reduce irritation

• Postural and breathing retraining to improve circulation and pelvic control

• Guidance on restoring core and hip stability to support better erectile function

At our clinic in Madison, New Jersey, we specialize in treating the whole body connection to pelvic health. Our one-on-one pelvic floor therapy sessions help men restore function, reduce tension, and regain confidence.

If you’re struggling with erections when standing or suspect pelvic floor dysfunction may be involved, schedule an evaluationat Pelvic Health Center in Madison, NJ. Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com. We’ll help you understand the root cause and develop a personalized plan to get you back to feeling your best.