What You're Describing is Normal Erectile Physiology
The pattern you describe—hardness during sexual arousal but flaccidity at other times—is completely normal male physiology, not a dysfunction. 1
Understanding Normal Erectile Function
The penis is supposed to remain soft and flaccid when not sexually aroused. This is the baseline physiologic state. 2
Normal Erectile Physiology Works Like This:
At rest (non-aroused state): The penis remains flaccid due to tonic smooth muscle contraction in the corpus cavernosum, which restricts blood flow and maintains the penis in a soft, non-erect state 1, 3
During sexual arousal: Neurologic signals trigger smooth muscle relaxation in the corpus cavernosum, allowing increased arterial blood flow into the penis, which creates rigidity sufficient for sexual intercourse 1, 3
After arousal subsides: The penis returns to its baseline flaccid state as smooth muscle tone returns and blood flow decreases 3
When This Pattern Would Actually Be Abnormal
You would have erectile dysfunction (ED) only if you experience: 1
- Inability to attain an erection firm enough for satisfactory sexual intercourse despite adequate sexual stimulation and desire 1, 2
- Inability to maintain the erection throughout sexual activity 1, 2
- Absence of morning or nocturnal erections (which suggests organic rather than psychogenic causes) 1
- Situational problems where erections occur in some contexts but not others 1
What Actually Warrants Evaluation
If you're experiencing difficulty achieving or maintaining erections during sexual activity, then comprehensive evaluation is warranted. 1
The evaluation should include: 1
- Detailed sexual, medical, and psychosocial history focusing on onset, severity, presence of morning/nocturnal erections, and situational factors 1
- Assessment for cardiovascular risk factors, as ED is a marker for underlying cardiovascular disease 1
- Morning serum total testosterone measurement 1
- Medication review (antihypertensives, antidepressants, and other drugs can cause ED) 1, 4
- Screening for diabetes, dyslipidemia, and metabolic syndrome 1, 5
- Physical examination including vital signs, genital examination, and assessment for penile deformities 1
Common Pitfalls to Avoid:
Don't confuse normal flaccidity with ED. The absence of spontaneous erections throughout the day is normal; only the inability to achieve erections with adequate sexual stimulation constitutes dysfunction 1, 2
Don't overlook cardiovascular assessment. ED often precedes symptomatic cardiovascular disease by several years and should prompt cardiac risk factor evaluation 1
Don't ignore psychological factors. Depression, anxiety, and relationship conflicts can be primary or secondary contributors to true ED 1
Bottom Line
At age 45, having a soft/flaccid penis when not sexually aroused is the expected normal state. The concern would be if you cannot achieve adequate hardness during sexual arousal and activity. If that's the case, seek evaluation as outlined above. If you're achieving satisfactory erections during sexual activity, what you're experiencing is simply normal male anatomy and physiology. 1, 2, 3