Now is a good time to get your giggles and smirks out before we jump into a problem that affects up to 20% of men (1). Just say, “penis” five times out loud (not if you’re at work or in public) and you should be good to read on. Erectile dysfunction (ED) is more common as men get older and with certain medical conditions such as heart disease, diabetes, and depression. Although there are some great treatments out there, an estimated 70% of men with ED don’t seek help for issues with impotence (1). Furthermore, in one study, only 11.6% of men actually received any treatment (2).
This isn’t the puberty talk you got in school or from your parents… we’re going to get down and dirty on this issue that prevents millions of men from getting down and dirty. ED is defined as the inability to achieve or maintain an erection sufficient enough for intercourse. Believe it or not, you need to do a lot more than just get in the mood in order to get an erection. It requires the cooperation and teamwork of nerves, blood vessels, hormones, and emotions.
How erections work
Achieving an erection is all about going with the flow… blood flow that is. First, stimulation – either tactile or emotional – triggers the release of chemicals from the nerves that go to the penis called neurotransmitters. These neurotransmitters cause the vessels that supply blood to the penis – called arteries, or their smaller counter-parts arterioles – to dilate by relaxing the muscle in the walls of these blood vessels. Once dilated, blood flow increases to the penis. Those neurotransmitters also relax muscles of penis itself, allowing it to expand and fill with blood. With the inflow system now dilated, it actually compresses the venous drainage system, which is usually responsible for returning blood back to the rest of the circulation. In essence, with these nerves active, part of the parasympathetic nervous system, the incoming blood becomes trapped. As the penis fills with blood, it becomes more rigid. And voila!
When the erection goes away, whether because of ejaculation or lack of stimulation, the reverse happens. During ejaculation, different neurotransmitters from the sympathetic nervous system cause the arteries and arterioles to constrict, making the vessels smaller in caliber. This results in the venous system being able to expand again and return blood back to the rest of the circulation, like freeing a clogged drain. Even without ejaculation, without any stimulation, the same process will occur. As blood leaves the penis, it becomes flaccid once again, a process called detumescence.
Effects of erectile dysfunction on the body
At any point in that process, there are issues that could leave you down and out (in more ways than one). Here, we’ll go through the different systems involved and some potential causes for each (3).
1. Nervous system
Since various nerves are what allow you to sense tactile stimulation of the penis and tell the blood vessels when to dilate and constrict, they are essential for erections. There are numerous conditions that can affect the nervous system, which can all lead to difficulties getting or maintaining an erection. Some examples are spinal cord injuries, nerve damage from diabetes, and Parkinson’s among others.
2. Circulatory system
Plumbing, or circulation, problems can have direct effects on your ability to increase blood flow. Thus, just how blockages in the arteries – called atherosclerosis – of the heart can lead to chest pain and heart attacks, blockages in the arteries to the penis can result in abnormal function of this organ. Reasons why atherosclerosis happens are similar everywhere in the body and include these common risk factors: high blood pressure, diabetes, high cholesterol, inactive lifestyle, obesity, smoking, and more.
The endocrine system is the organ system in your body responsible for making hormones. Similar to how those nerves release neurotransmitters that result in relaxation of muscle tissue, hormones are released from specialized organs, such as the testicles, into the bloodstream to have an effect on another target organ. Hormonal regulation of your body is very important and very complex. Any disturbance or imbalance in certain hormones can result in a variety of signs and symptoms depending on which ones are involved. When it comes to ED, some of the more common hormone imbalances involved are the thyroid hormones, testosterone, and estrogen. These imbalances can lead to trouble dealing with stress, anxiety, and low libido, all of which will affect getting in the mood.
4. Mental health
We all know the mind is a powerful thing… it’s true here too. Libido, or sex drive, is an important part of being able to get an erection. Low libido could result from being stressed, tired, anxious, depressed, burnt out, and more. Even if your anatomy and physiology are all working properly, you may have trouble with erections if your mental wellness is not in check. Sex is a mind-body experience, and as per usual, teamwork makes the dream work. Staying on top of your mental health is one of the best natural remedies to help with erectile dysfunction.
5. Side effects
The last thing to keep in mind is that certain medications may have side effects on any one of the above systems that could lead to erectile dysfunction. The most common groups of medications that can do this are certain medications for depression, anxiety, and some for certain types of heart conditions.
Erectile dysfunction treatment
The treatment for ED can vary depending on what the cause is. ED resulting from low libido or depression is treated much differently than ED from atherosclerosis. The first step is to ask for help!
I like to think of the penis as a dipstick for your health.
You may not notice that you’re feeling depressed or stressed out, but you’ll certainly notice ED. Likewise, while it’s easy to ignore weight gain and high blood pressure, ED will certainly come to your attention. The reason it’s important to notice and talk about ED is because of what it could mean for the rest of your health.
Did you know that because of the commonalities in risk factors, men have been found to develop ED as early as 2-3 years before any symptoms of a heart condition and up to 5 years before having a heart attack? (4) That means an extra 2-5 years before you might develop any signs or symptoms of heart disease to reduce your risk if you pay attention to what your penis is telling you (5). Heart disease is 80% preventable with the right changes. Think of it as getting your heart-on to get your… you get the point.
Your doctor will work with you to get to the bottom of what’s going on. The good news is that there are great treatments out there, regardless of what the cause is. They range from stress relief, talk therapy, and mental health treatment for psychological issues getting in the way to aggressive diet and exercise programs, medications, hormones, and more.
Whatever the case may be that is making it hard to get hard, you shouldn’t ignore it. Pay attention to your dipstick! Although men are sometimes accused of thinking with their genitals, sometimes it’s good to listen to what your penis is trying to tell you.
The information provided is meant for general information, not personal medical advice.
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1. Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res. 2003;15(1):63-71. doi: 10.1038/sj.ijir.3900949. PubMed PMID: 12605242.
2. Chew KK, Earle CM, Stuckey BG, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res. 2000;12(1):41-5. PubMed PMID: 10982311.
3. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342(24):1802-13. doi: 10.1056/NEJM200006153422407. PubMed PMID: 10853004.
4. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010;64(7):848-57. doi: 10.1111/j.1742-1241.2010.02410.x. PubMed PMID: 20584218.
5. CDC: https://www.cdc.gov/chronicdisease/resources/publications/aag/heart-disease-stroke.htm