How Erections Work
You can think of the penis like a tire. A tire can inflate by pumping it up with air or deflate by letting the air out. Erections work the same way but with blood instead of air. How the blood gets there and is regulated is a pretty impressive biological process. Read more about the biology behind pitching a tent.
What Can Go Wrong?
It is common for men to struggle to achieve or sustain an erection long enough for proper intercourse. This condition is called Erectile Dysfunction (ED) and can be due to many factors. With many men it comes down to anxiety: guys can get especially nervous about performing intercourse, using a condom, pleasing their partner, etc. Anxiety-driven ED is more common with younger men. ED can also be due to feelings of stress, guilt, and exhaustion.
ED can also be a physical issue. As explained above, erections require that the penis be able to receive and retain the increased volume of blood. Like we mentioned earlier, the penis can be thought of as a tire. To properly inflate and deflate a tire, you need a pump that can deliver enough air into the tire, and the tire needs a valve strong enough to hold in the air. So, if your body is unable to pump enough blood into your penis, or your penis is unable to retain the increased blood once it’s in there, you can have a difficult time achieving an erection.
With many older men, ED is caused by a narrowing of the arteries that carry blood into the penis. In fact, several studies have suggested that ED may be an early sign of cardiovascular disease and can be a warning sign to a cardiac event later in life, such as heart attack or stroke. If you are experiencing ED and have not had a recent physical evaluation by a doctor, you should go in for a annual exam to make sure all other systems are in order.
Common Physical Causes of ED
- Vascular diseases (e.g. arterial hardening and narrowing)
- Alcohol abuse
- Prescription drug use (e.g. depression or blood pressure medication)
Because the process for achieving an erection requires a strong psychological component, there are also several common psychological cause of ED:
Common Psychological Causes of ED
- Anxiety (fear of performance, putting on a condom, etc.)
- Guilt (e.g. infidelity)
- Problems in the relationship
In the end, most cases of ED are probably due to multiple physical/psychological factors.
Does Low T Cause ED?
It does not appear that low levels of testosterone inhibit a man’s ability to achieve an erection. However, low T is associated with reduced sexual desire which can make it more difficult for men to take that first important step.
What Can Be Done to Address and Treat ED?
Don’t be afraid to seek help. This is a common problem, and there are many things that you and a doctor can do to overcome ED. If you’re facing psychological hurdles to achieving an erection, it often helps to talk it over with your partner and try to get to the root of the problem. Many men struggle with this approach, but just sitting down and talking it through is often the best path to success. ED can also cause insecurities with your female partner as she begins to question her role in the problem. ”Am I not sexy enough? Does he not love me anymore?” Often a very open conversation can help both of you overcome this problem and improve your love life.
If you suspect a physical issue, it’s always best to see your doctor. Start with your GP or Primary Care physician. Your doctor will look for physical conditions that might be contributing to the problem. For instance, tests for cardiovascular disease or diabetes are common. If your GP cannot solve the problem, he/she will be able to refer you to someone who can. Once the problem is known, treatment can begin.
Erection-inducing drugs are now widely studied and available to help most men overcome ED. These drugs work by enlarging your blood vessels and therefore making it easier for blood to flow into the penis. However, there may be reasons that you shouldn’t take one or any of these drugs (e.g. problems associated with combining them with other medications), so always consult a physician before giving them a try.
Commonly Prescribed ED Medications:
Viagra (Sildenfil Citrate): The little blue pill was originally developed to treat certain forms of heart disease by relaxing blood vessels and improving blood flow to the lungs. Due to it’s notoriety in pop culture, many people take viagra recreationally believing that it will increase penis size, improve sexual endurance or increases libido. Unfortunately, it isn’t a magic bullet that can solve all sexual problems, but it will help to get it up if blood flow is a problem.
Cialis (Taladafil): Cialis works via the same mechanism as Viagra, but was developed later, and was designed to last in the body longer. On average, Viagra is effective on the day the pill is taken, while Cialis is effective for a couple of days. This feature earned it the nickname “The Weekend Pill.”
Levitra (Vardenafil HCl): A slight variation on viagra, Levitra works on the same principles.
Alprostadil: This medication is either injected directly (Caverject) into the corpora cavernosa (spongy tissue) of the penis or inserted as a urethral suppository (MUSE). Like the pills above, alprostadil is used to improve blood flow by dilating the blood vessels of the penis.
The Skinny on Penis Pumps
The penis pump (sometimes called a vacuum constriction device) is a cylinder that wraps around the penis and uses a pump to create a vacuum seal. They increase the body’s natural ability to retain blood in the penis, and therefore increase the rigidity of the penis. They have effectively treated ED for decades. It is important to explore the use of penis pumps and penis enhancers in consultation with a board-certified urologist. Many of the companies that produce these products have very poor / sketchy quality and others are down-right dangerous. Some penis pumps create a very large amount of pressure which is unsafe and can lead to permanent damage to the penis. Medical penis pumps are FDA-approved and have regulated manufacturing to ensure that they apply a correct amount to pressure.
For men who have not had success with pills or vacuum devices, there is yet another option. Thanks to modern medicine penile prosthesis are an option. There are a wide range of models, constructed out of a variety of materials, each with it’s own set of advantages and disadvantages, in terms of mimicking nature. Over 90% of patients are satisfied with the outcomes, so in circumstances of extreme ED, Peyronie’s disease, trauma to the penis, and congenital abnormalities, prosthesis offer the promise of a normal sex life. It is important to search out a urologist with experience in penile reconstructive surgery and carefully consider options before undergoing the procedure.