How does an erection happen?Getting an erection is a complicated process involving the sending of messages via nerves from the brain to the blood vessels in the penis resulting in increased blood flow.
Erections happen in response to sexual arousal resulting in blood being trapped in the spongy tissue of the penis. Th ere are two tubes of spongy tissue that run along the length of the penis. A tough fibrous, partially elastic outer casing surrounds this spongy material.
Messages from nerves at the end of the spine tell the blood vessels entering the spongy tissue (corpus cavernosum) of the penis to let more blood in. The spongy tissue then arranges itself in such a way that more blood can be stored in the penis.
The veins running through the outer sheath of the penis then compress which stops the blood from leaving the penis. As the blood flowing out of the penis is blocked off, the penis fills with blood and stretches within the outer casing, giving an erection.
In both the spongy tissue and blood vessels, muscle cells react to chemicals in the body, some which make an erection happen and some which make the penis flaccid (soft). The balance of these chemicals controls whether the penis is hard or soft.
When a man is sexually aroused, a substance called cyclic guanosine monophosphate (cGMP) is made in the penis and helps to keep an erection. A better erection happens if cGMP stays in the penis and is stopped from breaking down. Phosphodiesterase 5 (PDE5) is a natural enzyme that normally breaks down cGMP, and the erection is then lost.
By stopping PDE5 from doing its job, levels of cGMP are kept high which keeps a strong erection.
 Back to top
What part does the brain play in getting an erection? Note:
Did you know that a man’s brain sends a stimulus for an erection to happen three or four times through each night’s sleep? |
|
The brain plays an important part in getting an erection. For an erection to happen, the brain must be aroused by sensations (real or imagined), such as images, smells or sounds. When it receives this stimulus, impulses are sent down the spinal cord to the penis through nerves leaving the lower part of the spinal cord.
Erections can also happen from local sensations around the penis such as touch or a full bladder, which send impulses straight into the spinal cord to trigger the erection nerves. Back to top
What causes erectile dysfunction?Note:
Even if a physical condition is the major cause of the erectile dysfunction, psychological factors may also play a part. |
|
Many factors can affect a man’s ability to get and keep an erection. Often two or three factors are present at one time. Often erectile dysfunction is a sign of another serious, but sometimes undiagnosed health problem.
At other times there may be no clear reason for the erectile dysfunction. Research is helping medical scientists to understand what is happening on these occasions, and in doing so, is leading to new treatments becoming available.
Known causes of erectile dysfunction include:
|
Psychosocial problems
|
Performance anxiety
Sexual attitudes and upbringing
Relationship problems
Employment and financial pressures
Depression
Psychiatric disorders
|
|
Interference with nerve function
|
Spinal cord trauma
Multiple Sclerosis
Diabetic neuropathy
Pelvic surgery (prostate, bowel)
Parkinson’s disease
Alzheimer’s disease
|
|
Reduced blood flow
|
Atherosclerosis (narrowing of the arteries)
|
|
Interference by medication, alcohol and other drugs
|
Cigarettes
Alcohol and drug abuse
Drugs used to treat:
- Blood pressure
- Cholesterol
- Depression
- Psychiatric disorders
- Prostate cancer
|
|
Metabolic problems interfering with blood vessel function
|
Diabetes
High blood pressure
Obesity
High cholesterol
Sleep apnoea
Renal failure
|
|
Urological problems
|
Peyronie's Disease
Pelvic trauma
|
Back to top
Why is treating erectile problems alone not always enough?Note:
Erectile dysfunction can be an early warning sign for other more serious and life-threatening health problems such as diabetes and heart disease, so it is important to see your local doctor |
|
Erectile dysfunction is a common health problem often caused by other more serious life-threatening health problems such as heart disease, diabetes, hypertension, high cholesterol, obesity and depression.
Treating the erectile difficulties alone will not fi x the underlying health problem, which if left untreated can have serious health implications. This is why men with erectile dysfunction need to see their doctor and be correctly assessed.
It is important that any underlying problems are identified, and also treated, as a priority. Back to top
Could a medicine or a disease be causing the problem?Sometimes men have erectile problems when they are taking medicines for other medical conditions.
It is important not to stop taking prescribed medicine without first checking with a doctor.
By working with the doctor, most men can find suitable treatments that not only improve their general health and well-being, but also help the erectile problem. Back to top
Is it just part of getting old?Like the rest of the ageing body, ‘muscle tone’ in the penis reduces with age, as do many other aspects of sexual function. Arousal can take longer, it may take much longer before a second erection happens, and usually the erection is not as firm.
As an erection needs good blood flow into the penis, men who have a narrowing of their blood vessels may have problems in getting a normal erection. Because of this fact, men with heart disease, stroke, high blood pressure and diabetes are at greater risk of having erection problems.
Often problems of poor erections can be the first sign that the blood vessels of a man are poor and they are therefore at risk of heart attacks and stroke.
It is common for a healthy older man to still want sex and be able to have sex within appropriate limitations. Understanding what is normal in older age is important to avoid frustration and concern. Older men and their partners often value being able to continue sexual activity and there is no age where the man is ‘too old’ to think about treatment for erectile problems. Back to top
Can testosterone levels affect erectile function?Note:
Testosterone replacement therapy will not help your erectile problems unless you have confirmed testosterone deficiency. |
|
For most men testosterone treatment alone will not improve erectile function. Some men have a clearly low level of the male hormone testosterone. For example, they may have Klinefelter's syndrome, a condition where men can have small testicles, breast swelling and may lack other masculine features. These men should receive testosterone and are easily diagnosed by measuring their testosterone levels.
There are often reports in the media that testosterone replacement in ageing men is the cure for all ageing problems including erectile dysfunction. This is simply not true and is not supported by research where ageing men have been given testosterone.
Certainly many men do have lower testosterone levels as they move into their sixties and seventies. Older men may notice a variety of changes in their bodies such as reduced muscle mass, increased fat, less energy and lower sexual function, all of which could be because of lower testosterone levels. However, these changes are often because of ageing alone, and testosterone does not usually restore erectile function in this situation.
Men with low interest in sex (low libido) should have their testosterone measured, as testosterone treatment may improve their sexual interest.
Other hormonal problems, such as high prolactin and thyroid disease may affect erectile function and should be assessed if appropriate.
 More information: Low Testosterone
Back to top
Do prostate problems cause erectile dysfunction?Symptoms due to prostate enlargement tend to happen in the same age group of men who are affected by erectile dysfunction. Neither prostate cancer or benign prostate disease directly cause erectile problems. However, treatments for these types of prostate disease often cause erectile dysfunction.
During a radical prostatectomy operation, where the prostate gland is completely removed because of cancer, there is often damage to the nerves which control erections. Sometimes the nerves around the prostate need to be removed as the cancer has spread which then causes erectile dysfunction. Other prostate cancer treatment, such as radiotherapy, can also cause erectile dysfunction.
About one in ten men will fi nd it difficult to have a full erection after surgery for benign prostate disease, either by transuretheral resection of the prostate (TURP) or open/retropubic prostatectomy3.
More information: Prostate Problems Back to top
Why are psychological factors important?Note:
Even if a physical problem is the major cause of the erectile dysfunction, psychological factors may also play a part. |
|
There is a strong connection between thoughts and emotions and erectile dysfunction. The brain sends messages to the nerves at the end of the spine, which tell the blood vessels entering the spongy tissue of the penis to let more blood in. As a result, any other factors that distract the brain or interrupt these messages can have a major effect on erectile function.
Stress and anxiety are known to be major causes of erectile dysfunction. Concerns about sexual performance or physical appearance can also interrupt the processes involved in getting an erection. Financial or family worries are also known to affect sexual response.
Psychological and physical factors together can cause erection difficulties. If getting and keeping an erection is difficult during sexual intercourse with a partner, but not at any other time, then the problem may be purely psychological. If erectile dysfunction happens at all times, whether with a partner or when masturbating and morning erections are not happening, the cause of the problem is more likely to be physical.
Making sure that the situation and setting for sexual activity are right for both partners is very important for successful and satisfying sexual relations. Sometimes talking to a counsellor can help reduce anxiety and any other concerns about sexual performance.
What about depression?
Depression is a common and often unrecognised health problem which can be life-threatening. Depression is often linked with erectile dysfunction and also with heart disease.
Depression directly causes erectile dysfunction and low sexual interest, and treatments used for depression may worsen a man’s sexual ability and also lead to difficulty with reaching orgasm. Erectile dysfunction can also lead to depression which may be reversed by treating the erectile dysfunction. Depression should be thought about in all men with erectile dysfunction. Back to top
What are some of the rarer causes of erectile dysfunction?A less common cause of erectile dysfunction is Peyronie’s disease, which is the build-up of thick fibrous scar tissue (plaque) in the penis. This tissue can be painful and may cause the penis to curve.
Peyronie’s disease affects about one in 100 men, usually aged between 45 and 60. It sometimes
develops after surgery to the penis for other problems, and sometimes after penile injections.
Sometimes trauma to the pelvic area can cause bruising or more severe damage to the nerves or blood vessels, which may cause short-lived erectile problems. Long-distance and competitive bike riding are examples of this. Back to top
|
|
