The Physiology of Erections: Getting and Maintaining an Erection Involves Multiple Complex Steps

There are numerous physiological processes that must occur for a man to successfully develop and then maintain an erection. Failure to maintain an erection sufficient for intercourse, commonly known as erectile dysfunction (ED), used to be largely believed to be due to psychological problems. It is now known that the vast majority of cases of erectile dysfunction are due to physiologic problems.

Erections Are Physiologically Complicated

In order for the penis to become erect (an erection or tumescence), signals that begin in the central nervous system, traveling through the spinal cord and which ultimately involve hormones, blood vessels, nerves and muscle, must be strictly coordinated. Blood flow into and out of the erectile tissues of the penis have to be carefully regulated. Problems in any of a number of different steps can lead to the failure to initiate and/or maintain an erection sufficient for intercourse.

How Does the Penis Become Erect?

The penis is able to become erect because blood can accumulate in specialized spongy tissues along its length known as the corpus cavernosum. For this to happen, signals from various nerves in the parasympathetic nervous system initiate the release of specific neurotransmitters and hormones which cause relaxation of specialized smooth muscle in the penis (this is the point at which most of the ED drugs like Viagra and Cialis work). Arterial blood flow into the penis is increased while venous blood outflow from the penis is dramatically decreased. A different set of nerves controlled by the sympathetic nervous system control the act of ejaculation utilizing specific skeletal muscles. Once completed, blood flow out of the penis is increased and the penis becomes flaccid.

What Causes Erectile Dysfunction (ED)

For many years, erectile dysfunction was viewed as being primarily a psychological disorder. It is now clear that the vast majority of cases of erectile dysfunction are due to physiological alterations which interfere with any of the required steps in achieving and maintaining an erection. Any of a number of different things can lead to erectile dysfunction including specific medication use, smoking, alcohol use, diabetes, atherosclerosis, nervous system disorders and hormonal problems. It is estimated that 50% of men between the ages of 40 to 70 report at least some degree of ED (1).

What Can You Do About ED?

First, speak with your physician. Normal sexual function is a topic that should not be viewed as taboo and too “personal” to talk about. Numerous treatments are available for ED today and are not limited to oral medications. Secondly, maintain an active, healthy lifestyle to minimize the occurrence of disorders such as hypertension and atherosclerosis which can lead to a dramatic increase in the incidence of ED.

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