Erectile dysfunction (ED) is a big deal. It affects a man’s confidence, relationships, and even his identity “as a man.” But what if ED was more than just an unfortunate condition in the bedroom or a blow to your self-esteem? It turns out that your erection (or lack thereof) is actually an important indicator of your overall health. And you can actually improve your health—or even save your life—by paying more attention to the strength and frequency of your erection.
Welcome to the strange science behind erections. Learn more about how erections work, what can go wrong, and why erectile dysfunction is a crucial barometer of a man’s health.
Table of Contents
- How Do Erections Work?
- How ED Meds Work: PDE5 Inhibitors
- Erections are Healthy
- ED and Blood Vessels
- ED is Your Check Engine Light
Erections are Super Complicated
Erections might seem simple, but the number of things that have to go right “just” to get an erection can make a shuttle launch look easy. Your brain, nerves, heart, blood vessels, and a whole lot of hormones have to work together perfectly or nothing happens. It’s kind of like a bunch of dominos. If you miss a single step in the process, you’re in for a big letdown.
Here’s a quick checklist of things you need to get an erection:
- Normal Brain Function: You have to process arousal (obviously), then transmit a series of complicated chemical signals to trigger an erection. Depression, anxiety, insomnia, and stress can hinder these signals and contribute to ED.
- Functioning Nerves: Your spinal cord and nerves carry impulses from the brain to the penis. Spinal cord injuries and nerve damage block these essential signals preventing an erection.
- Unblocked Blood Vessels: Blood vessel linings expand and contract to create an erection. You need healthy blood vessels so blood can freely flow into the penis. It’s why blood pressure is so closely tied with your ability to achieve erections.
- Healthy Hormone Levels: Testosterone, thyroid, and prolactin levels all need to be within healthy ranges for normal libido and erectile function.
Erections are caused by an increased blood flow to the penis. That’s obvious. But do you know what causes that increased blood flow in the first place? The answer explains how erections work and how things can go wrong.
When men are aroused their brain tells blood vessels in their penis to release nitric oxide. Nitric oxide is the chemical responsible for increasing the blood flow into the penis. It also simultaneously shuts off the veins that let blood drain from the penis. The result is that a “flip” gets switched and up to 6x the normal blood flow gets trapped in the erectile tissue of the penis (called the corpora cavernosa if you want to get technical). When this happens, the penis expands, stiffens, and huzzah—you have an erection.
An erect penis contains up to 6x the normal amount of blood flow.
This process (called the “rigidity response”) works smoothly as long as your blood vessels are healthy and your blood pressure is normal. In fact, this reaction is so strong that an erection would last forever (and not in a good way) if not for a group of chemicals called phosphodiesterases. (PDE 5 for short). They help bring you back down to earth, but an imbalance in this relationship can result in erectile dysfunction.
PDE 5 enzymes are responsible for turning your erection off. They do this by canceling out the chemicals that trigger an erection (like nitric oxide), returning your blood flow back to normal. When nitric oxide and phosphodiesterases are balanced these enzymes stop your erection exactly when they should (and not a moment sooner!).
If you have too little PDE 5, you can get dangerously long erections (priaprism). And when PDE 5 works too well your erection gets “turned off” prematurely and you experience ED. If the imbalance is so severe, your erection gets prevented entirely.
This chemical balancing act is just one example of how complicated and fragile erections can be. That’s why when a man experiences ED it isn’t just an isolated incident or “a problem downstairs.” Erections involve your heart, hormone levels, enzymes, mood, and blood pressure. ED isn’t a problem with your penis. It’s a problem with your body.
Erectile dysfunction is nature’s “check engine light.” It signals that something serious is wrong with your cardiovascular system, hormone levels, nerves, or even your mental health. The problem is that men don’t want to talk about or deal with ED, even though early intervention can prevent serious—even life-threatening problems later on.
Men need to start taking ED seriously because this “inconvenient” condition has far-reaching health implications for men of all ages.
Erections are complicated (have I mentioned that yet?), so the list of things that can cause ED is long. Depression, insomnia, and stress factor in, as well as Peyronie’s Disease, previous priapism (erections lasting longer than 4 hours), and injury to the penis itself. Even multiple sclerosis or nerve damage from diabetes can cause ED. However, many of the most common causes of erectile dysfunction are identical to the biggest risk factors for heart disease. And the reason is – size matters. But not like you think.
The blood vessels in the penis are a lot smaller than other parts of the body. That means that cardiovascular problems will usually show up as ED years before something more serious like a stroke or heart attack. ED might seem harmless, but the risk factors that cause erectile dysfunction are the same risk factors for cardiovascular disease.
ED is your body’s early warning system indicating serious underlying problems with how your body works.
High cholesterol, high blood pressure (hypertension), smoking, obesity, and a sedentary lifestyle all contribute to both erectile dysfunction and heart disease. In fact, studies show that men with ED have a:
- 44-48% increased risk of cardiovascular disease
- 35-39% increased risk of stroke
- 19-25% increased risk of death from all causes
Blood vessels in the penis are small, so ED symptoms often occur years before a potential stroke or heart attack
Erectile dysfunction is one of your body’s early warning signs. Hypertension, nerve damage, cardiovascular disease, hormone imbalance, and depression, can show up as ED long before any other signs. The problem with erectile dysfunction is that like the check engine light in your car, ED doesn’t tell you exactly what’s wrong. You still have to pop the hood and take a look.
See a doctor if you experience ED—even if you’re already taking ED medication. Erectile dysfunction is a rare opportunity to identify and treat health risk factors like obesity, hypertension, and diabetes. Tackle ED at the first warning signs and take control of your care with your doctor. It’s a lot better than the alternative.
Geek Out: More Erectile Dysfunction Resources
Not enough info for you? No problem. Nerd out on erectile dysfunction with research and studies from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you on the way to a healthier manhood.
- Mechanisms of Penile Erection and Basis for Pharmacological Treatment of Erectile Dysfunction (ASPET)
- Prediction of Cardiovascular Events and All-Cause Mortality With Erectile Dysfunction (AHA)
- Diagnosing erectile dysfunction could save your patient’s life (CUAJ)
- Erectile dysfunction, metabolic syndrome, and cardiovascular risks: Facts and Controversies (TAU)
- Do lifestyle changes work for improving erectile dysfunction? (AJA)
- Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction (J Sex Med)
- Can lifestyle modification affect men’s erectile function? (TAU)
- Modifying Risk Factors in the Management of Erectile Dysfunction (World J Men’s Health)
- Diagnostic Evaluation of Erectile Dysfunction (AFP)
- Erectile Dysfunction and Risk of Cardiovascular Disease (J ACA)
This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.