Note: Although this is written primarily for men, it is equally relevant to females. Since the penis and clitoris are homologous organs, whenever you see the word “penis” you can substitute the word “clitoris.” In terms of solutions, only simple and natural ones will be mentioned. A discussion of oral medications, urethral suppositories, injections and penile implants will be a topic for another time.
The penis is one of the most “magical” of organs—uniquely capable of transforming its size, shape, and constitution in a matter of nanoseconds. The remarkable upsurge is possible because blood inflow is maximized while outflow is minimized, resulting in penile blood pressures that far exceed arterial blood pressure.
Rigid erections can only occur when there is a “perfect storm” of three events:
Event #1 (Pre-penile): Arterial blood flow to the pelvis needs to increase substantially.
Event #2 (Penile): Smooth muscle within the arteries and the spongy sinuses of the erectile chambers of the penis must relax to allow engorgement with blood.
Event #3 (Post-penile): The pelvic floor muscles must engage and compress the deep roots of the penis to morph the swollen penis into a rigid one. The blood pressure in the penis resulting from the inflow of blood alone, in the absence of the contribution from the pelvic floor muscles, will not exceed systolic blood pressure, so the pelvic floor muscles play a vital role with respect to both rigidity and durability of erections.
When erections go south, it comes down to failure in one or more of the three events, which can be pre-penile, penile, or post-penile.
The problem lies within the arterial blood supply to the pelvis, which is not capable of delivering enough blood flow to fill the penis. Typically, the pelvic arteries are clogged with fatty plaque (atherosclerosis), which is often due to an unhealthy lifestyle: poor diet, physical inactivity, being overweight and use of tobacco. Diabetes is a very common cause of impaired blood flow (although it also adversely affects the nerve supply). Insufficient blood flow may also occur because of the blood pressure lowering effect of blood pressure medications. Psychological issues such as performance anxiety cause constriction of the inflow to the penis by virtue of the adrenaline released as a result of anxiety, adrenaline being a potent constrictor of blood flow.
Solution to Pre-penile ED
Lifestyle “angioplasty”—meaning getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve all aspects of health in general and blood vessel health in particular.
The problem lies within the penis itself. Because of poorly functioning smooth muscle within the arteries and sinuses of the erectile chambers, the penis cannot properly swell with blood. This smooth muscle cannot relax enough to allow blood flow to inflate the penis and pinch off the venous drainage. This failure of relaxation of the smooth muscle in the penile arteries and spongy sinuses parallels the failure of relaxation of smooth muscle in our arteries that causes high blood pressure (a.k.a. “essential” hypertension). Loss of this smooth muscle and scarring can happen with aging, following prostate cancer surgery, from Peyronie’s disease (abnormal scar tissue within the penis) or because of disuse atrophy (loss of penis form and function because of lack of use as it was intended to be used).
Solution to Penile ED
Age-related malfunctioning smooth muscle and scarring is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards erectile function—exercising the penis via regular sexual activity will actually help its continued functioning and health of the smooth muscle of the penile arteries and sinuses.
The problem is weakened pelvic floor muscles. These feeble muscles are incapable of compressing the roots of the penis sufficiently to increase the blood pressure in the penis to the levels needed for rock-hard rigidity.
Solution to Post-Penile ED
Pelvic floor muscle training to improve the strength, tone and endurance of the pelvic floor muscles will optimize erectile rigidity and durability.