Understanding erectile dysfunction

Erectile dysfunction is a fairly common problem in general practice but it is often
difficult one to discuss, as both the patient and doctor may find this an embarrassing subject.

I hope this article might help blokes feel more comfortable talking about the subject, allowing you to receive better treatment and satisfaction in the sex arena.

How do erections work?
The mechanically-minded will love this. You see, the penis runs on a hydraulic system. On the top of the penis are two large spongy chambers called the corpora cavernosa, and along the base is a third chamber that surrounds the urethra called the corpus spongiosum. These chambers have a rich blood supply which enables them to fill with blood when required.

There are two main pathways to getting an erection.
The first pathway is at the level of the brain. When thinking about sex, or the possibility of sex, the brain sends a signal down the spine to a special area in the middle of the back called the ‘thoracolumbar erection centre’. This in turn signals for blood to be redirected from the pelvis into the penis.

The second pathway is via a spinal reflex from stimulation of the skin on and around the penis. This is the same reflex that leads to erections when receiving a massage. This reflex directs more blood towards the penis to help fill the chambers mentioned above.
In both of these cases, the parasympathetic nervous system, the nervous system associated with feeling relaxed, runs the show. If someone is stressed or fearful, it makes getting an erection very difficult.

No matter what path starts an erection, once the blood is flowing, the chambers of the penis start to fill, stretching the penis and making it firm.
A special neurotransmitter, nitric oxide, helps maintain the erection. After ejaculation, the parasympathetic system turns off and the blood flows out of the penis again, shrinking back to regular size.

This may sound a little complex but I wanted to highlight some of the important parts of the process as it helps explain how problems with getting erections can start.
In a nutshell, there are three main areas where erection problems can start:

* Problems with the hydraulic systems
* Problems with the signalling supply
* Problems with the control system

Hydraulic problems
Hydraulic problems can be separated into two main areas, problems with the hydraulic chambers and problems of delivery of blood to fill the chambers.
Damage to the hydraulic chambers is not very common; the main causes being direct trauma to the penis causing scar tissue to form, or Peyronie’s disease. Peyronie’s disease is a thickening of the outer layer of the penile chambers. This can lead to unusual bending of the penis that can limit the flow of blood and also makes penetration very difficult. The good news is that there are treatments available that can help reduce the scar tissue and help improve erections.

The most common causes of decreased blood flow to the penis are diabetes and heart disease. Both these conditions can lead to plaques forming in the arteries that supply the penis. As these plaques can decrease the flow of blood, this can result in a drop in pressure, making it harder for the penile chambers to fill and reach full engorgement.
It’s important to note that the arteries that supply the penis are almost the same size as the arteries that supply the heart. Having difficulties gaining erections can be an early indicator of heart disease — another good reason to be open and frank with your doctor.

Signalling problems
When it comes to the signalling causes of erection difficulties, there are two main causes. Either the electrical system via the nerves is not working, or the hormonal system via the blood supply is not working.

Damage to the spinal cord does not necessarily block the ability to gain erections. While erections that start at the level of the brain may be blocked, men who have spinal injuries are often able to gain erections via the reflex pathway as it does not require a direct connection to the brain.

Unfortunately, some operations can cause particular damage to the nerves that supply the penis which can result in total inability to gain erections. By far the most common hormonal cause of erection difficulty is either low testosterone or thyroid disfunction. Testosterone is important at the level of the brain for increasing desire for sex, but also plays a role in keeping levels of nitric oxide up which is essential for a strong, lasting erection.

Thyroid dysfunction can cause reduction in sex drive, difficulty getting erections and altered ejaculation. The good news is that both of these hormones are easily tested and if there are alterations in their levels, this can be addressed.

Control system problems
By far the biggest causes of erection problems are stress, anxiety and depression.
As mentioned above, for an erection to occur, the body needs to be relaxed, which allows the parasympathetic nervous system to initiate the development of an erection. If you are stressed or nervous, getting an erection is much more difficult.
Depression is known to reduce libido, however, some of the medications used to treat depression can also affect abilities to get erections.

If you have worries or concerns, your family doctor is a great person to talk with. If you are not comfortable talking about this with your regular doctor it can be sometimes be worth seeing a men’s health doctor. We have pretty much heard most of the stories and you can feel reassured that there would be no judgement of sexuality or practices.

By Dr George Forgan-Smith
General Practitioner
INFO: Follow Dr George’s blog www.thehealthybear.com.au