Let’s come right out and say it: Having trouble getting an erection can be a frustrating and embarrassing experience. But as awkward as it can be to talk about it with your doctor, it’s important that you do. Problems with getting or staying hard can be an early sign of more serious health problems.
How erections work
An erection, in short, is caused by blood flowing into the penis. Nerves from the brain and spinal cord communicate with blood vessels down below, which causes two tube-like cavities in the penis to fill with blood. During this process, the tissue in the cavities expands like a dried-out sponge being soaked in water. The penis then traps the blood, making the shaft hard.
“Due to representations in media, we think of erections as something that just happen to guys, and that guys can just get them anytime they want. In reality, it’s actually a very complex system,” says Dr. Marah Hehemann, a urologist at the Men's Health Center at UW Medical Center – Roosevelt and an assistant professor in the Department of Urology at UW School of Medicine.
What happens when you experience erectile dysfunction
It’s no wonder, then, that different parts of that system can break down, making it hard to achieve or maintain an erection, a phenomenon called erectile dysfunction (ED). These issues affect millions of men at all different stages of life. Studies have found that 20 percent of men under the age of 40 experience some sort of ED, and that percentage increases the older you get.
Hehemann describes five parts of your body that need to be working and healthy to get an erection:
- Your vascular system, which is the system of arteries and veins that carries blood throughout your body, including in your penis. Everything from diabetes to high cholesterol to smoking can damage your blood vessels.
- Your nerves, which send signals from the brain to the penis, can be damaged by things like trauma or prostate cancer surgery.
- Your testosterone, which is a hormone that you can be deficient in.
- Your penile tissue, specifically the tissue located in the two cavities that fill up with blood during an erection. It can get scarred, preventing it from engorging with blood.
- Your autonomic nervous system, which controls automatic processes like heart rate, breathing and digestion, also controls erections. It’s made up of the “fight or flight” sympathetic portion and the “rest and digest” parasympathetic portion — the latter promotes erections. If you’re anxious or stressed, the sympathetic system can override the parasympathetic system, leading to ED.
Any of these systems not working correctly can prevent you from getting hard, but a whole host of treatments exist today, from medication like sildenafil (Viagra) and tadalafil (Cialis) to things like vacuum pumps, injections, gels and even implants.
The most common cause of erectile dysfunction
One of the most common causes of ED, however, can’t be fixed with just a pill or a pump: Vascular disease is responsible for the vast majority of cases.
In fact, if you’re developing vascular issues, it’s likely to first show up in your penis. Why? The arteries that supply blood to the penis are only 1 millimeter in diameter, whereas your coronary arteries are 3 to 4 millimeters, and the carotid arteries in your neck and femoral artery in your thigh are even larger. When plaque builds up in the arteries, the smaller ones will start clogging first.
“The penile arteries can become affected before someone has signs of the coronary arteries being affected,” says Hehemann. “ED oftentimes precedes heart disease.”
If Hehemann suspects vascular issues are causing a patient’s ED, she will measure the blood flow in their penis with a special kind of ultrasound. Finding reduced flow on this test indicates that a person may be up to three times more likely to develop cardiovascular disease.
Saving more than just your sex life
Because ED might be a sign that you have vascular disease, asking your doctor about it can truly be lifesaving.
“I like to tell patients that blood vessels in the penis are sort of our early warning system,” says Dr. John Amory, a physician at the General Internal Medicine Center at UW Medical Center — Roosevelt, as well as a professor at UW School of Medicine. “If the blood vessels in your penis are not working one hundred percent, the blood vessels in other organs, like your kidney, your heart and your brain, may need to be examined.”
If Hehemann sees a patient who is having trouble in bed, the first things she looks for are risk factors like family or personal history of early heart attacks, high cholesterol, high blood pressure, diabetes, obesity, alcohol abuse, and smoking or vaping. People of any age can experience ED because of vascular issues caused by these conditions and behaviors.
If they exist, addressing them is the first step to treating their ED — and doing so will improve the health of more than just their sex life.
After all, one of the most important ways to treat vascular disease is adopting a healthy and active lifestyle, including getting enough exercise and eating a plant-based diet. In fact, Hehemann authored a review paper in 2016 showing how those sorts of lifestyle changes can improve erectile quality and stave off dysfunction by improving cardiovascular health.
A motivation for better health
If erectile dysfunction has a silver lining, it’s that it motivates men to see a doctor who can help address not only the ED but any underlying conditions that may be to blame.
“There’s this interesting phenomenon in men’s health where erectile dysfunction has brought men in to see the doctor because that’s a problem for them, and then for the doctor to say, ‘Oh gosh, you have all these other things going on,’” says Amory. “I think Viagra has saved a lot of men’s lives.”
Of course, Viagra itself won’t save your life, but learning from your doctor that you’re at risk for heart disease and changing your lifestyle could. If you have not been proactive about your health, perhaps the opportunity to improve your sex life will change that.
“If that’s the motivating factor for someone to take care of themselves, start exercising and improve their diet, I’m happy to be their cheerleader,” says Hehemann.