What is an erection and what causes ED?

The penis is truly an amazing organ. What is inside this marvelous appendage and how does it work?

A small tube called the urethra runs from the bladder thru the prostate and thru the penis allowing urine and semen to exit from the body. The rest of the penis is occupied by several cylinders of spongy erectile tissue (the paired corpora cavernosa and the corpus spongiosum). A network of arteries, veins and nerves runs
thru the walls of the spongy erectile tissue. An erection is when the empty spaces inside the corpora fill up with blood; the more blood, the bigger and firmer the erection.

The penis doesn’t make anything or process anything. It plays only a passive role in urination and ejaculation. You don’t need your penis for anything other than sex. It’s primary purpose is to become erect when the time is right.

In the unaroused state, the penis is mostly just “hanging out”. It doesn’t require much blood to meet its oxygen and metabolic needs. The small arteries and arterioles are constricted and the penis is flaccid. When we get sexually excited, nerves transmit impulses from the brain to the these arteries signaling them to dilate and increase blood flow. Chemicals are released locally that cause the smooth muscle layer in the arterial wall to relax and and allow increased blood flow. The corpora fill with blood and the penis becomes larger and hopefully rigid enough for penetration. Erectile dysfunction (ED) is the term we use for when this process doesn’t work optimally. ED can obviously vary from a minimal to severe problem.

Most of the time, the problem is with the arteries. As we age, microplaque deposition (arteriosclerosis) in the walls of the arteries causes them to become stiff and narrowed (“hardening of the arteries”). It becomes increasingly difficult for the smooth muscle in the arterial wall to open the vessels and allow enough blood in to fully fill up the storage spaces in the erectile tissue and the erection becomes less and less firm over time.

High blood pressure, high cholesterol, diabetes, smoking, sleep apnea, kidney disease and other factors can all accelerate arteriosclerosis. If you have a history of heart attack, coronary artery disease, bypass surgery or stent placement or stroke, you almost certainly have significant disease in the arteries of your penis as well.

There are many other potential causes of ED:

  • Medications you take can interfere with getting and/or maintaining erections and ejaculation.
  •  Prostate or pelvic surgery or radiation can damage or affect the nerves in the penis as can diabetes, MS and Parkinson’s.
  •  Low-T, anxiety disorders, depression and stress can all interfere with the process.
  •  Alcohol and recreational drugs may play a role.
  •  Prostate enlargement is often associated with ED.

Virtually all men experience ED to some degree in their lives. Proper treatment of ED depends in large measure on making the correct diagnosis as early as possible. The Charleston Men’s Clinic specializes in the diagnosis and treatment of ED. Your  consultation with our board-certified specialist is very thorough and complete. You will definitely leave the office fully understanding why you have a problem and totally informed about all the treatment options available. Hopefully, you will choose us to provide the solution to your problem.