You have always had some difficulty your erection. However, it was easy to ignore.
Then one day you overhear some mates complaining about how it ‘pops’ up in the most inconvenient, embarrassing times.
Over and over again.
At the gym. In the supermarket. Anytime a pretty girl walks past.
You cant even get it up when you need to.
It got you thinking.
“What is a normal erection?”
“What is an abnormal erection?”
“Should you try erection pills or natural remedies?”
“What is the best erection medicine for you?”
Normal Erection Vs Erectile Dysfunction
Sexual intercourse is a part of life that is interwoven into the very fabric of human social interactions.
The possibility of sexual interactions is never far away from the mind and, therefore, the ability to get an erection and engage in normal intercourse becomes vital for reproduction, personal satisfaction as well as your mental wellbeing.
Nevertheless, there are instances where a man’s penis can’t become fully erect to partake in sexual activity. This condition, known as erectile dysfunction (ED), has various causes and can also be indicative of other health problems. We stress that Erectile Dysfunction should NOT be ignored.
What is normal erectile function?
The penis consists of smooth muscles and connective tissue that are arranged in such a way that they form the corpus cavernosa.
This contains penile sinusoids – low-pressure spaces that can easily fill up with blood, causing an erection. This blood is then prevented from leaving to maintain the erection.
When you take a closer look, normal erectile function is brought about by a complex mechanism that calls upon various neural, vascular and biomolecular interactions.1 In the flaccid state, the smooth muscles in the penis are contracted. This means that blood can’t freely flow in but venous blood can flow out.
When you’re sexually stimulated, the non-adrenergic non-cholinergic and the parasympathetic cholinergic nerves release nitric oxide and acetylcholine respectively.
This increases the amount of cyclic guanosine monophosphate (cGMP) that causes the smooth muscles to relax, increasing the blood inflow into the sinusoids in the corpus cavernosa.
As the penile lacunar spaces fill up with blood, they compress the venules that drain blood out of the penis. This results in a sustained erection because more blood is coming in compared to the one that is leaving.
How and why does erectile dysfunction occur?
In simple terms, if there’s any interruption in the process described above, you are likely to have a problem achieving and/or maintaining an erection.
Generally, erectile dysfunction is divided into two categories, depending on the cause. It is either psychogenic or organic3. Other times, the causes of your inability to become erect cut across both categories.
Let’s take a closer look at these categories of ED.
Is your erection normal?
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Psychogenic erectile dysfunction is caused by psychological factors, usually associated with anxiety, stress and depression.
When you have these or related conditions, the amount of adrenaline in the body increases. Noradrenaline is a potent erectolytic neurotransmitter – literally an erection killer.
Some of the causes of psychogenic erectile dysfunction include:
a lack of sexual arousability
Looking at the list, it’s clear that these causes aren’t physical but mainly psychological.
Organic erection difficulties
On the other hand, organic causes of erectile dysfunction vary from iatrogenic, hormonal, neurogenic or vasculogenic. Other diseases can also be at fault for causing your inability to achieve or maintain a rigid erection.
Normal erectile relies on perfect signalling by the nerves that innervate the smooth muscles of the corpora cavernosa. When this signalling is interrupted, you can have trouble getting your penis to erect.
The nerve signalling can be interrupted by nervous system diseases like Alzheimer’s, Parkinson’s or stroke. The signals can also be interrupted through spinal injuries. There is also nerve damage in the pelvic area caused by trauma or surgery.
When this nerve function is impeded, there is a reduction in secretion of nitric oxide that’s needed for normal erectile function.
Vasculogenic causes of erectile dysfunction impair the flow of blood in and out of the penis. For the penis to erect and maintain its rigidity, arterioles need to let blood into the penile tissue so that it grows tumescent.
However, vasculogenic causes of ED due to trauma, hypertension, atherosclerosis or Peyronie’s disease can impair this blood flow.
This category of causes is the most common when it comes to impairing your ability to get an erection.
This is because you are more likely to develop vasculogenic ED owing to your lifestyle choices. Unhealthy eating habits and a sedentary lifestyle cause hypertension and diabetes, both of which are causative in erectile dysfunction.
Additionally, you can also develop arterial stenosis from persistent cigarette smoking.
Hormonal conditions like hypogonadism and hyperprolactinemia can cause you to have diminished libido. Also, these conditions interfere with the release of nitric oxide.
As we already discussed in the previous sections, this chemical is needed to set off the cascade of reactions needed for normal erectile function.
The male sex hormone testosterone directly affects the smooth muscles of the corpora cavernosa. During hypogonadism, a man’s testes don’t produce enough of this hormone. This means that reduced testosterone leads to reduced erectile function.
Latrogenic erectile dysfunction is the kind that you get after getting some form of medical treatment. This can, therefore, be prescribed medication or surgery.
Medications like beta-blockers and antidiuretics that are indicated for treating hypertension can have adverse effects on your ability to get and maintain an erection.
When you have prostate cancer, your doctor might prescribe antiandrogens to treat the cancer. However, testosterone is an androgen. This class of drugs, consequently, reduces your ability to produce testosterone leading to erectile dysfunction.
Other drugs that can inhibit your ability to get an erection include:
opiates used to manage pain
hydrogen blockers that are used to treat ulcers
antidepressants like selective serotonin uptake inhibitors and the tricyclic class
Surgeries often cause some damage to the surrounding nerves. If any of the damaged nerves control or contribute to the normal erectile function, you might find difficulties in getting your penis to become erect.
It is also important for you to note that the cause for erectile dysfunction is rarely excluded to one category. It’s usually a mixture of causes.
What risk factors predispose you to develop erection issues?
We have covered the direct causes of this condition. However, there are some instances that – if not attended to – put you at a greater risk of being unable to achieve an erection. In this situation, you develop what is known as acquired erectile dysfunction.
Some of the common risk factors that can cause you to change from normal erectile function to ED include:
a sedentary lifestyle and obesity
alcohol and drug use
peripheral vascular disease
These are just a few of the conditions and instances that can put you at risk of being unable to develop and maintain an erection. Many of these conditions happen together to cause erectile dysfunction.
However, obesity can single-handedly lead to ED even without influence from the other risk factors.4 Other independent risk factors that lead to erectile dysfunction include resistance to insulin as well as metabolic syndrome. Added to this is a sedentary lifestyle where you don’t have enough exercise.
Lifestyle choices also play a huge role in the development of erectile dysfunction. If you partake in the abuse of alcohol and other drugs, you are more likely to develop the condition.
The alcohol causes decreased libido as well as vascular insufficiency. This compromises the blood flow required for normal erectile function.
Abusing other drugs like antidepressants can also cause ED. This is because they affect the central nervous system by altering the number of neurotransmitters.
If you have benign prostate hypertrophy as well as symptoms in your lower urinary tract, you could have problems achieving an erection. This is because these seemingly mild and harmless conditions can cause the cavernosal smooth muscle to become toned. This toned muscle isn’t able to contract properly as is required to cause an erection.
In a nutshell, what is a normal erection?
Generally, a large majority of men will experience some problems getting an erection at least once in their lives. Things usually return to normal. However, if you have lifelong erectile dysfunction or acquired it later in life without any relief, rest assured that help is available.
The highly experienced team of Doctors at the Men’s Health Clinic Australia can assist you in the diagnosis and treatment of Erectile Dysfunction. If you are unsure if you are suffering from Erectile Dysfunction take this quiz for a personalised assessment.