If there is one thing guaranteed to bring fear to even the most steeled of men it is an honest and frank discussion about an erection – or the lack thereof. It seems a violation of one’s manliness to discuss erectile dysfunction, to even utter it makes men feel alone and embarrassed, but the truth is that it is a very normal occurrence. Over 40% of men have some trouble getting it up when they want to get down. 

It seems a violation of one’s manliness to discuss erectile dysfunction, to even utter it makes men feel alone and embarrassed, but the truth is that it is a very normal occurrence.

While having a few too many drinks on a Friday night may occasionally affect the ability to have and sustain an erection, the regular occurrence of an inability to initiate and maintain an erection that allows penetrative sex is what we are talking about.

So pour yourself a stiff drink, as we firm up for a chat about all things soft. 

You may find yourself asking what causes erectile dysfunction (ED). Is my lack of erection once something to be worried about? Isn’t that what Viagra is for?

The truth is that almost all men will have trouble gaining and sustaining an erection in the course of their sexual lives, and it isn’t anything to be embarrassed about or concerned by. 

There are many causes and many treatments, most of which aren’t advertised on a giant yellow billboard with the message – LONGER LASTING SEX. Yeah, that doesn’t work.

Before we get into the causes and the cures, let’s begin with a quick lesson on how the penis actually works. 

To start we have to talk about arousal – we need arousal to begin the chemical cascade in the brain that sends messages to the penis to start the erection process. Blood vessels in the penis dilate and blood flow is increased into the penis. 

This is when things get interesting, as the pressure builds…and builds.. and builds… roughly eight times the normal blood flow heads to that area and this all happens in special tissues called the corpora cavernosa and corpus spongiosum. As this pressure builds it blocks off the final piece of the erection puzzle, the tunica, which stops the blood from escaping back out and there we have it, we now have an erection. 

Physical causes

As you can see there is a lot to do with blood flow when it comes to an erection and this brings us to the first category of ED: the physical causes. 

To make it easy we are going to ignore physical trauma as a cause as the list of injuries to the spine, pelvis and penis itself that can cause ED is wide and varied and focus on the more common concerns. 

ED in men over the age of 40 will usually have something to do with blood flow so high blood pressure, heart disease, high cholesterol and diabetes can all affect the amount of blood that can flow to the penis, limiting erection potential. 

Having long term blood pressure issues, diabetes or carrying excessive weight also can damage blood vessels and the nerves that send signals to the penis stimulating an erection. So you may want to pass on that post coital cigarette if you want to keep things looking up. Just remember even though this hits after 40, what you do in the lead up has a massive impact, plus sex only gets better after 40.

Psychological causes 

For men under the age of 40 who suffer from ED – and reports put the percentage as high as 40-50% of younger men – the cause is often psychological. 

Life can be stressful, younger men are more likely to suffer from the effects of addiction, depression and anxiety, and have the highest likelihood of suicide as the cause of death. 

Plus under 40 is the most common time to report broken sleep – babies and work stress, relationship issues and performance anxiety. 

The challenge for under 40s is that a lot of men turn to porn when ED occurs to help stimulate themselves, which often increases premature ejaculation and the challenge of getting an erection. 

So how do we fix all this?

The first step is to talk to someone who knows how to help, a doctor or men’s health physiotherapist is the best starting point. This will help to determine the physical and psychological causes and help to remove the barriers to having fun with your erection. 

  • Physical changes:
    • The first method to treat ED is developing some good pelvic floor muscles to help improve the blood flow and strength of the area. For younger men, pelvic floor retraining can help to improve the strength of an erection. 
    • Healthy diet and exercise – as mentioned above it’s all about blood flow, so reducing excess weight and improving your overall cardiovascular fitness makes a big difference. 
  • Psychology and counselling:
    • If you have performance anxiety, relationship or work stress, anxiety, depression or anything else that you feel affects your mental health, talking it over with someone helps. Making an appointment with someone qualified helps you to develop strategies to build back confidence and move forward.
  • Penis pumps:
    • While penis pumps or ‘vacuum constriction penile devices’ may be fun to use to add some spice to the bedroom – just like the female “pussy pump” – this does have good medical validity and acts as an alternative to medication. The pump is placed over the penis to promote blood flow and then a restrictive ring is placed at the base of the penis to maintain the erection.
  • Medication
    • Viagra (Sildenafil), Cialis (Tadalafil) and Levitra (Vardenafil) are all medications that help to alter blood flow to the penis to promote an erection with the effects positive in up to 76% of men with an erection lasting for up to 2 hours.
    • Single use injections into the penis to maintain an erection can also be used but this is under strict medical guidance. 
  • Surgery
    • This is for the more severe cases – inflatable or malleable rods can be surgically inserted into the penis and used to achieve an erection. The pump is actually hidden in the scrotum adding a new element to foreplay. 

Like most conditions that affect men, if you can open up and talk about it there is a lot that can be done to help. It’s best to consider ED as a two-fold condition and one with many treatments available. It isn’t just about getting it up, it’s about working towards better management to ensure a long and healthy sex life.      

This article was contributed by Alex Mackay, a Senior Physiotherapist who specialises in musculoskeletal, pelvic health and pelvic pain at Brisbane’s Ironside Sports and Physiotherapy. If you want to hear more from Alex you can follow him on Twitter @MackayPhysio.