The Erection Section
Tips for keeping your manhood primed and perky and what to do when it develops a mind of its own
From puberty onwards, men’s erections face many challenges, from the early days of over-excitement, tight clothing, alcohol-fuelled weekend binges, peer pressure, unrealistic performance expectations, recreational drug use and too much porn. Later in life, stress, shift-work, trying for a baby and money worries can also take their toll on man’s most prized body part. Aging doesn’t help either, as it comes with the added risks of type 2 diabetes, cardio-vascular disease, high blood pressure and cholesterol, all medically linked to erection difficulties (1).
The ability to attain and maintain an erection is an integral to a man’s sense of wellbeing and can be crucial in maintaining a happy sexual relationship. An inability to ‘perform’ poses a direct threat to a man’s confidence in his sexual prowess. It is well documented that men are often reluctant users of the healthcare system. Embarrassment and fear are the main reasons why a significant number of men fail to discuss sexual problems with a health care professional and many find it extremely difficult to talk to their partner. Erection difficulties can be an early warning sign of both cardio-vascular disease and diabetes so they need to be taken seriously (2).
What can you do to prevent problems developing?
- Hearten up – The link between the heart and the penis has been scientifically proven – in the physical sense, not romantically! A diet that is good for your heart is also good for your erection. Check out the Mediterranean diet, which includes fruit, vegetables, nuts, olive oil, fish and wine (preferably red). Women take note – it might feel easier to find yourself an Italian or French lover than convince your man to give up curries, kebabs and rib eye steak, but mention the impact on his erection and he just might listen.
- Slim down – If you’re displaying what could be described as a beer belly, losing weight will not only make your penis look bigger (it’s a question of perspective) it will also help your blood pressure, reduce cholesterol and potentially prevent type 2 diabetes.
- Sweat it out – There is evidence that links a sedentary lifestyle to erectile dysfunction (ED). Forms of aerobic exercise such as running or swimming can help prevent ED. But watch out for any form of exercise that puts excessive pressure on the perineum (the bit between the balls and bottom). Men who cycle regularly should wear padded shorts, stand up frequently while peddling and ‘no-nose’ bike seats protect against genital numbness and sexual dysfunction, according to the National Institute for Occupational Safety and Health.
- Pack it in – Smoking can damage your blood vessels and restrict blood flow to the penis (3).
- Chill out – Stress boosts levels of the hormone adrenaline, which makes blood vessels contract…bad news for your erection, which requires a great blood supply. Anything a man can do to ease tension and relax is likely to give his sex life a boost. Take a soak in the bath, try yoga, exercise, get meditation apps for your phone, take time out and switch off your phone and laptop.
- Tuck yourself in – Night-time and morning erections are a sign of good health and tell us important things about both blood flow and nerve supply to the penis (4).
- Cut down – Beer goggles may well increase desire, but brewer’s droop is a disappointing outcome for everyone involved. Too much alcohol is not good for erections.
- Keep it up – Maintaining sexual activity helps, well, maintain sexual activity. Actually, it’s more about the importance of frequent erections because they stimulate frequent blood flow to the penis which keeps the tissue healthy. Remember the old adage ‘if you don’t use it, you lose it’ but also remember ‘all things in moderation’. Try to avoid pornography, which can cause counter-productive conditioning, and do it the old fashioned way using your imagination.
- Play safe – Penile injuries can occur during some of the riskier types of sex and that can subsequently cause erectile dysfunction. Be careful with penile rings.
- Ditch drugs – Anabolic steroids are often misused and long-term use can shrink the testicles and reduce their ability to make testosterone. There is also evidence that they can cause erection problems (5).
Tales of the Unerected
If your manhood is no longer rising to the occasion, medical and psychological reasons could be causing its lack of vitality. But if you still get morning erections or erections for masturbation, it’s likely that you have psychogenic erectile dysfunction. No, this doesn’t mean that you have some deep-seated psychological issue or that you are imagining that your most prized asset doesn’t work. What it does mean is that there isn’t a medical cause for your lacklustre performance in the bedroom department.
Generally speaking, psychogenic erectile dysfunction is caused by depression, stress or relationship distress. The most common causes are performance anxiety and fear of failure.
Anxiety and fear trigger the production of adrenalin and noradrenalin, which has a negative impact on the blood flowing into your penis, or can it can trigger the blood to flow out of your penis at the most inopportune moments (6).
So what should you do if your erection seems to have developed a mind of its own? First things first…
- See your GP – They will check your blood pressure, cholesterol and will ask you to provide a urine test to check for type 2 diabetes. Some doctors will also carry out blood tests to check your hormone levels, including testosterone. Testosterone gives you the desire for sex and helps erectile function. However, it also has other important biological effects particularly on the metabolic system, bone and muscle integrity, the cardiovascular system and the brain (7). Depending on the results of your tests, your GP will provide advice on the variety of treatment options available and prescribed a treatment that is right for you and your partner.
- Get your mind on your side – Worrying triggers feelings of stress, fear and anxiety which produces adrenalin and noradrenalin. Telling yourself not to worry doesn’t help, you need to find ways to get your mind on your side or distract yourself from negative thinking.
- Stop ALL negative behaviour – This can arise as a consequence of sexual difficulties. Common behaviours include apologising during sex, arguments, rushing or avoiding foreplay due to the fear that an erectile response will be short lived or even avoidance of all intimate or sexual activity. In general, negative behaviours lead to further failure and distress and further erode a man’s sexual confidence.
- Be intimate – The longer a sexual problem exists, the greater the potential impact on a on a couple’s relationship. Avoidance of intimate/sexual contact is common. The man or his partner stops initiating, in case his penis doesn’t stand to attention at the desired moment. Partners can feel angry or resentful when he runs for the hills at the first sign they are feeling frisky. One suggestion is to take sexual intercourse off the agenda for a while and focus instead on kissing, cuddling on the sofa, stroking and massage, taking a shower together. Remember what you enjoyed doing in the early days of your relationship or before there was a problem and start doing them again, this will reduce performance anxiety and improve relaxation and arousal.
- Pelvic floor exercises – Among the multiple factors involved in the presence of erectile dysfunction, the pelvic floor appears to have an important influence, although its exact role is unclear. A study carried out by Professor Dorey showed that pelvic floor muscle exercises, also known as Kegels, were significantly effective for some men with erectile dysfunction (8). This bears out the experience of me and my colleagues who have been teaching men to do pelvic-floor exercises (often alongside other medical interventions) for the past 10 years.
- Talk to your partner – Many men and women find it difficult to discuss their sexual relationship, so try talking outside the bedroom or go for a walk as it can be easier to talk when you’re not looking directly at one another. Alternatively, write down your thoughts and worries and leave it for your partner to read in their own time.
- Moderate masturbation – Frequent masturbation and pornography use can cause problems with erections. I’ve been asked many times ‘how much is too much’? Well, it depends on the man. If he can get erections for masturbation but he is finding it difficult to get turned on during partner sex, he may have conditioned himself to only respond to highly arousing pornographic material and a firm grip! Two useful websites that can help men understand the impact their masturbatory habit is having on their sexual responses are yourbrainonporn.com and www.nofap.org.
Finally, sex is good for our physical and mental health and a vital part of most relationships. It is after all, an intrinsic aspect of what it means to be human and an essential aspect of our wellbeing. Therefore it is important that men who experience erection difficulties seek help as soon as possible, this can allay fears, diagnosis any underlying health problems, provide an opportunity for early intervention that can prevent more complex problems developing and help maintain happy and healthy relationships.
- NHS Diabetes Factsheet 33. Diabetes and erectile dysfunction ‘ED is a marker of ill health’ 2011
- Jackson G. et al. Erectile Dysfunction and coronary artery disease prediction: evidence based guidance and consensus. International Journal of Clinical Practice. 2010;64 (7): 848-857
- Porst H. Erectile Dysfunction (ED). In: Porst H, Reisman Y (EDS), The ESSM Syllabus of Sexual Medicine. Medix: Amsterdam; 2012
- M Kirby, V Lehman. Sleeping with ED. National Services for Health Improvement; 2008
- H Rashid S Ormerod, E Day. Anabolic androgenic steroids: what the psychiatrist needs to know. Journal of continuing professional development. 2007; vol.13
- Kirana PS, Porst H. Erectile Dysfunction. In: Kirana PS, Tripoldi R, Reisman Y, Porst H (eds) , The EFS & ESSM Sullabus of Clinical Sexology. Medix: Amsterdam; 2013
- T H Jones. Testosterone Deficiency in Men. Testosterone deficiency: an overview. Oxford University Press 2013
- Dorey , Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice; 2004: 819