Causes of Male Erection Problems
There are two broad categories of men’s erection problems: physical (or bodily), and psychological. In the early days of sex therapy, psychological erection failure was thought to be the most common. Indeed, some experts (Masters and Johnson, to be exact) suggested that up to 90% of men who had erection problems were in fact experiencing a psychological form of the problem. And it’s my belief that this is till a major problem for men today. You see, we are faced with many issues and problems that can cause men to feel a weakness in their psychological structure around sex. These are often wrongly held beliefs that lie out of consciousness, and which are therefore hard to identify and remediate. But this may also be why so many therapists turn to the physical issues which can cause erectile failure without looking ta the psychological issues first.
I am thinking of the shadow unconscious here. The energy held in repressed emotional wounds from childhood which lie hidden in the unconscious and which determine so much of our relationship with the future sexual partners we choose. It follows that dealing with – ie healing the emotional issues from the past – can really have an impact on our sexual performance, and pleasure, in our adult lives.
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But things are different now! Forty-plus years on from the time when few treatments could deal with physical issues, we know that psychological problems are not the only issue. A huge number of erection problems are caused by bodily problems, that is to say, physical problems that lie in the body.
Naturally, as you may already have realized, any problem that affects the penis will of course have a massive impact on the man who owns it. So how do you separate the causes of erectile dysfunction into emotional or psychological and physical?
If you’re a man who has – even once – experienced the loss of erection during sex, then you will know how worried you were the next time that it might happen again – and how much it affected you. Read more on this here.
Before we start to consider the factors that affect erection problems, it would be helpful to consider the mechanism of erection. That way we can see how the interaction of physical and emotional or psychological factors may cause a man to suffer a loss of erection.
The penis’s erectile tissue obviously has to fill with blood, and any problem that affects this mechanism – and the penis’s ability to fill with blood – will affect a man’s erection capacity. It follows that any problem with arterial blood flow can affect a man’s erection, as can any problem with the mechanism which blocks the veins that drain blood away from the penis.
These two mechanisms have to work in conjunction to produce a firm erection. In medical language, the latter is known as failure of the venous occlusive mechanism.
Blood vessel problems
When the small vessels which carry blood to the penis dilate to allow an erection to take place, they expand to something between 10 and 15 times their normal diameter. Any occlusion can cause major problems with the erectile mechanism. Even a small blockage can do this, and it’s not so unusual. Arterial blockages can be caused by cigarette smoking, hypertension, high cholesterol levels and injury to the groin or pelvic area.
Often men who have occlusion in this area will also have problems with blockage of arteries elsewhere in the body. There’s a saying among doctors that the erection problems start two years before the heart attack. But unfortunately the same is true in reverse: heart problems can precede erectile problems.
Blockage of a single artery in the penis can occur because of injury or trauma – this is the most common cause of penile arterial problems in young men.
Arterial problems can also occur in men with diabetes: unfortunately, they can suffer both nerve damage and arterial damage. Plaque buildup on the internal walls of the arteries further reduces their diameter. And men who have high levels of cholesterol have a clear risk of arteriosclerosis which will block the arteries of the penis. The extra lipid builds up in the wall of the artery and eventually causes a significant degree of blockage.
And high blood pressure – due to the arterial stenosis which accompanies the problem, rather than the high blood pressure itself – can be a cause of erectile dysfunction.
Failure of the venous occlusive mechanism
Equally as common as the arterial problems that we mention above, failure of the venous occlusive mechanism can allow blood to drain away during an erection rather than be held in the erectile tissue. This will prevent the build up of pressure necessary for an erection to occur. This can be a problem with young men who have always had erection problems all their lives – some surgeons offer surgery designed to repair the fault.
Another cause of erection problems worth mentioning is Peyronie’s disease, in which non-elastic scar tissue develops along the inside of the erectile chambers of the penis. This can even become calcified and line the tunica albuginea in such a way that the tissue cannot be compressed adequately as the penis erects: this in turn prevents the veins being squeezed shut, thereby allowing the problem of venous leakage to develop.
By contrast, if the trabecular smooth muscle and the vascular spaces of the penis are unable to relax sufficiently, the sinusoidal expansion will not be enough to permit adequate blood into the penis for an erection to develop. This can happen if a man is over-aroused (i.e. emotionally excited) when he has excessive adrenaline in his body.
Finally, cigarettes cause generalized arterial blockage and may also affects the cavernous smooth muscle so that it cannot dilate. Overall, though, the outcome is the same: the penile veins are not compressed enough to produce the heightened intracavernous arterial pressure which lies behind the erection problem.