Let’s talk about something important for men’s health: the erection. It’s a topic that might feel awkward, but understanding the mechanics of a penile erection is a normal part of life and overall health. Many guys have questions or concerns about their erection at some point, and that’s completely okay.
Here at NAU Urology Specialists, Dr. Mistry and our team talk about these things every day. We understand the need for discretion and maintain patient confidentiality; our privacy policy details how we protect your information. You want straight answers and real help, and that’s what we aim to give.
Understanding how things work down there, including the complex interplay of nerves and blood vessels, can help ease worries and show you when it might be time to chat with a doctor about your sexual health. So, let’s break down what’s involved in achieving and maintaining an erect penis.
Understanding How Erections Happen
So, what actually makes a penile erection happen? It appears simple, but a complex sequence involving the brain, nerves, blood vessels, hormones, and muscles must coordinate perfectly. It starts with physical or mental sexual arousal.
When you become aroused, your brain sends signals down the spinal cord, specifically involving sacral spinal cord segments. These signals travel via autonomic nerves, including parasympathetic fibers that originate from the sacral spinal cord and sympathetic fibers from the thoracolumbar spinal cord segments and chain ganglia. These nerves travel through the pelvic plexus and hypogastric plexus (including the superior hypogastric plexus) to reach the penis.
A key player in this process is the release of neurotransmitters, most notably nitric oxide (NO), triggered by signals from the cavernous nerves (branches of the pelvic plexus). Nitric oxide stimulates an enzyme that leads to increased levels of cyclic GMP within the penile smooth muscle cells. This causes smooth muscle relaxation, specifically affecting the trabecular smooth muscle within the corpora cavernosa and the vascular smooth muscle of the penile arteries.
This relaxation of penile smooth muscles allows the arteries supplying the penis to dilate dramatically, increasing blood flow into the spongy erectile tissue. The penis contains three cylindrical bodies of erectile tissue: the two paired corpora cavernosa (singular: corpus cavernosum) located side-by-side dorsally, and the single corpus spongiosum located ventrally, which surrounds the urethra and forms the glans penis. The paired corpora cavernosa are the primary structures responsible for rigidity.
As blood rapidly fills the corpora cavernosa, these chambers expand against a tough fibrous sheath called the tunica albuginea. This expansion compresses the small emissary veins that normally drain blood away from the penis, trapping the blood inside and drastically reducing venous outflow. This combination of increased arterial inflow and decreased venous outflow causes the penis to become engorged and rigid – achieving an erect penis.
For a truly rigid erection, contraction of the ischiocavernosus muscles and bulbospongiosus muscles at the base of the penis further increases pressure within the corpora cavernosa, helping to achieve maximum hardness. These muscles are under voluntary and reflexive control, innervated by the pudendal nerve (originating from sacral spinal segments), providing somatomotor penile function. The pudendal nerve also carries sensory information via the dorsal nerve of the penis.
In the non-aroused state, the penile smooth muscle maintains a state of tonic contraction, limiting blood flow into the erectile tissue. This is largely mediated by the sympathetic nerve system via sympathetic innervation releasing norepinephrine. When sexual arousal ceases or after ejaculation, sympathetic signals increase, nitric oxide release decreases, smooth muscle contraction resumes, and the trapped blood is allowed to flow out through the emissary veins, returning the penis to its flaccid state.
What If You Only Have One Testicle?
Sometimes health concerns related to male sexual function aren’t directly about the penis itself. For example, we sometimes get questions from men who only have one testicle. This is more common than you might think.
Why might someone only have one? Trauma is a significant reason. If you play contact sports like football, lacrosse, or baseball, wearing a protective cup is essential.
Losing a testicle to injury is painful and preventable. Encourage young athletes to use protection. It’s about safeguarding their future health, including hormone production and fertility.
Another reason is testicular torsion. This occurs when a testicle twists on its spermatic cord, cutting off blood supply. It usually happens during puberty and causes sudden, severe pain and swelling.
If a teenage son complains of sudden testicle pain, don’t delay. Head straight to the emergency room. Doctors typically have about six hours to untwist it and save the testicle through surgical intervention.
Waiting too long often means the testicle cannot be saved and must be removed. Timeliness is critical in these situations. This highlights the importance of prompt medical attention for acute scrotal pain.
Testicular cancer is another cause, often affecting younger men. Treatment usually involves removing only the affected testicle (orchiectomy). The chance of cancer developing in the remaining testicle later is relatively low, perhaps less than 5%, but regular self-exams are still vital for early detection.
You can learn how to perform a testicular self-exam easily; it’s a simple check that can be done monthly. Familiarity with your body helps detect changes early. This proactive approach is crucial for men’s health.
Sometimes, a testicle doesn’t descend properly from the abdomen into the scrotum during development (an undescended testicle or cryptorchidism). If it wasn’t corrected surgically in childhood (orchiopexy), it might have been removed later due to complications, or it may have never fully developed. A history of an undescended testicle can increase risks for the remaining one, including cancer risk and potential fertility issues.
Men with one testicle, especially if it resulted from an undescended one, might have a higher likelihood of low testosterone or fertility problems. If you had an undescended testicle, getting fertility checked early, perhaps around 18 or 19, is a prudent step. Addressing potential infertility challenges is often more difficult when discovered later in life when trying to conceive.
Testosterone Levels and Your Health
Whether you have one testicle or two, testosterone levels play a significant role in overall male health and well-being. This hormone isn’t solely about sex drive or erectile function. It’s crucial for maintaining bone density, muscle mass, mood, energy levels, and cardiovascular health.
Doctors often look for a total testosterone level above 250 ng/dL just for general health benefits related to bone and heart health. However, feeling well involves more than just meeting a minimum number. You might technically be within the ‘normal’ range but still experience symptoms associated with low testosterone (hypogonadism).
These symptoms can include persistent fatigue, reduced libido (low sex drive), difficulty achieving or maintaining erections, problems building or maintaining muscle mass despite exercise, increased body fat, or mood changes like irritability or depression. Issues with mental health can sometimes be linked to hormonal imbalances. Guys in physically demanding jobs might notice a decline in stamina or performance, even if their lab results aren’t critically low.
You can find more details about low testosterone symptoms and effects on our website. At NAU Urology Specialists, we focus on treating the individual, considering symptoms alongside lab results. If your testosterone level is 350 or 400 ng/dL, but you feel consistently unwell with typical low T symptoms, it might be considered low for your specific needs.
We discuss various hormone management options based on your unique situation, symptoms, and health goals. Treatment isn’t solely dictated by lab values but by how you feel and function day-to-day. Options might include lifestyle changes, medications, or testosterone replacement therapy.
If you have only one testicle, getting your testosterone levels checked periodically is a sensible measure. Knowing your levels helps manage your overall health proactively and address any potential deficiencies early. This contributes positively to long-term men’s health.
When Ejaculation Doesn’t Go As Planned
Beyond erections and testosterone, sometimes the concern revolves around ejaculation. One condition we frequently discuss is retrograde ejaculation. This occurs when semen travels backward into the bladder during orgasm instead of exiting through the penis.
First, it’s important to know that this condition isn’t physically harmful. The semen mixes harmlessly with urine in the bladder and is expelled during the next urination. However, it can cause emotional distress or fertility concerns for some men.
Does it feel different? Dr. Mistry relies on patient reports since he hasn’t experienced it personally. Some men, particularly those who develop it suddenly later in life, find it very bothersome, describing the orgasm as feeling less complete or lacking the usual sensation of expulsion.
What causes retrograde ejaculation? Certain types of prostate surgery are a common cause. Procedures like Transurethral Resection of the Prostate (TURP) or Holmium Laser Enucleation of the Prostate (HoLEP), often performed for benign prostatic hyperplasia (BPH or enlarged prostate), frequently result in retrograde ejaculation because they can affect the bladder neck mechanism – the internal urinary sphincter muscle which normally undergoes smooth muscle contraction to close off during ejaculation.
Doctors should always discuss this potential side effect before performing such surgeries. Fortunately, newer treatments for BPH, such as UroLift or Prostate Artery Embolization, generally carry a lower risk of causing this issue. Discussing all available options and their potential impacts on sexual function with your urologist is vital.
Medications can also be responsible. Certain drugs used to treat high blood pressure or BPH, like alpha-blockers such as tamsulosin (Flomax) or silodosin (Rapaflo), are known culprits as they relax the bladder neck smooth muscle. Some psychiatric medications or drugs used for nerve pain, like gabapentin, might also contribute in some individuals.
Certain health conditions, such as diabetes mellitus (especially with associated neuropathy) or nerve damage resulting from spinal cord injuries, stroke, or multiple sclerosis, can lead to retrograde ejaculation. These conditions can impair the nerve signals, including sympathetic innervation, required for proper bladder neck function during orgasm. The pelvic plexus and hypogastric plexus contain nerves critical for this function.
Can retrograde ejaculation be treated? If it’s caused by a medication, stopping or switching the drug often resolves the problem relatively quickly, sometimes within days. If it’s a result of surgery that has permanently altered the bladder neck anatomy, it is usually irreversible.
For men experiencing retrograde ejaculation due to diabetes or other nerve-related issues, medication like pseudoephedrine (found in Sudafed) may sometimes help. Pseudoephedrine works by stimulating sympathetic nerves, promoting smooth muscle contraction at the bladder neck. This approach is often considered when fertility is a primary concern, as it can potentially restore forward ejaculation.
Even if forward ejaculation cannot be restored, achieving pregnancy is still possible. Sperm can often be successfully retrieved from the man’s urine collected shortly after orgasm. This recovered sperm can then be used for assisted reproductive techniques like intrauterine insemination (IUI) or in vitro fertilization (IVF), offering viable options for couples trying to conceive.
Other ejaculation problems also exist, including premature ejaculation (ejaculating too quickly), delayed ejaculation (difficulty or inability to ejaculate), anejaculation (complete absence of ejaculation), or reduced intensity of orgasm (hypo-orgasmia). If you notice any persistent changes in your ejaculation or orgasm, consulting a urologist can help determine the underlying cause and explore potential management strategies. Addressing these male sexual health issues often requires a comprehensive evaluation.
Factors That Can Affect Your Erection
Many factors can impact your ability to achieve and maintain an erection firm enough for satisfactory sexual intercourse, a condition known as erectile dysfunction (ED). It’s important to recognize that ED is not just an issue for older men; it affects men across various age groups. Understanding the potential causes is the initial step toward finding an effective solution and improving erectile function.
Physical health conditions are major contributors to erection problems. Conditions that negatively affect blood flow or nerve function are frequently involved. Consider common health conditions like heart disease, high blood pressure (hypertension), high cholesterol (hyperlipidemia), and diabetes mellitus – these can all damage blood vessels (leading to atherosclerosis) throughout the body, restricting vital blood flow to the penis needed for a firm penile erection.
Neurological disorders such as Parkinson’s disease or multiple sclerosis can disrupt the nerve signals originating from the brain and spinal cord that control erections. Pelvic surgery (e.g., radical prostatectomy for prostate cancer) or injuries to the pelvis or spinal cord can also damage relevant nerves (like the cavernous nerves) or the erectile tissue itself. Hormonal imbalances, particularly low testosterone, can decrease libido (sexual desire) and contribute to difficulties with erections.
Lifestyle choices significantly influence erectile health too. Smoking tobacco damages blood vessels and impairs vascular smooth muscle function, directly hindering the mechanisms needed for an erection. Excessive alcohol consumption can depress the central nervous system, reduce sexual arousal, and impede blood flow, making erections difficult to achieve or maintain.
A sedentary lifestyle and being overweight or obese often contribute to cardiovascular problems, which are strongly linked to ED. Certain prescription and over-the-counter medications can also have ED as a potential side effect. These include some drugs used to manage high blood pressure, antidepressants, antipsychotics, anti-anxiety medications, antihistamines, and others.
You can review common causes of ED to get a better understanding. It’s crucial to discuss any concerns about medication side effects with your doctor before making changes. Sometimes adjusting the dosage or switching to a different medication can resolve the issue.
The psychological aspect, including mental health, should not be overlooked. Chronic stress, anxiety (especially performance anxiety related to sex), depression, low self-esteem, guilt, and relationship conflicts can all dampen sexual arousal and interfere with the neurological and vascular processes required for an erection. Often, ED results from a combination of physical and psychological factors, creating a cycle where physical difficulty leads to anxiety, which further exacerbates the erection problems.
When to See a Urologist
If you’re experiencing persistent trouble with achieving or maintaining erections, have consistently low energy levels, notice changes in ejaculation, or have concerns about your testicular health (like pain, swelling, or lumps), it’s appropriate to schedule a visit with a specialist. A urologist is a medical doctor who specializes in diagnosing and treating conditions affecting the urinary tract (kidneys, bladder, ureters, urethra) and the male reproductive system (testes, prostate, penis).
We recognize that discussing these personal issues can sometimes feel uncomfortable or embarrassing. However, urologists manage these specific problems daily. Our focus is entirely on understanding your concerns without judgment and collaborating with you to find effective solutions.
Delaying medical consultation often prolongs worry and prevents you from accessing treatments that could significantly improve your quality of life and relationships. Many underlying causes of erection problems are treatable with lifestyle changes, medications, therapies, or other interventions. Furthermore, sometimes erectile dysfunction can be an early indicator of more serious underlying health conditions, such as undiagnosed heart disease or diabetes, so getting evaluated is important for your overall long-term health.
At NAU Urology Specialists, we provide comprehensive urologic care, addressing a wide range of issues from hormone management (like low testosterone) and prostate health (BPH, prostatitis, prostate cancer screening) to sexual dysfunction (ED, premature ejaculation) and testicular conditions. We have convenient office locations serving the Austin area, including Round Rock, North Austin, South Austin, and Dripping Springs.
You can contact us to ask questions or schedule an appointment by calling 512-238-0762. Alternatively, you can find more information and resources on our website at armormenshealth.com. Our team is dedicated to providing expert care for men’s health concerns.
Conclusion
Dealing with concerns about your erection, related issues like testosterone levels, or changes in ejaculation is a common experience for many men. It’s important to remember that your sexual health is intrinsically linked to your overall physical and mental health. Understanding the potential causes – ranging from physical health conditions like high blood pressure or diabetes, lifestyle factors like smoking, medication side effects, and psychological influences like stress or anxiety – empowers you to take action.
Don’t hesitate to seek professional guidance from a urologist if you are experiencing persistent erection problems or other related male sexual health issues. Effective treatments and management strategies are often available. Addressing these concerns can improve not only your sexual function and confidence but may also lead to the early detection and management of other significant health conditions like heart disease.
Taking the step to get help for your erection concerns is a positive move for your comprehensive health and well-being. Open communication with a healthcare provider is the foundation for finding the right path forward. Remember, addressing these issues proactively supports a healthier future.