Erectile Dysfunction

Erectile dysfunction is a serious problem for any man. It does not endanger the affected male's life, but let's be honest, for many afflicted it is a terribly unpleasant situation that greatly disrupts their personal lives. The erectile dysfunction is further complicated by the fact that many men feel ashamed and refuse to speak about their problems with a doctor. The purpose of this article is to describe how the erection works, what causes the disorder and how it can be treated.


The erection means enlargement and induration of the penis. It is necessary for a normal sexual intercourse, which means for inserting the penis into vagina and performing copulation movements that are terminated by ejaculation (expulsion of semen from the urethra) accompanied with orgasm.

The mechanism of erection

To explain the mechanism of erection, it is necessary to say a few simple words about the anatomy of penis and its blood supply. Male urethra runs through the penis, it opens into the glans and it is a common way for both the urinary and genital system. In addition, the penis contains two cavernous bodies. They are hollow structures closely related to local blood vessels. Local arteries of the penis include two significant cavernous arteries that flow through many small arterial branches into the cavernous bodies. In normal state, only small amount of blood flows through these small arterioles and the blood from the cavernous bodies is quickly removed by local blood veins.


During erection, parasympathetic nerves cause the small arteries opening into the cavernous bodies to open causing a huge blood inflow into the cavernous bodies. Their volume increases and this causes the enlargement and induration of the penis. In addition, the enlarged cavernous bodies compress local veins decreasing the blood outflow and allowing the erection to persist.


When the sexual arousal disappears (in ideal case after an ejaculation and orgasm), the local arteries re-close, the blood flows slowly out of the cavernous bodies and the erection disappears.

Causes and symptoms

Damaged local blood vessels and nerves

Given that the nervous system leads necessary impulses and the blood directly increases the volume of the penis, their disorders may be clearly accompanied with erectile dysfunction. The nerve damage may be caused for example by diabetes and multiple sclerosis. The damage of the penile blood vessels may be related to atherosclerosis and long-term untreated high blood pressure.

Hormonal disorders

Erectile dysfunction may be caused by lack of male sex hormone testosterone. Similar consequences may have excess of hormone known as prolactin (for example due to prolactinoma).

Peyronie's disease

This relatively common disease leads to excessive deposition of solid connective tissue within the penis. This is followed by penile deformation and painful sensations during erection.


Some medications may be responsible for erectile dysfunctions including some antidepressants, antihypertensive drugs and medications against the Parkinson's disease.

Psychological erectile dysfunction

This is probably the most common case of erection disorders including stress, depression, fatigue, anxiety, etc.


This is quite the opposite problem when there is a prolonged painful erection without sexual stimulus that may directly endanger the tissues of the penis.


Any male patient with erectile dysfunction should be examined by a urologist and sexologist. It is logical to assume that the problems are psychological as this is the most common cause of erectile disorders. Vascular problems may be detected by ultrasound examination of blood vessels of the penis.


There are several treatment options. However, they all need the patient’s trust and cooperation with his doctors.

Prescribed drugs

Conventional drugs support the erection opening the arterioles leading into the cavernous bodies. These drugs include a substance known as sildenafil (Viagra and others). The effectiveness of these drugs is generally very good, but there are some side-effects. They may be especially dangerous for cardiac patients when combined with nitrates and that is why they should never be taken without consulting a doctor.

Natural products

Various natural products administered in form of food supplements have a great effect against psychic-related erectile dysfunction.


Psychotherapy, led by a qualified psychologist, is another effective method in therapy of erection disorders caused by psychic troubles.

Vacuum pump

This tube-shaped device is tightly fitted onto the penis, then it drains the air out and the resulting vacuum causes the erection. When the penis is erected, a “strangling” band is put around the base of the penis to keep the blood within the penis. However, the band must be kept for only a limited period of time as it can cause local ischemia.

Surgical solution

If erectile dysfunction is caused by impaired blood flow into the penis, vascular surgeons may perform surgical interventions to repair local arteries.

Penile prosthesis

Penile prosthesis is an extreme solution of the problem. Cavernous bodies are removed and replaced by two longitudinal balloons. The patient can inflate them by a special pump for a necessary time. After the intercourse, the balloons may be deflated again. However, this is a very expensive and only rarely used approach.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources