Dr. Anne Truong explains how erections work and what goes wrong. An erection requires coordination between your brain, nerves, hormones, and blood vessels. About 30 million US men have ED, yet 67% don't know it, and 90% of cases stem from physical causes like arterial disease or valve problems in the penis.
Questions this video answers
March 22, 2022
"The persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance."
Four types: visual (sensory), psychogenic (thought-triggered), reflex (touch-triggered via spinal loop), and nocturnal (REM sleep-related).
At least 30 million men (study from the early 2000s).
The International Erectile Dysfunction Questionnaire (SHIM / IIEF-5); it has five questions and asks about sexual activity over the last four weeks.
Chapters
This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthfulmenpodcast.com for more information and resources from the show. See you on the inside. Hello there. I'm excited to be here today to record this podcast because this is one of our first episode and we're going to start talking about the basics first, the foundation, anatomy and physiology of sexuality and particularly how an erection happened. And what goes on in the body when this happened is actually quite complex. So let's first start with what defines erectile dysfunction. Because erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. So that means that it can include struggling to have an erection or a long enough erection to complete intercourse, or an inability to ejaculate. So it's a whole spectrum of a partial erection all the way to inability to not able to ejaculate. And according to a very well known and quoted study, there are at least 30 million men in the US with but that study was done in the early 2000s and it's probably a lot more now compared to when that study was published. So now we have a definition of what ED is. Let's talk about how an erection happened. And first and foremost there are four type of erection. And did you know that there are four types of erection? The first one is by visual. That's when you are stimulated by visual stimuli, the senses, the smell, even taste. And it starts in the brain and then it increases blood flow, goes to the penis. Know that every time we talk about the brain, that the brain is the largest sexual organ of the body. Everything starts in the brain. If you don't pay attention to what's going on in the brain, nothing's going to work down below. That's the reason why it's up on top. The number 2 second type of erection is psychogenic erection and is triggered by thought and nerve in the brain that sends messages down to the penis. And then the third type of erection is called reflux erection where touch to the penis causes the reflux which actually does not involve a the brain. It just touched to the penis and then it sends messages to the nerve and the spinal cord in the pelvic area and it's just a loop and it just kind of bypasses the brain. And that's called reflux. And then the fourth one is called nocturnal or nighttime erection, which only occurred during rapid eye movement or REM sleep. So when you have REM sleep when you dream, and so if you don't dream as much or don't sleep as well, you're not gonna have nocturnal or morning erection. So that's why one of the reason why sleep is very important. And so let's get back to the orchestration how erection works. It's actually a very complex reaction in your body that involve multiple system in your body. And for an erection to happen, it involves the brain has to be in a good place. So the brain sends messages to the spinal cord, which are the nerve in the neck down to the sacrum area. So your nerve have to be working well. And. And then hormone hormones has to be released that the hormones are released in the pituitary gland in the brain. And then your neurotransmitters are these messages that the nerve releases. That has to work well. And then your arteries system, the arteries have to work well and the veins as well. And all of this has to be orchestrated and synchronized for an erection to happen. And if one of those system is not working well, then you will not have a full erection or an erection not maintained. And so that's one of the reason why ED is more common, because there's so many multiple step that is involved for an erection to happen. Starts from the brain go down to the penis. And the penis can actually get engorged to at least 10 times the blood flow than in a flaccid state. So, you know, that is something that I want to stress is that there's a lot going on, multiple steps. So when you involve multiple steps, there's more chances that something may not work well. And so let's start first how an erection happens that the brain gets stimulated, then it goes to the nerve down your spinal cord. And. And then the nerves send neurotransmitters to the blood vessels. The blood vessels dilate and open up and then it fills. The blood goes into the penis and enlarges the penis. So think of the tissue of the penis is the corpus cavernosum and the corpus spongiosum. And think of the penis like a sponge. And it gets filled up with water. So when it gets filled up with water or blood, it engorges. And then because the penis is wrapped around this fibrous sheet, when it's engorges that sheet actually compresses the veins that is on next to the sheet. And therefore, when the veins are compressed, the blood is kept in the penis and it doesn't drain out of the penis. And therefore you have an erection that is maintained. And the most often the problem with ed, it happens either in the arteries or the veins. And the vein leakage is the most common. And therefore, if the valves in the veins are not working well, you'll have leakage and therefore present more as an erection that is partial or an erection that is not maintained as well. So I also want to stress that ED doesn't mean that you cannot have an erection. You can still have an erection and still have ed. And so one of the questionnaire that I advocate that men take is called the International Erectile Dysfunction Questionnaire, or the SHIM Test, S H I M. And I'll put that link on the show. Note that if you take the test, it's only five questions and you answer it and your activity for the last four weeks, it will give you a score. And depending on your score, you will know how your sexual performance is or whether you may or may not have ED. Know that 67% of men do not know that they have ED, even though they show signs of ED. And so we talk about the anatomy of how an erection happen and know that it is such a complex process and the brain is the filter. You have to be in the mood for it as well. But one thing I want to stress is that 90% of ED is really more physical causes and that only 10% are more psychological, more in performance anxiety and trauma. So if you have ED, 90% of the time, it's probably going to be physical. We'll discuss that more in the later episodes on what caused ed. And we already talked about how ED can happen because of those involving the multiple systems that I talk about as well. And so to summarize that, you know, an erection, an erection is a complex mechanism that occur and that is working well. Great, Sam.
