The Science Behind Erectile Dysfunction — How Does An Erection Happen?

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@sexualhealthformenpodcast.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 episodes and we're going to start talking about the basics first, the foundation, the anatomy and physiology of sexuality and particularly how an erection happened. And what goes on in the body when this happens 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 ED. But that study was done in the early 2000s and it 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 types of erection. 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. Go 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 gonna work down below. And that's the reason why it's up on top. The number 2 second type of erection is psychogenic erection. And it's 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 the brain, it just touches to the penis and then it sends messages to the nerve in 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 occur 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 going to 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 of how erection work. It's actually a very complex reaction in your body that involves most 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, it's in the neck down to the sacrum area. So your nerve have to be working well. 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 in the veins as well. And all of this has to be orchestrated and synchronized for an erection to happen. And if one of those systems 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 steps 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 flaccidity state. So 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 then the nerve sends 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. When they get filled up with water or blood and it engorges. And then because the penis is wrapped around this fibrous sheath, when it's Engorges, that sheath actually compresses the veins that is next to the sheath. 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 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 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. 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 to 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 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 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 talk about how ED can happen because of those involving the multiple system that I talk about as well. So to summarize that, you know, interaction is a complex mechanism that occur and that if they're working well. Great. Thanks for listening. Be sure to go to my website@sexualhealthformenpodcast.com for more resources. And remember to join my men's club at Menone Club, a place where I help a community of men regain their sexual confidence. And if you like the show, I would appreciate it. If you subscribe, leave a review on Apple Podcasts or wherever you listen and know that you have sexual vitality for life. Until next time, this is Dr. Anne signing off.