An erection occurs
when the soft spongy tissue in the shaft of a man's penis
fills with blood, causing the penis to enlarge and stiffen.
Spongy spaces
(technically known as corpora cavernosa and corpora spongiosa)
along the length of the penis fill with blood in response
to physical stimulation, psychological stimulation, or both.
This process requires that the blood supply and the nerve
connections to the penis are working properly.
Dilation of the
arteries that feed blood to the penis results in engorgement
of the spongy tissue. Simultaneous contraction of the muscles
at the base of the penis prevents the blood from draining
out through the veins, thus maintaining the erection.
Nerves in the
spinal cord also control erection, which receive input from
physical contact to the penis and/or surrounding areas,
sexual thoughts, dreams, or images, and sex hormones.
Barring an erectile
disease, and provided there is sufficient blood flow and
nerve impulses, a man is capable of getting an erection
when sexually stimulated. It is important to know that erections
come and go. The ability of a man to get an erection is
an automatic, normal function similar to his ability to
breathe and blink his eyes.
A Normal Part
of Aging
An erection can take place in as little as several seconds
or it can occur gradually over a longer period of time.
In the later years of a man's life, beginning in the 50's
and increasingly in the 60's and 70's, it can sometimes
take longer to achieve an erection even with direct stimulation
and a man may notice that his erection is not as firm as
when he was a teenager. This is a normal part of aging,
but causes some men distress because they measure their
maleness or ability to please a partner by the firmness
and speed with which they become erect.
However, the
older man has some advantages over the younger one because
his ejaculatory control is usually greater, therefore he
can maintain an erection for a considerably longer period
of time without feeling the ejaculatory urgency common in
younger men. This advantage may be lost in men who have
prostate problems because they often experience leakage
of the blood supply required to maintain an erection, and
can have weaker ejaculations.
B>Penis Size
Not Related to Pleasure
Men of all ages occasionally have concerns about the size
of their erect penis and whether it is sexually adequate.
Although a common worry, the size of a man's erection is
not related to his ability to please a partner or enjoy
sex himself.
In fact, continually
thinking about penis size can interfere with achieving an
erection, and with the giving and receiving of pleasure.
There is rarely
a relationship between the size of a flaccid penis and its
size when erect. A small flaccid penis can show a remarkable
change as it erects and a large flaccid penis sometimes
changes very little in length or thickness, as it becomes
erect. An erect penis is typically between five and seven
inches long with a diameter between 1.25 and 1.5 inches.
Of course there are variations in this range, which allow
for some larger and some smaller penises.
It is not uncommon
for a man's penis to curve a bit when it is erect. The degree
of the curve varies from man to man, but it generally causes
no discomfort or interference with sexual activity.
Peyronie's Disease
A very pronounced curve occurs in a condition called Peyronie's
disease. Although it is not certain, it is thought to be
caused by the development of hard, fibrous, inflamed tissue
in the shaft of the penis, and usually starts as pain during
erection, caused by stretching of inflamed penile tissue.
As the disease
progresses, the pain subsides, and then fibrous tissue develops,
causing the penis to curve to the left, right, or upward.
The majority of cases of Peyronie's disease require medical
attention and are generally curable.
Another erectile
disorder, priapism, is the continual and pathological erection
of the penis. It is usually caused by nonsexual factors
such as spinal cord disease, leukemia or sickle cell disease,
and, according to some reports, with the use of cocaine.
Sometimes it happens for no known reason.
In cases of priapism,
the increased blood flow that causes an erection is unable
to drain from the penis in the usual way because the release
mechanism has been broken down by the disease or affected
by drugs or other unknown factors. It is extremely painful
and may require surgery if the problem does not respond
to medical treatment. Certain non-medical circumstances,
such as painful stimulation of the penis, or disturbed emotional
states such as fear, anger, guilt, anxiety, or shame can
cause a man to lose his erection or prevent him from getting
an erection in the first place. Emotional difficulties and
the anticipation and worry about possibly losing an erection
are common causes of a man's erectile difficulties.
Hope for Erectile
Problems
If a man repeatedly experiences difficulty achieving or
maintaining erections, he should not despair. In the last
ten years much has been learned about treating erectile
problems. The first step is to contact a competent urologist
who can perform the necessary diagnostic tests to determine
if medical factors are contributing to the problem.
In addition to
a thorough urological evaluation, the man and his partner
should consult a psychotherapist who specializes in sexual
therapy.
Regardless
of the origins of the erectile problem (medical, psychological,
or in some cases both), as with any change in normal functioning,
there can be an emotional impact on the man and his partner.
Through counseling, the unspoken fears and misunderstandings
of both partners can be explored, resulting in improved
self-esteem and better communication.