Erectile Rigidity: “A Perfect Storm”


Andrew Siegel MD   12/13/14

**Note: Although the following blog is written primarily for men, it is equally relevant to females. Since the penis and clitoris are homologous organs, whenever you see “penis” you can substitute “clitoris.”

Last week’s blog reviewed how the penis is one of the most “magical” of organs—how it is uniquely capable of transforming its shape, size and constitution in a matter of nanoseconds. The take home message was that the remarkable upsurge is possible because inflow of blood to the penis is maximized while outflow is minimized, resulting in penile blood pressures that far exceed arterial blood pressure.

Rigid erections can only occur when there is a “perfect storm” of events. First, the arterial blood flow to the penis needs to increase substantially (pre-penile event). Second, smooth muscle within the arteries and the spongy sinuses of the erectile chambers of the penis must relax to allow engorgement with blood (penile event). Third, the pelvic floor muscles must engage to turn the swollen penis into a rigid penis (post-penile event). The blood pressure in the penis resulting from the inflow of blood alone–in the absence of the contribution from the pelvic floor muscles–cannot exceed systolic blood pressure, so the pelvic floor muscles play a vital role with respect to penile rigidity and durability of erections.

So, when erections go south, it comes down to failure in one or more of the three events,  pre-penile, penile, or post-penile.


Pre-penile ED

The problem lies within the arterial blood supply to the pelvis, which is not capable of delivering enough blood flow to fill the penis. Typically, the pelvic arteries are clogged with fatty plaque (atherosclerosis), which is often due to an unhealthy lifestyle: poor diet, physical inactivity, being overweight and use of tobacco. Diabetes is a very common cause of impaired blood flow (although it also affects the nerve supply in an adverse way). Insufficient blood flow may also occur because of the blood pressure lowering effect of blood pressure medications.

Solution to Pre-penile ED: Lifestyle “angioplasty”— getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve all aspects of health in general and blood vessel health in particular.


Penile ED

The problem lies within the penis itself. Because of poorly functioning smooth muscle within the arteries and spongy sinuses of the erectile chambers, the penis cannot properly swell up with blood. This smooth muscle cannot relax enough to allow blood flow to inflate the penis and pinch off the venous drainage. This failure of relaxation of the smooth muscle in the penile arteries and spongy sinuses parallels the failure of relaxation of smooth muscle in our arteries that causes high blood pressure (“essential” hypertension). Loss of this smooth muscle and scarring can also happen with aging, following prostate cancer surgery, from Peyronie’s disease or because of disuse atrophy.

Solution to Penile ED: Age-related malfunctioning smooth muscle and scarring is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards erectile function—exercising the penis via regular sexual activity will actually help its continued functioning and health of the smooth muscle of the penile arteries and spongy sinuses.


Post-Penile ED

 The problem is weakened pelvic floor muscles. These feeble muscles are incapable of compressing the roots of the penis sufficiently to increase the blood pressure in the penis to the levels needed for full erectile rigidity.

Solution to Post-Penile ED: Pelvic floor muscle training to improve the strength, tone and endurance of the pelvic floor muscles will optimize erectile rigidity and durability.


Wishing you the best of health,

2014-04-23 20:16:29


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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Co-creator of Private Gym pelvic floor muscle training program for men  

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