The Price Paid for ED is Diminishing Dimensions: Use it or Lose it!

Andrew Siegel MD  8/22/2020

Our cells, tissues, and organs are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes.  Plasticity enables adaptive hypertrophy (growth) or disuse atrophy (shrinkage) depending on the exposure. The phenomenon of “disuse atrophy” can occur to any body part—including one’s genitals—when not used in the manner intended by nature.

sculpture emasculated Reykjavik

Photo above taken in Reykjavik, Iceland


Our composition is “fluid” as opposed to “static”; our tissues are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon and permits our tissues to maintain normal function when burdened with adverse “resistances.” Conversely, we can tap into this powerful resource by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.


Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and bio-mechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body– to maintain peak functioning they need to be put into the service for which they were designed.

Exercise is all about adaptation.  Our body will adapt—in neuromuscular, mechanical, and metabolic terms—to the specific demands that are placed upon it. This is why both endurance and resistance exercises get easier the more effort put into doing them. As the body is subjected to gradual and progressive “overloads,” the heart, lungs and muscles adapt and a “new normal” level of fitness is achieved.  


As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a plaster cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, known as “disuse atrophy.” Contrast this with the opposite scenario—exercising one’s arms by doing curls on a regular basis that results in  hypertrophy of the arm muscles.

When our bodies are sedentary—for example on the basis of a severe injury requiring bed rest—there is a rapid demineralization and thinning of our bones. Spinal cord injured patients who are paralyzed undergo such a rapid demineralization. Astronauts who spend time in zero gravity (which takes all bio-mechanical forces away from the bones) experience a remarkably fast demineralization and risk not only thin bones—as does anybody with rapid demineralization— but also of developing kidney stones from the calcium mobilized from the bones.

A nice review of bone health.


The penis is a marvel of design, under the right circumstances uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline in nanoseconds.  This is accomplished by relaxation of the smooth muscle within the arteries supplying the erectile chambers and that within the erectile sinuses of the erectile chambers. This sudden rush of blood is not the case in our non-genital organs, in which blood flow can be increased upon demand (e.g., our muscles when exercising), but nowhere to the extent that it happens in the penis.


Erections serve the obvious role of enabling penetrative sexual intercourse and reproduction, but also function to keep the penile tissues richly oxygenated, elastic and in good working order.  Non-sexually mediated REM (rapid eye movement) sleep nocturnal erections occur several times per sleep cycle among healthy men. The leading theory is that the express purpose of these nocturnal erections is to keep penile tissues oxygenated, robust, and functional.


In the absence of regular sexual activity (or erections), disuse atrophy– wasting away with a decline in both structure and function of penile smooth muscle and erectile tissues can occur. In a vicious cycle, the poor blood flow resulting from disuse produces a state of poor oxygen levels in the penile tissues that, in turn, can induce scarring, resulting in a loss of penile length and girth and negatively affecting one’s ability to achieve an erection.  Herein lies the importance of getting “back in the saddle” as soon as possible following surgery that can affect erectile function, such as radical prostatectomy.


Studies have demonstrated that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly have a two-fold higher incidence of ED as compared to men reporting intercourse once weekly.

Specific pelvic exercises–including resistance workouts–can enhance and optimize genital structure and function, the topic of a future blog.

Bottom Line: Our bodies are adaptation “machines”—our cells, tissues and organs endowed with a remarkable capacity for “plasticity,” the ability to be shaped and molded in an adaptive response to resistance. So, to perform at high levels of function—no matter what the activity is—stay active. Stay operational in order to continue being able to stay operational.  USE IT OR LOSE IT!  

Wishing you the best of health,

2014-04-23 20:16:29


Always bring homework!

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.  This blog is excerpted from the Sexual Function section of Prostate Cancer 20/20.

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health


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8 Responses to “The Price Paid for ED is Diminishing Dimensions: Use it or Lose it!”

  1. The Ryan (@RyanDanielst) Says:

    Is the loss of dimensions from non-use, permanent?

  2. Ryan Says:

    I read that study that some men go without sex (like a week or so) build up more testosterone than those who have sex every day. Any truth to it?

  3. Vanishing Penis Syndrome (VPS): What You Should Know | Our Greatest Wealth Is Health Says:

    […] In the absence of sexual activity, the erectile tissues can atrophy, resulting in a loss of penile length and girth and contributing to progression of erectile dysfunction.  Erections and sexual activity serve to keep the penile tissues (collagen, smooth muscle, elastin, etc.) richly oxygenated, supple, and healthy. Use it or lose it. […]

  4. Long Covid Short: Coronavirus-Induced Erectile Dysfunction | Our Greatest Wealth Is Health Says:

    […] the mechanism that ensures blood trapping in the erectile chambers. This situation is referred to as disuse atrophy. The long and short of it is that future erections demand current erections, since the surge of […]

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