How Hard Can It Be? Understanding Erectile Dysfunction

As part of my series on the Aging Male, Love and Medicine will tackle erectile dysfunction (ED) – failure of the penis to remain erect in order to reach sexual satisfaction. Most men have experienced this at one time in their lives.  Men are embarrassed, anxious and depressed when their penis isn’t working.  They report frustration because they can’t please their partner. For men in healthy relationships, their partner’s needs matter a lot.

I interned in a sleep lab in graduate school. Sleep studies were used to differentiate psychogenic ED from physiological ED. A normal man spends about two hours in a tumescent state while asleep, having three to four erections a night. A man with psychogenic ED would probably be not far from the norm; a man with physiological ED would remain soft. Diabetic men spent nights in the sleep lab while erections were recorded and it was there that the first correlation between ED and diabetes was discovered.

First, important facts:

  • Having erectile dysfunction does not mean that you’re not attracted to your partner.
  • While erectile dysfunction is more common in men over 50, it can happen at any age.
  • The presence of erectile dysfunction does that mean you can’t have an orgasm
  • The little blue pill does not work for all types of ED. 
  • There is no bone in the penis.
  • You should see a doctor to evaluate and treat ED.

What causes an erection? 

It’s actually fascinating how it all works. The process begins in the brain. Arousal causes nerves to send messages (via neurotransmitters) to the arteries which result increased blood flow to the penis. The arteries fill up and expand the erectile tissue.
Because blood must remain inside the penis to stay hard, erectile tissue is wrapped in sheathes that cinch up to prevent blood from leaving the penis during erection. When stimulation ends, or following ejaculation, pressure in the penis decreases, blood is released, and the penis returns to its normal shape.

What causes erectile failure?

Now that we know it involves blood flow, neurotransmitters and nerves, anything that damages those systems can cause problems. Common causes are:

  • Heart disease (#1)
  • Hypertension
  • Diabetes
  • Metabolic syndrome (hypertension, high blood sugar, waistline obesity and high cholesterol)
  • Medications – particularly medications for depression and high blood pressure
  • Parkinson’s disease and Multiple Sclerosis
  • Hormone problems
  • Prostate and bladder surgery
  • Psychiatric disorders such as stress, anxiety and depression
  • Relationship conflict or insecurity

ED can be the FIRST indication of a serious medical condition! Thank your penis for bravely showing you something that you need to know.

ED is treatable, the earlier the better. Resist the temptation to buy those supplements sold at the gas station or online. See a medical professional. You are not alone.  Treat the cause first, not the symptom!

You have heard me say this many times: what is good for the heart, is good for the brain. The same adage works here:

what is good for the heart
is good for the brain
is good for the penis.

Wake up every morning, hopefully with morning wood, and think bloodflow. How can I get the blood flowing to the places I need it most?  Then get moving!


  1. Penelope Smith on June 26, 2019 at 8:46 pm

    It is interesting to know that heart disease can lead to erectile failer. That is good to know that there can be an underlining cause. It seems like it might be smart to talk to a doctor about treatment options and testing for an underlining problem.

    • Anne Koplin on July 11, 2019 at 2:20 am

      Yes. Erectile dysfunction may be the first sign of early heart disease. A medical workup is indicated for anyone suffering from ED. Unlike high blood pressure which is notoriously silent, the penis is telling you something loud and clear!

  2. tim adam on August 29, 2019 at 10:26 am

    Great Post , this article help me lot ,thanks for posting !!

    • Anne koplin on August 29, 2019 at 3:34 pm

      Appreciate your comment and your readership! If there’s anything on your mind you’d like to see on loveandmedicine, let me know 😌

    • Anne Koplin on October 29, 2019 at 6:30 pm

      I’m so glad. Remember Ask Dr. Annie K is open for questions 24/7.

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  4. Stefan Bradley on September 13, 2019 at 2:59 pm

    I appreciate that you mentioned how erectile dysfunction can happen to people of any age. I will be turning 35 this year and have started to notice that maintaining an erection for a long period of time has become difficult, I was worried that there might be something wrong with me since I am not too old. It may be best for me to speak to a professional to find out what can be done about erectile dysfunction at my age.

  5. Ethan on October 11, 2019 at 10:47 am

    great post its really informative soo helpful for me

    • Anne Koplin on October 29, 2019 at 6:27 pm

      I’m glad this was helpful. Such an important issue that effects your self esteem, mood, everything. I’m here to bring these subjects to the forefront so people can get help and know they are not alone. Thanks for being an Love and medicine reader. Ask Dr. Annie K is open 24/7!

  6. Darrien Hansen on October 21, 2019 at 3:46 pm

    I had no idea that erectile dysfunction is common in men over the age of 50, but can also happen at any time in one’s life. I am 36 and have started to notice that I have been having difficulties with my sexual performance as I have continued to age. Perhaps it would be best for me to find a professional that can help me identify the root of my erectile dysfunction.

    • Anne Koplin on October 25, 2019 at 3:28 pm

      Dear Reader,
      Yes, ED can happen at any age absolutely. I would suggest you start with your primary care physician. S/he can perform the initial evaluation of the source of the ED. Do not despair! There are treatments for this.