All About Erections

We've had several blogs about female sexual health issues, so here's a blog dedicated to the dudes.

One of the most common male sexual health concerns I get from adolescent and young adult male patients is about erections. In early puberty, it is common for young males to have spontaneous erections and nocturnal emissions ("wet dream"). My young teen patients often ask about this. It's totally normal and healthy. In order to have an erection, your brain/hormones, circulatory system (veins, arteries, etc.), and parasympathetic nervous system have to work together. As the teens get older, the concerns turn away from the embarrassment of the quantity of spontaneous erections and more towards the quality of erections.

When you think of erectile dysfunction, I bet you envision an old guy in the Cialis or Viagra commercials. You may not realize that erectile dysfunction and other types of sexual dysfunction can happen in the young as well as the old. As stated by University of Wisconsin's own urology team, mild and moderate erectile dysfunction affects approximately 10% of men per decade of life (i.e.,10% of males in their teens, 20% of men in their twenties, etc.).

Some common causes of erectile dysfunction in teens and young adults:

1. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), have been associated with sexual side effects. Other medications that can contribute to sexual dysfunction include blood pressure medications, allergy medications, muscle relaxants, and chemotherapy agents.

2. Psychological concerns. The feelings of sexual excitement that lead to an erection start in the brain. Conditions such as depression, anxiety, or even stress can interfere with that process. Performance anxiety, where one partner is nervous about not living up to the expectations of the other partner, can definitely lead to erection problems. Guilt due to feelings that masturbation or sexual activity is wrong/dirty, will also negatively impact erections.

3. Physical causes. Erections can't happen without proper blood flow. Anything that causes circulation problems (clogging the arteries, high blood pressure) can lead to impotence.

4. Other medical causes. Thyroid issues and other endocrine/hormone problems, and medical conditions involving the penis (like Peyronie's Disease, where fibrous tissue causes a curve to the penis) can all lead to erection problems.

5. Other drug use, including anabolic steroid use, alcohol, heroin, and other substances can also lead to sexual dysfunction.

What happens if the exact opposite happens — an erection that doesn't go away? Priapism is a prolonged, painful erection. It can be associated with drug use, trauma, or medical conditions like sickle cell anemia.  It is a medical emergency!  Like the commercials say, any erection lasting more than 4 hours needs to be seen by a health care provider immediately. There could be permanent penis problems if not addressed.

While medications are often prescribed to older gentlemen with erectile dysfunction, these are less commonly prescribed to young males since substance use and psychological causes are the most common reasons for erectile dysfunction (however there is definitely a role for medications in certain circumstances). These meds are often obtained illegally. Do not take these medications without the advice of a health care provider — they can have some serious side effects! Recreational use of erectile dysfunction medication can also lead to poorer sexual health outcomes. A healthy lifestyle, including healthy diet, exercise, avoiding drugs, getting enough sleep, and managing stress or other mental health concerns is the best way to maintain sexual health. If you are able to get an erection with masturbation, but you have difficulty maintaining an erection with a partner, your problems are more likely to be psychological in nature. Talk with your partner about it — this will probably make you more at ease the next time you are sexually active. If you are not comfortable having this conversation with your partner, this may mean that you aren't quite ready to be intimate.

If you have any questions about erections or any other part of sexual health, make sure to ask your health care provider.  Remember to use condoms every time you have sex!