Erections: Understanding and Managing Common Disorders

Erection is a complex physiological process that must occur before sexual intercourse, in order to allow for the successful penetration of the male’s penis into the female’s vagina. Erections are also necessary for certain types of intimate touching, such as genital stimulation. Despite how common they are, erections can be affected by numerous disorders, allowing for difficulty with achieving and maintaining them. Understanding and being aware of these disorders is vital in order to manage them and ensure an enjoyable and satisfactory sexual experience.

Understanding Erections

Usually occurring during sleep or upon waking, erections are caused by the increased blood flow into the penis, stemming from nerve stimulation and the relaxation of certain muscles. This process also requires the presence of certain hormones, such as testosterone and norepinephrine, and is usually activated by sexual arousal or stimulation.

During an erection, the spongy chambers located in the penis called the corpora cavernosum and corpus spongiosum will fill with more blood than usual. This causes the penis to grow in size, become firm, and become erect in order to allow for sexual intercourse.

The muscles surrounding the penis, which are now relaxed, in addition to bedroom etiquette (e.g. moving slowly and listening to your partner’s responses) also play an important role in preventing the erection from dissipating. Ensuing actions such as increasing or continuing stimulation, as well as providing physical comfort, also allows men to maintain their erection.

Common Disorders Related to Erections

When encountering difficulties with achieving an erection or having difficulty in maintaining it during sexual activity, it is important to understand the underlying factors that may be causing it. Notable reasons may include physical and/or psychological stress and anxiety associated with sexual performance or intimacy.

More serious disorders of erections include:

• Erectile Dysfunction (ED): The inability to gain and maintain an erection long enough to successfully complete sexual intercourse. It is the most common male sexual disorder and is caused by a variety of physical and psychological factors, including stress and anxiety, a decrease in the level of hormones, and lifestyle diseases such as obesity, cardiovascular disease or diabetes.

• Premature Ejaculation (PE): A form of sexual dysfunction in men where he ejaculates too quickly during sex, thus not providing adequate pleasure for his partner. This is caused by excessive stimulation or anxiety, and can also be due to a decrease of hormones such as testosterone.

• Retrograde Ejaculation (RE): Another form of sexual dysfunction in men where the semen enters the bladder instead of exiting via the urethra. This is due to a number of medical conditions, such as diabetes, as well as certain surgeries that may affect the bladder, and certain medications.

• Priapism: An excessive and painful erection that lasts for more than four hours. It is usually caused by an underlying medical condition, such as a blood disorder, and can potentially lead to impotence if not treated immediately.

Managing the Disorders

It is important to identify potential underlying causes associated with erectile dysfunction, premature ejaculation, retrograde ejaculation, and priapism. For instance, if there are life changes such as quitting smoking or losing weight, or a change in medication or lifestyle, these are factors that should be addressed to help manage the disorder.

In order to prevent the discomfort associated with ED, it is important to relax and take the time to engage in foreplay and other intimate activities, such as cuddling and kissing. Other options to promote erections include medications and physical stimulation, such as using vacuum devices or injections into the penis.

PE can also be managed with the use of medications, as well as relaxation techniques, to help reduce performance anxiety. In some cases, counseling may be beneficial to help the individual understand and gain insight into the disorder.

RE is usually managed with the use of bladder catheterization and other treatments, depending on the underlying cause.

The treatment of priapism is urgent and should be attended to immediately. The most common treatment is to inject a medicine called alprostadil directly into the penis, to reduce the blood flow and urge an erection to dissipate.


While erections are an essential part of sexual activity, a variety of disorders can affect a man’s ability to achieve and maintain an erection. Understanding how these disorders can be caused and managed is key to maintaining an enjoyable sex life. If erectile dysfunction, premature ejaculation, retrograde ejaculation, or priapism become problematic, it is important to seek medical advice or therapy in order to help overcome the condition. By being aware of these disorders, couples can have a more knowledgeable approach to managing and preventing them, in order to enjoy a