Sexual health

How an erection works

An erection is a blood-flow event. At rest, the smooth muscle inside the penis stays tight and only a trickle of blood gets in. When you’re aroused, nerves release nitric oxide, that muscle relaxes, the arteries widen, and spongy chambers fill with blood. As they swell, they press on the veins, so the blood stays in.

That’s why it’s a relaxation response. You can’t force it, and anything that tightens that muscle works against it.

Stress, anxiety and the loop

Almost every man has a night when his body doesn’t cooperate. Stress, tiredness and alcohol are the usual reasons, and once in a while is nothing to worry about.

Here’s the catch. Noradrenaline, one of the body’s stress chemicals, tightens that same smooth muscle and the penis’s blood vessels. In one study, men whose erection trouble came from the mind had higher noradrenaline in penile blood. So worry about performing can create the very problem you’re worried about.

This kind of performance anxiety is common: one review puts it at roughly 9 to 25 in 100 men. It can also keep finishing too fast going.

• Slow down. Take the finish line off the table for a while.
• Breathe, and bring your attention back to touch and what you feel, not how you’re doing.

How porn can shape arousal

The brain is built to respond strongly to something new, and to respond less to the same thing over and over. That’s normal. Porn offers an endless supply of new. A real partner can’t compete with an endless feed, and shouldn’t have to.

Getting used to it, sometimes called desensitization, is real, but it shows up mostly with compulsive use. In one brain-imaging study, men whose use had become compulsive got used to the same sexual images faster and were pulled harder toward new ones.

In one large survey of young men, most of those who had erection trouble with a partner had none with porn. That points to arousal patterns, not broken plumbing.

• Notice privately: is real-life sex starting to feel less exciting than the screen?
• Try a break and see what changes.

The research shows links, not proof that porn causes erection problems.

When to get checked

It’s common. In a large study of men aged 40 to 70, about half had some degree of erection trouble. It’s also very treatable: today’s medicines work for most men.

See a doctor if

• Erection trouble keeps happening, not just once in a while.
• You finish much sooner or later than you want, and it bothers you.
• You have diabetes, heart disease, high blood pressure or high cholesterol.

Ongoing erection problems can be an early warning sign of heart or blood-vessel disease, often showing up before any heart symptoms do. So the visit is worth it, even if it feels awkward. Your regular doctor is a good place to start.

See a therapist if

Stress, anxiety, low mood or relationship strain is part of it, or porn feels hard to control. A therapist or sex therapist can help.

Connection over performance

Arousal starts with touch and with what’s on your mind. Pressure to perform feeds the stress side, which tightens the very muscle that has to relax.

So the body works best when your attention is on the person in front of you and what you feel, not on a scoreboard. Good sex isn’t a test you pass.