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How Do Erections Work? A Comprehensive Guide

11 min read
How Do Erections Work? A Comprehensive Guide

Sexual intercourse may be a crucial part of relationships and an act that is paramount to human reproduction. Erections play a key role in a man’s ability to participate in sex. In order to become erect, the penis transcends beyond its resting flaccid state. Once erect, an individual’s penis needs to maintain rigidity for a suitable timeframe allowing them to have satisfactory sex.

When individuals are unable to do this, it’s possible that they’ve developed a condition known as erectile dysfunction (ED). ED is thought to affect roughly 30 million men in the US alone. When erectile dysfunction is present, it may be possible that the quality of life for both partners in a relationship suffers due to the erectile issues.

Despite the importance of healthy erections, not everyone is lucky enough to have satisfactory erectile function. This article explores the physiology of erections, investigates what individuals can do to improve their erectile function, and addresses some frequently asked questions surrounding erections.


  • Increased blood flow to the penis allows it to transform from a flaccid to an erect state.
  • Erections play a key role in the reproduction process.
  • Erections may occur in five stages, ranging from latency to detumescence.
  • Both physical factors (e.g. obesity, injury) and psychological factors (e.g. stress, depression) may affect erectile function.
  • For those with limited erectile function, making lifestyle changes or seeking guidance from a medical professional may lead to positive outcomes.

What makes a penis erect?

According to research, sexual stimulation leads to the release of neurotransmitters within the cavernous nerve terminals. This leads to smooth muscles becoming relaxed and a number of occurrences:

  1. Dilated arterioles and arteries through increased blood flow in diastolic and systolic phases.

  2. Incoming blood gets trapped by expanded sinusoids.

  3. Compression of subtonic venular plexuses reduces venous outflow.

  4. The tunica gets stretched to maximum capacity, further decreasing venous outflow.

  5. An increase in the partial pressure of oxygen as well as intracavernous pressure leads to the penis reaching the fully-erect stage.

  6. Additional pressure increase due to the contraction of ischiocavernosus muscles leads to the rigid-erection stage.

  7. What is the purpose of an erection?

    Erections play a crucial role within the male reproductive system, allowing the penis to increase in size and firmness as a result of increased blood flow. As sexual stimulation takes place, blood flow to the genitals continues and the testes enlarge, getting them ready for ejaculation (the expulsion of semen from the tip of the penis).

    The stages of getting erect

    The states of the penis may be considered binary by many; a penis is typically either flaccid or erect. While this may describe the penis at resting and fully aroused states, it fails to account for the stages in between.

    Based on our research, it’s generally agreed that the development of an erection is a multi-stage process. Research claims it can be divided into five stages, which we’ve highlighted in the table below. While other research suggests that erections take place in six stages, which includes one additional step - an initial resting stage. 
    Diagram of the Stages of Getting Erect

    Stage 1: Latent Latency describes the state of existing but not yet being developed.
    Stage 2Tumescence Tumescence involves becoming swollen by sexual excitement.
    Stage 3: Erection (complete) When the veno-occlusive mechanism starts to work, complete erection takes place.
    Stage 4Rigid Erection Repeated penile stimulation leads to a strong contraction, forcing blood into all chambers and resulting in rigidity.
    Stage 5 Detumescence Detumescence refers to when the swelling subsides and often occurs after ejaculation has taken place.


    NOTE: Table descriptions are based on our interpretations using dictionary definitions/notes from other research.

    What factors impact the quantity and quality of erections?

    A number of factors may have an impact on a person's erectile function. However, such factors can typically be categorized into two different kinds; psychological and physical.

    Psychological factors

    Psychological factors refer to characteristics that affect us emotionally. These may affect a person’s thoughts, feelings, and mental health. Some of the psychological factors which may have an effect on a person's erectile function are highlighted in the table below.


    Stress is a state of worry caused by various situations (stressors). Examples of stressors may be work, relationships or financial difficulties.

    Chronic stress is thought to have a negative impact on sexual function for men and women. Exposure to chronic stressors may result in anxiety or depression.

    Relationship issues

    Relationship difficulties may lead to a damaged sex life. A person’s sex life may be affected for a number of reasons.

    Some of which may include a loss of attraction or negative feelings held between partners. Some research suggests that sexual problems may also lead to relationship unhappiness.


    Depression is a mental health condition which affects a person’s mood and motivation.

    While a firm association is established between depression and ED, some research suggests it may be difficult to say whether depression is a cause or effect of ED.

    Performance anxiety

    If an individual becomes nervous and fixated on performing well during intercourse, they may be unable to achieve or maintain an erection.

    A research paper claims 9-25% of men are affected by sexual performance anxiety, which may contribute to psychogenic erectile dysfunction.

    Post Traumatic Stress Disorder

    Post traumatic stress disorder (PTSD) refers to a mental health condition which is often triggered by a traumatic event. PTSD is often associated with flashbacks and nightmares.

    Some research has found that participants who suffered from PTSD were at a higher risk of developing ED.

    Bipolar Disorder

    Bipolar disorder (BD) is a mental health condition in which an individual can experience severe mood swings.

    Research into newly diagnosed BD and risk of erectile dysfunction concluded that there was a temporal association between bipolar disorder and erectile dysfunction.


    Schizophrenia is a type of psychosis whereby individuals struggle to differentiate between their subjective experience and reality.

    Some research found that patients with a diagnosis of schizophrenia reported a high frequency of sexual dysfunction, including difficulties with erections and orgasms.

    Physical factors

    To state the obvious, physical factors refer to things that affect a person’s physical state. Such characteristics might include illnesses, medical procedures, and injuries. A number of physical factors that may have an impact on a person’s erectile capabilities are explained in the following table.

    Heart conditions

    Heart conditions or cardiovascular disease may be linked with damaged erectile function.

    In fact, some research suggests that erectile dysfunction may even be a critical warning sign for existing or impending cardiovascular disease.

    Hormonal problems

    Hormonal issues may have a range of undesired effects and It’s possible that they may be linked to erectile difficulties.

    Research acknowledges evidence which suggests that between 10-20% of men with ED may have hormonal abnormalities.


    Diabetes is a condition which causes an individual's blood sugar levels to become excessive. A complication of diabetes can be sexual dysfunction with a specific dysfunction being erection difficulties.

    Research suggests that erectile dysfunction can be present among anywhere between 35-75% of diabetic men.


    Obesity is linked to a number of health complications, with damaged erectile function being one of them.

    Research has found that incidences of ED are significantly higher in overweight and obese men compared to those in a regular weight range.


    It’s possible the medication you take may have an affect on your erectile function. Research suggests that drugs such as antidepressants may lead to erectile dysfunction.

    This may create a chicken and egg scenario, with antidepressants used to treat mental health conditions which may also be linked to ED.

    Medical procedures

    It’s possible that surgical procedures such as radical prostatectomy (RP), a procedure used to treat prostate cancer, may result in damaged erectile function.

    Many RP patients may experience ED for as long as two years following the procedure.

    Physical injury

    With the male pelvic region being a sensitive area, physical injury may result in erectile difficulties.

    A systematic literature review concluded that individual’s suffering from pelvic ring fractures (PRF) were at an increased risk of developing erectile dysfunction.

    What can you do to get better and more erections?

    People may use a number of techniques in an attempt to increase the quality and quantity of their erections. We’ve explored some of the existing research and highlighted a few methods that may help to improve an individual’s erections below.

    1. Try Kegels

    Existing research suggests that strengthening the pelvic floor muscles may effectively treat erectile dysfunction and premature ejaculation. While there may not be a widely accepted optimal pelvic floor muscle training regime for erectile health, Kegels are considered a popular option.  

    Kegel exercises were first defined by Dr. Arnold Kegel, as a technique for strengthening the pelvic floor muscles and possibly preventing difficulties such as urinary stress incontinence. The exercises involve switching between contracted and relaxed muscle states within the pelvic floor muscle group.

    2. Practice regular exercise

    Given that physical health conditions such as obesity and heart disease may cause erectile issues, it might not be a surprise that exercise could have an effect on erectile function. If you don’t get regular exercise, becoming more active may improve the quality of your erections.

    Research suggests that getting regular physical exercise may improve erectile function, with metabolism, arterial pressure, and hormones playing a role.

    Research suggests that getting regular physical exercise may improve erectile function, with metabolism, arterial pressure, and hormones playing a role. One study concluded that weekly exercise of 160 minutes for 6 months contributed to a decrease in erectile problems among men with ED caused by lack of activity and obesity among other factors.

    3. Improve your eating habits

    A person’s diet is another area that may have an impact on their health. Food intake may be considered a protective factor for conditions that may affect erections, such as obesity. 

    Making an effort to eat a ‘healthier’ diet may help to improve a person’s erectile function.

    The Mediterranean diet contains food such as fruit, vegetables, nuts, and fish with research acknowledging that the diet may serve as a dietary approach to prevent ED and preserve sexual function. Other research suggests that individuals who consume plant-based diets may be less likely to experience ED.

    4. Quit smoking

    Smoking is generally regarded as a ‘bad’ habit and is one that may lead to a number of undesirable effects including cardiovascular and neurological disease. A perhaps lesser known negative effect of smoking is potential damage to an individuals quality of erections.

    There are links between smoking and the development of erectile dysfunction. In fact, research suggests that current smokers may be at risk of a 51% increased chance of developing ED, while ex-smokers could face a 20% increased likelihood compared to people who have never smoked.

    5. Reduce your alcohol consumption

    Alcohol is often enjoyed socially or when winding down from a busy week at work. However, when alcohol use becomes excessive it may be dangerous. Alcohol-abuse is linked to the development of health conditions including liver failure, dementia and types of cancer. Too much alcohol may even damage a person’s erections.

    Alcohol-abuse is linked to the development of health conditions including liver failure, dementia and types of cancer. 

    A review of 216 studies (and 216,461 participants) acknowledges what they referred to as a “J-shaped” relationship between alcohol consumption and the risk of erectile dysfunction. It noted that moderate amounts of alcohol may lead to relaxation and disinhibition, but chronic use may result in vascular damage.

    6. Reduce your stress levels

    An individual’s stress levels may be affected by a number of factors including their relationships, financial concerns and workplace stressors. Stress can create an imbalance in neural circuitry, affecting a person’s cognitive ability, anxiety and even decision making.

    The impact of stress can affect a number of areas of an individual's life, with the possibility that stress may affect people sexually.

    Research notes that psychological stressors may affect an individual's sexual function, with chronic stress seemingly leading to negative effects on sexual function for men and women.

    7. Improve your sleep

    Not getting enough sleep may lead to a number of undesirable issues including obesity, diabetes, depression and anxiety. The recommended amount of sleep for a healthy adult is over 7 hours. 

    If you aren’t getting enough sleep regularly then you may also be at risk of sexual issues.

    Research suggests that insufficient sleep may affect sexual function, with ED patients potentially having sleep disorders that contribute to the sexual dysfunction. Other research states that while short sleep duration’s causal link to ED is not validated, short sleep may be an independent risk factor for ED for select subgroups.

    8. Check your testosterone levels

    Testosterone is the primary hormone in men responsible for sexual development and fertility. However, the amount of testosterone that men have varies on a case by case basis. If your testosterone levels drop below a healthy amount, it’s possible that you have what’s known as a testosterone deficiency. 

    Testosterone is the primary hormone in men responsible for sexual development and fertility.

    Some studies have highlighted a link between testosterone deficiencies and erectile dysfunction. Suggesting that testosterone therapy may be a valuable option. If you believe that you are suffering from a testosterone deficiency it’s worth getting your testosterone levels checked by a medical professional and treatment if necessary.

    9. Get professional help

    While it may be tempting to take matters into your own hands, erectile issues can have a significant impact on an individual's day-to-day life. It’s thought that erectile issues such as ED can lead to a range of serious issues including withdrawn sexual intimacy, psychological difficulties, and a reduced quality of life for both partners.

    While it may be tempting to take matters into your own hands, erectile issues can have a significant impact on an individual's day-to-day life.

    Research examining data from a survey on male health issues found that most of the men with erectile dysfunction hadn’t sought treatment. With some men believing the issue would resolve itself and others believing that it’s a natural part of aging. Despite it being a sensitive area, individual’s should feel comfortable consulting a doctor and getting professional medical help to treat their erectile issues.


    What if I can’t get or keep an erection?

    If you struggle to become erect or maintain an erection it may be a sign of erectile dysfunction. By definition, ED is a sexual dysfunction which inhibits individuals from achieving or maintaining a rigid erection suitable for satisfactory sex. If you believe you are suffering from ED or any other sexual dysfunction seek professional medical help.

    How often do men get erections?

    Men may experience several times a day but the frequency of daytime erections may vary. For example, an individual frequently exposed to sexual stimuli may experience erections more frequently than someone who is not. A good measure is Nocturnal Penile Tumescence Testing (NPT), which measures an individual's erections while they sleep. It’s said that a normal male has anywhere between 3 and 6 erections at night.

    What can I do to get more erections?

    It depends on individual circumstances, individuals with sexual dysfunctions such as ED may be able to increase their erections with a number of techniques. Based on the research in this article, strengthening pelvic floor muscles, living a healthier lifestyle, reducing stress, and getting professional help may have a positive impact on a person’s erectile function.

    Is there a way to make an erection go away?

    Erections may go away during the post-ejaculation refractory period. This occurs after a person has ejaculated and during this time they may be unable to remain aroused and notice they lose their erection. However, if you aren’t engaged in sexual activities and wish to lose an erection try to think of non-sexual thoughts. If you are concerned by your inability to lose an erection you should consult a medical professional for advice.

    What can I do if an erection hurts?

    Although erections are typically associated with pleasure more than pain, if you are experiencing any form of penile pain you should consult a doctor immediately.


    Based on the research in this article, it seems that healthy erections may play a vital role in relationships and the sex lives of both partners. The formation erections take place as part of a multi-stage process. Although erections are something that many men may take for granted, they are a crucial part of human reproduction. Conditions such as erectile dysfunction may prove a real barrier to healthy erectile function and to a person’s quality of life.

    Based on the research in this article, it seems that healthy erections may play a vital role in relationships and the sex lives of both partners. 

    There are a number of techniques that individuals may utilize to try and improve their erectile function. These may include living a healthier lifestyle and reducing bad habits. While such techniques may prove effective, if you are experiencing erectile difficulties you should always consult a doctor for guidance. While the information in this article is intended to be informative, it cannot be considered a substitute for professional medical advice.

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