What is erectile dysfunction(ED)?

It is inability to either achieve or maintain a sustained erection sufficient enough for a penetrative intercourse.

How does normal erection occur?

Erection is a very dynamic and multistep process. The sexual desire is caused by normal level of testosterone and prolactin hormones in blood. Low level of testosterone and high level of prolactin can decrease sexual desire.

When one gets sexually excited by stimuli which can be visual, touch, sound some biochemical changes happen in brain which indicate to the brain that the individual is sexually excited. If the brain is disturbed because of any reason, it rejects the stimulus and erection will not be achieved. This can happen if the individual is under stress, depressed, anxious due to prior failures to achieve erection or if individual is mourning.

If the state of mind is sound, then it assesses the situation, if the situation is conducive for sex then the brain send signal to backbone through a network of nerves that can be considered akin to electrical wires. From the back, the signal is taken to penis through cavernosal nerves. If there is a back problem like slipped disc, these nerves may get compressed and may affect erection. Once the signal reaches the penis, the amino acid Argenine (this can be considered analogous to coal) is burned to produce chemical called nitric oxide (think of this as fire that is being produced by burning coal). Once the concentration of nitric oxide increases in penis it causes some changes in blood flow to penis.

There are 2 types of tubes in penis carrying blood in and out of penis. Under influence of nitric oxide, the tubes carrying blood into penis open up and more blood flows into the penis.

At same time the tubes carrying blood out of penis compresses. There is more inflow and less outflow of blood, leading to penile engorgement, a process called erection.

There are 5 stages of erection:

Stage 1:Penile blood flow increases and it leads to enlargement of penis. However it is not rigid.

Stage 2:There is pooling of blood in penis leading to mild rigidity. It will be difficult to penetrate the vagina if it is not well lubricated. However, if the vaginal is well lubricated one will be able to penetrate the penis in by supporting and directing it using ones hand.

Stage3: In this stage all the tubes carrying blood out of penis get completely occluded. The penis becomes hard and doesn’t buckle. Weather the vagina is lubricated or not, one will be able to penetrate in this stage.

Stage4:This happens at time of orgasm. The penis fills to its maximum capacity. There is no inflow of outflow of blood in this stage. The penis is hardest in this stage.

Stage5: After orgasm, all the changes get reversed and penis becomes flaccid again. It will remain flaccid for a variable time period called refractory period. In this period it is impossible to gain erection again.

What cause erectile dysfunction?

It may be difficult to gain erection under following situations:

• 1.There is low level of testosterone or high level of prolactin.


• 2.The mind is disturbed because of stress, anxiety (can be performance anxiety as well), tension, depression or some personal or family tragedy.


• 3.The nerves that carry signal from brain to back (spine) and beyond are not well nourished. (can be due to deficiency of certain vitamins)


• 4.These is some backbone problem (can be slipped disc of infection of back bone) leading to compression of exiting nerves.


• 5.These is low level of argentine leading to low levels of Nitric oxide (Less coal to burn hence less heat).


• 6.The nitric oxide gets metabolized too quickly. (fire gets doused too soon).


• 7.There is some narrowing of tubes (called arteries) carrying blood into the penis.Hence, even if they open up, not ample blood flows in. This can happen especially in patient with high cholesterol, diabetes.


• 8.The tubes that carry blood out of penis fail to get compressed and hence outflow continues. (This is analogous to inflating a tyre that is punctured. One will achieve erection but it will not last.)

How to treat erectile dysfunction?

Treatment involves evaluation the underlying cause. It will require a few blood tests. After finding the underlying anomaly, it can be corrected with medications. Needless to say it requires your participation. Follow the underwritten advice religiously. Don’t be fearful of failure leading to aborted attempts of coitus. Understand that if the signal doesn’t descend down the mind, medications are less likely to work. Adopt a healthy lifestyle. Have a detailed understanding of how erection happens, imagine it and believe in yourself. Imagine yourself getting better. Think positive. Mind is a very strong influence on the body and it starts producing changes you believe or want. So think positive and remain positive.

Advice for Patients with ED/PME

• 1.Start the day by drinking 4 glasses of warm water.


• 2.Freshen up and do running for 45 minutes.


• 3.Do kegel exercise 10 min session 3 times a day.


• 4.Eat 4 walnuts in morning after workout.


• 5.Meditate for 15 minutes and try to control the mind and prevent it from wandering. Anxiety decreases the chance of getting erection.


• 6.Remain hydrated throughout the day and ensure that the colour of urine at all times should be as clear as drinking water. If it is yellowish, drink 2 glasses of water more. This helps to maintain blood viscosity and you understand if the blood is less viscous, it flows better.


• 7.Take a platter of salad and fruits daily. Increase intake of beet root and water melon.


• 8.Drink a glass of fruit juice without salt daily. Best juice would be beet root.


• 9.Keep body weight in check (Ideal adult body weight is height in cm-100).


• 10.Reduce intake of salt. There should be minimum/no salt intake in between meals.


• 11.Omit smoking


• 12.Social drinking is allowed.


• 13.Take a glass of warm milk with half teaspoon of organic turmeric and 4 pinches of black pepper in the night before sleeping daily.

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