Ever wondered why achieving an erection is referred to as achieving an erection, as if it should come with some kind of merit badge? That’s because it is an achievement. An erection is the end result of several systems working together, a triumphant salute to teamwork, a collaborative effort that has resulted in the existence of both you and me.
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An erection requires a synergistic effort similar to summoning Captain Planet. Which, as the boy in you knows, is no small feat. Captain Planet, that carbon-neutral cartoon crimefighter, could only be mustered by the combined powers of the Planeteers. This ethnically diverse gang of do-gooders would put their magic rings together to summon the Captain, after which some environmentally-friendly ass-kicking would ensue. It’s the same with the protagonist in your pants; thanks to a healthy alliance of bodily processes, you have achieved an erection.
You could think of your boner as the anatomical equivalent of a blue-skinned superhero with a green mullet. Or not.
In the case of an erection, your Planeteers are blood vessels, nerves and testosterone levels. “We need all three to have an erection,” says Dr Ridwan Shabsigh, president of the International Society of Men’s Health and a professor of urology at Cornell University in New York.
Vasodilatation – blood vessels dilating and filling the penis under high pressure – is the proud sponsor of a stiff penis. Shabsingh explains that the vascular function happens with nerve mediation. “This means the nerves coming from the brain upon sexual stimulation give orders to the blood vessels to open up,” he adds. “And this function needs chemistry.” The chemical in question is testosterone. “This is a function that can go wrong easily,” Shabsingh continues. “Any illness that affects these three elements – blood vessels, nerves or hormones – can cause erectile dysfunction.”
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Smoking is a one of the chief culprits. Shabsigh has produced award-winning research using ultrasound technology to reveal that there is less bloodflow in the penises of smokers than in non-smokers. “If you smoke heavily, you are going to start experiencing erectile dysfunction when you are around 30.”
If smoking is your bloodstream’s sworn nemesis, then alcohol and drugs are your nervous system’s arch-villains. Shabsigh cites a recent case where a 28-year-old patient of his found– after years of committed varsity binge-drinking – that he couldn’t get an erection. “He told me that for four years he could not remember Friday to Sunday. Now, this comes with a price, and the price is your sexuality.”
The symptoms of a deficiency of the third Planeteer, testosterone, may be subtle says Dr Amir Zarrabi, consultant urologist at the University of Stellenbosch’s department of urology at Tygerberg Hospital. Zarrabi cites decreased libido, weight gain, depressed mood, improper sleeping habits, low self-esteem and poor quality erections. “This is an important condition for doctors to recognise and treat, not only to improve the patient’s quality of life but also to prevent complications of low testosterone.”
Related: What Your Penis Says About Your Life Expectancy
An upset chemical balance increases your risk of metabolic syndrome, says Shabsigh. This is a bouquet of four conditions: high blood pressure, high cholesterol, diabetes and abdominal obesity.
But if you’re not one of the overweight binge-drinkers who visit Shabsigh in his New York practice, does this really affect you? The answer is yes. The only requirement for ED is that you have a penis. “Erectile dysfunction is a worldwide phenomenon,” Shabsigh says. “It affects every society, culture and race. Nobody is protected.”
The state of our erections is the sum of our life choices. Shabsigh refers to the paths men take as we grow older: “Take someone in his teens. What does he do? He plays soccer and rugby, he jumps over fences. He is active in terms of exercise, he might have poor diet but activity covers a lot of it. That man turns 25 and he has to earn money and deal with the burdens of life. In his thirties he has a wife and children, and by that time his parents are getting old. By mid-thirties, that man is crushed from above and below from pressure. He has the stress of the older and the younger generation and the economy. Maybe he’s employed. Maybe he’s employed intermittently.”
Sound familiar?
“That man has aspirations,” Shabsigh continues. “This is the asset-building phase of life, so he wants to own a house. Maybe a holiday house. He wants a nice car. He wants to go on nice vacations. He wants to save for retirement and for his children to go to school.”
Shabsigh explains that there are two ways of coping with stress: coping properly or coping badly. Here’s how to cope badly: “You escape to drink. You comfort with food. You drop exercise because you have no time or you’re too stressed out – all these lifestyle changes happen in the early thirties.”
“That man is busy and doesn’t go to the doctor for a check-up,” Shabsigh continues. “By his late thirties and early forties he starts growing a belly, and by his early fifties he’ll have a heart attack.”
Shabsigh may have just described You or Future You – far from your carefree days of kicking soccer balls and jumping over fences, you’re faced with how you elected to grow up. Choose life. Choose a job. Choose a family. Choose coping. Choose drive-thrus. Choose an erectile dysfunction-beerboep combo. Choose deep-fried samoosas to be served at the wake after your premature funeral.
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Anyone with an email address knows that millions of pills – and busty Eastern European singles – are waiting to cure your flagging erections. But knowing that your next hard-on is a tablet away won’t cure the problem that an impotent penis is warning you about.
“We can treat erectile dysfunction with drugs,” Shabsigh says. “But that’s not enough.” Shabsigh mentions the “doorknob prescription” that is common throughout his industry. It’s when the doctor reaches for the doorknob after an appointment and the patient tactically adds that he has erection problems and the doctor quickly signs a prescription – all in the process of ushering the patient out of the room.
Zarrabi says there are three prescription drugs currently available to treat ED, and “all of them are generally very safe and have few serious risks and side effects”. But it’s the pills that come without prescriptions that can leave your entire body permanently stiff. “Unlike the prescription drugs, these pills and potions have not been clinically tested in scientific studies on hundreds of patients and the safety of these drugs can therefore not be guaranteed,” Zarrabi says.
“Many of these pills come from underground clandestine factories and the quality is poor,” says Shabsigh, adding that these pills may contain inactive ingredients, and some have been known to contain traces of rat poison.
Zarrabi says he’s recently seen an increase in the use of drugs to treat erectile dysfunction among young men and university students. “These are men who do not suffer from erectile dysfunction, but believe that the drugs will enhance their sexual performance. Apart from the fact that this is not true, there is also the very serious risk of developing priapism.”
This condition, Zarrabi explains, is a prolonged, painful erection that lasts for more than four hours after sexual stimulation has ceased, and can occur as a side effect of erectile dysfunction medication. “This is a serious condition requiring emergency care by a urologist,” Zarrabi stresses. “If not treated quickly, it may result in irreversible damage to the tissue inside the penis, causing permanent erectile dysfunction.”
“Testosterone is a good treatment if you have testosterone deficiency syndrome under medical supervision,” Shabsigh says, warning that the testosterone available on the black market can be very harmful. “If you have normal testosterone levels and you take testosterone you will have more harm than good. Testosterone from outside the body shuts down the internal production.”
Your knob doesn’t need doorknob prescriptions. It needs a doctor who has time to talk with you. “Don’t just run to the Internet and order a cheap pill just to get a hard-on. That’s not going to help you,” Shabsigh says. “Cure and treatment are possible with medication but a pill and an injection is not enough. You have to combine the pill and the injection with exercise, diet and a healthy lifestyle.”
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Impotence is two kinds of problems: it’s a today problem (you can’t get it up) and it’s a tomorrow problem (you’re likely to get a heart attack, a stroke or diabetes).
Zarrabi describes how ED can be a harbinger of heart attacks: “Cholesterol deposits in arteries are the most common cause of reduced bloodflow in both the arteries of the heart and the penis,” he explains. “Therefore, when a middle-aged man develops erectile dysfunction, the possibility of underlying coronary artery disease must be suspected. Symptoms of erectile dysfunction develop on average three years earlier than symptoms of coronary artery disease.”
“If you are not healthy, the penis will be first to show you. Erectile dysfunction is a predictor of future disease,” Shabsigh says. “This is a golden piece of information that can alert someone years in advance, and hopefully change lifestyles.”
Your scarcity of stiffness is a flashing Check Engine light. It’s a glaring indicator that one of your systems – chemical, mental or vascular – needs fixing. “The day you are diagnosed with erectile dysfunction is the day you review your health,” Shabsigh says.
Shabsigh wrote the first-ever academic paper on the natural history of erectile dysfunction. “The natural history is what would happen if you leave the condition untreated,” he says. “We thought once you have erectile dysfunction, you’re stuck with it. We did a major research study and we found, to our surprise, that a third of men with erectile dysfunction may improve, a third will worsen and a third will remain the same.”
The third who worsen share a common denominator: obesity. “There is a study that shows an inverse relation between the hours of watching TV and your erectile function,” Shabsigh says. “The less you watch TV, the better off you’ll be. Watching TV is a surrogate of activity.”
Fortunately, research shows that it works the other way too. And it’s by upping your exercise that you can break the cynical cycle. “Anything that will keep your heart healthy will also keep your penis healthy,” says Zarrabi.
Shabsigh says the recommended amount of physical activity per week is 150 minutes. “That’s two and a half hours,” he says. “So for five days, that’s thirty minutes a day. In addition to eating right and watching your waistline.”
It has to be consistent physical activity, he insists. “Science has shown that sustaining activity over months and years is much more effective than having enthusiasm for a few weeks and losing interest. The motto is: A little you can sustain is better than a lot you cannot maintain.”
“The research is for the future,” he points out. “What do we do today? One: go to the doctor once a year for health maintenance, even if you have no problems. Two: eat right and watch your weight. Three: be active. Four: watch your sexual function, because sexual health is the porthole to men’s health. Five: educate yourself. Read Men’s Health magazine.”
Those were his words; I didn’t even have to prompt him.
“The day you are on a stretcher wheeled to the emergency room we, as medical professionals, will pay attention to you,” Shabsigh says. “But we’re more interested in you twenty years before. I want to catch you earlier and make you not have a heart attack in your forties or fifties.”
Staying away from an early stretcher ride comes down to choosing how to cope with the stresses of your lifestyle. Choose coping properly. Choose exercise. Choose taking the stairs. Choose decades of organic erections. Choose smugness at your 30-year school reunion.
“What is the most common reason for dropping exercise?” asks Shabsigh “‘I just don’t have time for it.’ You never have time; you make time.”
In the words of Captain Planet, whose existence depends on the same holistic and co-operative principles used in achieving an erection: the power is yours.
