Andrew Siegel MD October 10, 2015
(Gaga Symphony Orchestra live at Palazzo Zuckermann, Padua, Italy; photo taken by Carlo Alberto Cazzuffi, September 2012; Permission to copy and distribute under the terms of the GNU Free Documentation License)
Achieving a rigid erection is a “symphony” that results from the interplay of four “orchestral sections,” nerves, blood vessels, erectile smooth muscle, and erectile skeletal muscle (pelvic floor muscles). The orchestral sections are led by the “conductor,” the brain (the main sex organ). Although each individual “musician” within the orchestral sections has a unique role, all work together in harmony to create a beautiful “symphony.” If any musician or orchestral section is off key, the disharmony can cause the “symphony” to be flawed resulting in a sub-par performance.
Sections of the Orchestra
Nerves: You can think of the nerves as the string instruments—the violin, viola, cello and double bass—vibrating in sync. This is arguably one of the most important sections, providing more than half of the musicians.
The penis has a rich supply of nerves that connect with the spinal cord and brain. Without these nerves and connections, the penis would be numb, cut off from the rest of the body and incapable of being stimulated with either touch or erotic stimulation.
Here is how things work when nerves are functioning well:
- When the penis is stimulated by touch, nerves relay this information to spinal cord centers, which then relay the message to the penile arteries to increase blood flow, resulting in the penis becoming engorged.
- Touch to the penis is also conveyed directly to the brain, enhancing this reflex spinal cord response.
- Erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) further stimulates the penis from excitatory nerve pathways that descend from the brain.
- With touch stimulation of the head of the penis, a reflex contraction of the pelvic floor muscles causes even more blood to be pushed into the penis, leading to a rigid erection.
Blood vessels: You can think of the blood vessels as the percussion instruments—the piano, xylophone, cymbals, drums, etc.—pulsing rhythmically. Kettledrums or timpani bring a level of excitement to the music.
Inflation of the penis is all about blood inflow and trapping. When there are issues with blood flow or blood trapping, it becomes very difficult to obtain and/or maintain an erection.
Here is how things work when the blood vessels are functioning well:
- With touch or erotic stimulation, nerves (as discussed above) cause the muscle within the walls of the penile arteries to relax, which increases penile blood flow.
- Muscle relaxation within the small arteries of the sinuses of the penile erectile chambers increases blood flow, resulting in penile engorgement.
Erectile smooth muscle: You can think of the erectile smooth muscle as the woodwind instruments—the piccolos, flutes, oboes, clarinets and bassoons—ranging from the highest tones in the orchestra to the lowest, analogous to the great range of smooth muscle contractility within the erectile chambers.
The erectile smooth muscle within the sinuses of the erectile chambers governs the inflation/deflation status of the penis. When the smooth muscle is contracted (squeezed), the penis cannot inflate with blood, but when the muscle relaxes, blood gushes into the sinuses and inflates the penis. Issues with the erectile smooth muscle make it difficult to obtain or maintain an erection.
As we age, smooth muscle in all arteries of the body stiffens, causing high blood pressure; paralleling this, there is an age-related stiffness of the erectile smooth muscle, which causes erectile dysfunction.
Here is how things work when the erectile smooth muscle is functioning well:
- With touch or erotic stimulation, the smooth muscle within the sinuses of the erectile chambers relaxes, under control of the nerves, which allows blood to flow into and fill the sinuses.
- As the sinuses approach complete filling, veins that drain them are pinched, trapping blood within the sinuses.
- This smooth muscle relaxation results in penile blood pressure becoming equal with the overall systolic blood pressure (normally 120 millimeters) and an engorged penis, plump but not rigid.
Erectile skeletal muscles (pelvic floor muscles): You can think of the erectile skeletal muscles as the brass instruments—the trumpets, French horns, trombones, and tubas, made of brass and capable of the loudest sounds in the orchestra. These instruments are particularly important in the loudest, most exciting portions of the music, corresponding to the role of the pelvic floor muscles as one approaches climax, maintaining rigidity and driving ejaculation.
The pelvic floor muscles are the rigidity muscles, necessary for transforming the plump penis to a rock-hard penis. These “rigidity” muscles surround the deep roots of the penis. When these muscles are not functioning optimally, one loses the potential for full rigidity.
Half of the penis is hidden and internal and is known as the penile roots. Like the roots of a tree responsible for foundational support, the roots of the penis stabilize and support the erect penis so that it stays rigid and skyward-angling with excellent “posture.” When erect, it is these muscles that are responsible for the ability to lift one’s penis up and down as the muscles are contracted and relaxed. These rigidity muscles compress the roots of the penis, causing backflow of pressurized blood into the penis; additionally they are responsible for ejaculation—compressing the urethra (urinary channel that runs through the penis) rhythmically at the time of climax to cause the expulsion of semen.
An erection–defined in mechanical (hydraulic) terms– is when the penile blood inflow is maximized while outflow is minimized, resulting in an inflated and rigid penis. The pressure in the penis at the time of an erection is sky-high (greater than 200 millimeters), the only organ in the male body where high blood pressure is both acceptable and necessary for healthy function. If the systemic blood pressure were this high, it would be considered a “hypertensive crisis.” This explains why blood pressure pills are the most common medications associated with erectile dysfunction.
Unlike humans, many mammals have a bone called the os penis to permit penile rigidity. In the absence of this handy set up, nature has cleverly engineered a better alternative…after all, who wants an erection 24-7-365? A convenient and readily available fluid—blood—is used as a liquid medium and pressurized tremendously to achieve an erection. Brilliant!
Here is how things work when the pelvic floor muscles are functioning well:
- With touch stimulation of the head of the penis, there is a reflex contraction of the pelvic floor muscles; every time the head of the penis is stimulated, the pelvic floor muscles contract.
- The pelvic floor muscles surround the roots of the penis and as they compress and squeeze the roots with each contraction, blood within the roots is forced back into the external penis, thereby pushing more blood into the penis and causing more clamping of venous outflow—a tourniquet-like effect—that results in penile high blood pressure and full-fledged rigidity—a brass-hard penis.
Brain: You can think of the brain as the conductor of the orchestra—the maestro—who has the vital role of unifying and coordinating the individual performers, setting the tempo, executing meter, “listening” critically and shaping the sound of the ensemble accordingly. The conductor is the key player and if he is having an off day and does not bring his “A” game, there will be disharmony in the orchestra and the symphony will be flat and unimpressive.
Psychological and emotional status has a significant impact on erectile function. Mood, stress levels, interpersonal and relationship issues, etc.—acting via the mind-body connection and mediated via the release of neurochemicals—can influence erectile function for better or worse. Stress, for example, induces the adrenal glands to release a surge of adrenaline. Adrenaline constricts blood vessels, which has a negative effect on erections, the basis for the common occurrence of adrenaline-fueled performance anxiety.
Now that we have looked at the sections of the orchestra and have deconstructed the erectile process, let us use this schema as a means of treating the specific part of the process that may have gone awry.
Nerves: Since intact and functioning nerves are fundamental to the erectile process, stimulation of the nerves can be an effective means of resurrecting erectile function. Penile vibratory stimulation induces the reflex between the penis and the spinal cord that results in gradual filling of the penis with arterial blood. It contributes to erectile rigidity via inducing reflex contractions of the pelvic floor muscles when the vibrations are applied to the head of the penis. By enhancing this reflex and triggering nerve activity in the brain, spinal cord and peripheral nerves, vibratory stimulation is capable of inducing an erection and ejaculation.
Blood Vessels: Clogged arteries caused by fatty plaques, often a consequence of an unhealthy lifestyle, can compromise the blood supply to the penis. Lifestyle “remake” consists of common-sense measures to improve all aspects of health in general and blood vessel health in particular. This means getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy) diet, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc. The oral ED medications—Viagra, Levitra, Cialis and Stendra—can be helpful when there is compromised blood flow to the penis. They work by inhibiting the chemical that causes erections to dissipate.
Erectile Smooth Muscle: Age-related dysfunction of erectile smooth muscle is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards sexual function—exercising the penis via regular sexual activity will actually help the health of the smooth muscle of the penile arteries and sinuses.
Erectile Skeletal Muscle: Pelvic floor muscle training will improve the strength, tone and endurance of the pelvic floor muscles and will optimize the rigidity function.
Brain: Finding a solution for the psychological and emotional issues that adversely affect sexual function would merit winning the Nobel Prize! Lifestyle measures are vital for optimal brain function. Getting sufficient sleep is particularly important. Stress management is essential as stress is one of the main erection killers. Finding balance in life is key. When in a sexual situation, being “in the moment” as opposed to “spectatoring”—observing your performance as if you are a third party—is fundamental for optimal functioning.
Bottom Line: An erection is a highly complex symphony, orchestrated by the main sex organ—the brain—and executed at the level of the penis via the individual performances of the orchestral members who comprise the orchestral sections—the nerves, blood vessels, erectile smooth muscle and the pelvic floor muscles. All orchestral members play a vital role in the creation of a magical synergy, resulting in a spirited, powerful, passionate performance that climaxes in a tension-releasing symphonic finale.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.
Tags: Andrew Siegel MD, blood vessels, brain, conductor, erectile dysfunction, erectile smooth muscle, erection, lifestyle remake, musicians, nerves, orchestra, orchestral sections, pelvic floor muscle training, pelvic floor muscles, penile vibratory stimulation, penis, symphony, use it or lose it