What is Necessary for Erections to Occur Under Normal Conditions?

by Alex Shteynshlyuger MD


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.


How Do Erections Occur?

Under normal conditions, men require visual, mental or tactile (touch) stimuli for an erection to occur.  What you see, what you think about and what you feel when you touch someone are the reasons you’re able to achieve an erection.

Signals from your eyes, brain, and skin activate a neural pathway that causes small molecules called neurotransmitters, including nitric oxide, to be released from the blood vessel walls of the penis. The release of nitric oxide (NO) in turn causes blood vessels to dilate. Increased blood flow to the penis leads to engorgement or enlargement and hardening of the penis, what we call a ‘hard erection.’

What Causes Erection Problems or ED in Men?

thinking_sex_shutterstock_71881087The most common cause of erectile dysfunction (ED) is a failure of blood vessels to dilate.  This is usually caused by peripheral vascular disease or microvascular disease as a result of hypertension or cholesterol plaque build-up in blood vessels.

Failure of neural pathways can also occur but less commonly.  This can happen in patients with neurological disease (MS, spinal cord injury, peripheral nerve injury after prostate surgery, diabetes, depression, etc).  

Anxiety and stress can cause a similar problem leading to ED which is very common in younger men.

Read about risk factors for ED and prevention of erectile dysfunction.

What is Necessary to Get Hard Erections

For a man to obtain a hard erection, a few things are required.  First, one must have the stimulation of some sort to provoke an erection. This can be a visual sight, a mental image or a touch of the genitals or even skin touch by a partner.

The blood vessels need to be wide enough and to be able to widen to allow increased blood flow to the penis.  If the blood vessels are clogged or diseased and cannot expand to allow increased blood to flow to the penis the erection will not occur.  In addition, the ‘shell’ of the penis needs to be strong enough to prevent blood from leaving the penis faster than it comes. When the penis ‘shell’ is not working well, men have what is called a “venous leak”.

Abnormal Hormones and Erection Problems

Hormones play an important role in regulating normal body processes.  Normal hormone levels are important in keeping erections ‘healthy’.  Abnormalities in hormone levels can cause erection problems in men.  For example, low testosterone levels can affect the ability to obtain and maintain erections.  High prolactin levels, usually caused by a microscopic prolactinoma, and high estradiol levels (often occur in obese men) can cause problems with erections.  Low thyroid levels or hypothyroidism can also cause erection problems in men.

Prostatitis, Urethritis and Perineal Injury

Inflammation of nerves or tissue surrounding the nerves that lead to the penis often cause erection problems in men.  It is not uncommon for men to experience erection problems after a severe bout of UTI such as urethritis or prostatitis. Often, men also experience urinary problems such as slow urine stream.  Erectile dysfunction can often occur as a result of an STD.

Injury to the muscles and nerves involved in obtaining and maintaining erections can also cause erection problems in men. Perineal injury after falling from a motorcycle, bicycle or from horseriding are most common causes of injury to the nerves involved in erections.

What You Need to Know:

  1. Good Workouts Lead to Better Sex
  2. How is impotence Diagnosed?
  3. High Blood Pressure is a Cause of Erection Problems

Learn More About:

  1. Top 5 Causes of ED
  2. Prevention of Erectile Dysfunction
  3. New Treatment for Erectile Dysfunction without Medications
  4. Testosterone and Sex
  5. Medications for ED

Scheduling Appointments with ED Specialists


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.  We have excellent reviews from patients and their partners. 

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.


ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex ED Problems Including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods.  We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.

He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.

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