When Stress Gets You Down

Last Editorial Review: 1/30/2005

 Worried about your sex life? Ease up. You don't have to let stress get in the way of a good erection

WebMD Feature

Reviewed By Michael Smith

When trouble strikes men below the belt, it often comes as a surprise -- not to mention the shock. And whether it's erectile dysfunction or premature ejaculation, one of the main culprits is stress -- even if you don't realize that the torment in your brain is the cause of distress down below. But understanding the inner workings of erections can help get you back on track.

To understand how erections work, here's a crash course.

Erections 101

Most of the neural communications from our brain down to our spinal cord are involved in everyday voluntary tasks -- activities you normally can control -- such as coordinating the muscles for shaking hands, signing checks, or dancing. However, one set of communications, controlled by the autonomic nervous system (ANS), regulates all sorts of the good, visceral stuff such as blushing, gooseflesh, and orgasms.

The ANS has two parts. The sympathetic nervous system mediates sexual arousal, reaction to emergencies, and vigilance by increasing your heart rate, boosting your blood pressure, and speeding your breathing. It's responsible for the classic "fight-or-flight" response, which is mediated by two main chemical messengers, epinephrine (adrenaline) and norepinephrine.

The parasympathetic nervous system, in contrast, primarily counters the sympathetic one by mediating the body's calm and vegetative functions. Eat a big meal, take a nap, meditate, and the parasympathetics kick in, slowing down your heart rate, breathing, and so on.

Like most other organs in the body, the penis receives both sympathetic and parasympathetic messages, and proper sexual function requires an impressive amount of choreography between these two branches of the ANS. To begin with, the parasympathetics need to modify blood flow to the spongy tissues of the penis so that they fill up and an erection can occur. That's simply how the organ works. Terrific. So far, so good.

And what may happen next? Well, for social reasons that may have had something to do with, er, getting that erection in the first place, a guy might just begin to feel -- how should I say this -- a little less calm and vegetative. He begins to breathe faster. His blood pressure goes up. In short, the sympathetic system kicks in throughout the body. With more and more sexual arousal, activation of the sympathetics increases and he holds on to (figuratively speaking) the parasympathetic aspect of the situation as long as he can. Finally, he can control things no longer. The sympathetic system reaches its height of stimulation, he ejaculates, and the parasympathetics are inhibited, resulting in the loss of the erection, usually within a short period of time.

Erections Gone Awry

During significant stress, one of two things may occur. In the first scenario, the male becomes too anxious to establish enough parasympathetic input to the penis to get the erection in the first place. The result is stress-induced impotence.

In the other scenario, the guy has managed to get an erection but then becomes anxious about something -- say, Alan Greenspan and the prime lending rate -- and shazzam, his ANS rapidly shifts from calm, vegetative parasympathetic to adrenaline-surge sympathetic. Things have gone too fast, and he suffers from either loss of erection or premature ejaculation (or both).

Interestingly, it requires remarkably little stress for the autonomic system to produce erectile dysfunction. And more than a few men are affected. Although statistics are, as you might imagine, difficult to compile, the National Institutes of Health estimates that 5% of 40-year-olds and 15%-25% of those 65 years and up have this problem. Causes can be broadly classified as "psychogenic" (the result of psychological factors) or "organic" (the result of such conditions as blockage of the blood vessels supplying the penis, as can occur in atherosclerosis or diabetes); or nervous system abnormalities that limit the ability to direct blood to the penis (as can occur after a stroke or in multiple sclerosis).

Stress vs. Disease

So, how does the average guy tell the difference between erection problems due to stress (psychogenic) and those due to physical problems (organic)? It's simple, really. He needs to figure out what his penis is doing while he is asleep. Human males, like most other primates, normally have erections at that time, particularly during the rapid eye movement stage, when dreaming occurs. If a man has normal nocturnal (while sleeping) erections, the inability to perform is almost certainly psychogenic. If the nocturnal erections are disrupted, there's a high likelihood of underlying organic problems.

Health care professionals check for nocturnal erections by using a high-tech, electronic pressure cuff transducer. They attach the device to the base of the guy's penis, wire it up to satellite relays, 24-hour operators -- the works -- and by the next morning they have an answer: thumbs up or down on the erection. A drawback of this, of course, is that you may be so convinced that the damned thing is going to electrocute you during the night that it becomes a stressor in and of itself.

The Postage Stamp Test

A great low-tech alternative that you can try at home is to take a strip of postage stamps, loop it snugly around the base of the flaccid penis, overlapping the ends by one stamp (moistening the overlapping stamp) to make a sealed loop. If the stamp roll is broken in the morning, there was a nocturnal erection. (Alcohol, sedatives, or sleep-inducing medications should be avoided for two days prior to the test, to help ensure you're in peak condition.)

Isn't that simple? Spending a paltry $2.22 (you do the math if you really want to know the average number of 37-cent stamps needed, although penny stamps would work just as well) gives you a result probably just as good as that from the more technological version (but insurance plans won't likely pay for it).

The Speed Problem

So much for the erection problem. What about that other dilemma: stress-inducted premature ejaculation? One solution would obviously be to figure out how to feel less stressed about whatever it may be that is wreaking penile havoc.

But a second strategy targets the wiring. To slow himself down, a man can just try taking slow, deep breaths. Simple stretching of the chest muscles triggers a relaxation reflex that results in parasympathetic stimulation throughout the body. This, in turn, helps to hold the sympathetic component at bay just a little longer -- and that might just save the day.

Robert Sapolsky is professor of biological sciences at Stanford University and of neurology at Stanford University School of Medicine. Among his books are Why Zebras Don't Get Ulcers: A Guide to Stress, Stress-Related Diseases and Coping. In 1990, he won the Young Investigator of the Year Award from the International Society of Psychoneuroendocrinology for his research on testosterone and behavior in primates.

Originally published Oct. 30, 2000.

Medically updated May 12, 2003.

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