What is an Erection?

In order to understand a pelvic problem, we really DO first need to understand "how" things are supposed to work in the first place. And the question of "What is an Erection" really ought to be common question, yet the truth is that VERY FEW of you ever come out and ask me this!! 

But when I take the time to explain to you what an erection is, and how erectile problems can be an indicator of underlying pelvic floor muscle dysfunction, whether you have a vagina or a penis, you will be better able to understand your pelvic problem, be it seggsy-time dysfunction, or a pee or poop problem. And, YES, people with vaginas get erections, too!!

So what is an erection, you ask? Let's learn more, together!

What is an Erection?

An erection occurs when a person is stimulated physically, or in thoughts, (or in the case of teenagers, sometimes for no reason whatsoever!), and is caused by a combination of pelvic floor muscle activity, and blood flow changes. The pelvic floor muslcles are a prime driver, with the muscles at the base of the clitoris or penis contracting, effectively "trapping" blood inside the organ, causing it to engorge (fill up), lengthen and harden.  At the sometime, the arteries (blood vessels that bring new blood to the penis or clitoris) engorge, while the veins (blood vessels that carry blood away) constrict, assisting in this "filling up" or erection.

This 'engorges' the sex organ and causes the erection.

Penises AND Vaginas (via the Clitoris) BOTH get erections!

News Flash: Both penises AND vaginas (clitoris-es, actually) get erections!!

Erections indicate health of the cardiovascular system AND the pelvic floor musculoskeletal system. It’s true. You can read more in this blog post about how Erectile Dysfunction in people with penises can be an early sign of cardiovascular disease, so if you are having trouble raising the main sail, and haven't been going to  your regular annual health visits, save us all some time and money (& maybe your life) by getting your cute butt into your primary doc for a heart check, before booking a Pelvic PT appointment.

And while the heart check, and heart contribution to erectile dysfunction is an important one to investigate, by far the most common musculoskeletal cause of Erectile Dysfunction is strength and coordination problems in the pelvic floor muscles. 

And it's NOT loosey-goosey-weakness in the pelvic floor muscles that causes the erectile dysfunction...rather it's "hypertonicity" of the pelvic floor muscles--the fact that they are actually too tight and rigid and overworking all the time so they have no reserve strength or health left to create an erection when desired. 

Fun fact: This Pelvic Floor Muscle Overactivity (remember the fancy word, "hypertonicity") is the most common cause of nearly ALL pelvic problems (urges, leaks, constipation, etc) in all humans!  Not understanding how muscles that are "too active" can be weak?  No problem--check out these two Instagram Posts I did explaining it, with analogies of carrying a bag of flour all day, or staying in a wall sit all day, to help clear it up for you.

But I digress--let's start by understanding "the thing" which, today, is erections!

Demystifying Erections: Starting with Penises

A penis is made up of two side-by-side chambers called the corpora cavernosa, which are full of sponge like blood vessels, that run the whole length of the penis.

The urethra, which is the hole that pee and sperm go through, runs along the underside of this sponge-like tissue.

When aroused, the pelvic floor muscles at the base of the penis contract, and the arteries engorge (get bigger, bringing in new blood), and the veins constrict (get smaller, letting less blood out), and thus the sponge-like corpora cavernosa is filled up with blood, causing the erection.

For those of you playing Jeopardy at home, a membrane called the tunica albuginea is also involved here. You’re welcome.

If the pelvic floor muscles, and cardiovascular system is healthy, the erection is maintained through the act of intimacy, and the sexual response builds and ends in climax (with a dry ejaculate if you've had a prostatectomy).

After climax and potential ejaculation (the mechanics of that are for another post, friends), the pelvic floor muscles and veins that had constricted, holding blood in the penis, now relax, and the erection ends (fancy word alert: detumescence…dare you to use that in your daily life today).

And what about vaginas?

The clitoris actually has a very similar erection mechanism to a penis. It has a pair of corpus cavernosum that engorge to become erect, via a similar combination of automatic activity of pelvic floor muscles and blood vessels.

The clitoris actually has about 10,000 nerves in it, as compared to 4,000 in a penis and 3,000 in a finger...I made this fun IG post about it last year. The clitoris grows up to 300% during a typical erection, and this can sometimes take longer than a penis to become fully erect (foreplay, anyone)?

It should stay erect until climax, then, like the penis, following climax, the corpus cavernosum returns to normal sponginess and clitoris returns to normal size.

At least that's what is supposed to happen in an erection...

In Erectile Dysfunction (ED), that might not happen. And for the purposes of 'easiness of understanding', let's focus on erectile issues for people with penises (because they're easier to see and envision, really).

What if we can’t attain an erection? What if we can’t “get it up”?

We might not be able to attain an erection. Or, if we get one, it might be too soft to be useful....OR it might dissipate before the sexual response is complete (ie, before we ejaculate)...OR we could also have premature ejaculation...but that's for another post.

If the pelvic floor muscles are to blame for erectile dysfunction (which they often are), they are often too hypertonic (meaning squeezing themselves, and the penis parts, all the damn time). If the muscles are always tight and clenched, then the general penile tissue has low health, and therefore doesn't have the strength or endurance to support an erection formation (or endurance), and also might not have the muscular power required for orgasm or ejaculation. I have two fun Instagram posts about how muscles that are too tight are actually super weak here (bicep analogy) and here (leg analogy). Watch them if you want to understand this concept more.

The good news is that Pelvic Floor PT is ludicrously effective at improving pelvic floor muscle health and strength in clients with ED!! Simple, Specific Exercises can REALLY help connect your brain to your pelvic floor, then retrain you to use "active deepest/lowest abs, relaxed rectum" with daily life...allowing those pelvic muscles some much needed rest...I teach "Dr. Kelly's Big 3" to nearly all my clients, to restore this "more normal" muscle control. 

Ready to take the next step towards the pelvis of your dreams?

If you're interested in seeing a Pelvic PT, here's how you can book with me (in person or online), here's a blog post on how to find one near you, and here's a blog post with more details on how even just one visit of Pelvic PT can help reduce leaks and improve sexy-time after prostatectomy!!

For those seeking alternative avenues, perhaps you’re not ready to see a Pelvic PT in person, consider a high-quality online course from a trusted professional (like me!). Pelvic Floored offers world-class streamable pelvic wellness programs, that you can work through at your own speed, in the comfort and privacy of your own home, for a fraction of the cost of one:one Pelvic PT.  ALL Pelvic Floored online courses are seamlessly streamable between your computer, phone and tablet via the FREE Kajabi App (blue K, wherever you get your apps), so that after your course purchase, world-class pelvic health info, and exercises, are never more than a click away. 

What are you waiting for?!  Thanks for reading, buy a course, or make an appt today!

xoxo, Dr. Kelly 😊

Follow me on Instagram!
Schedule an in-person or telehealth visit HERE!

www.pelvicfloored.com