At first glance, the penis is an uncomplicated organ. Biologically, it really only has two jobs: to facilitate urination – whether the user is sitting or standing – and to perform the sexual act. Pushed into action by thought or sight, or simply by virtue of it being the morning, the penis fills with blood and becomes erect.
As ever in biology, however, the truth behind the action is much more complicated. Though the external result appears simple, the internal mechanism behind engorgement is a complicated dance of neuronal firing and about a dozen different capillaries and arteries successfully filling with blood.
Failure at any one point in these processes can lead to erectile dysfunction (ED), which may, in turn, act as a barometer for much wider male health problems.
“Because the penis requires a number of things [to operate] – hormones, neural stimulation, and healthy vasculature – it can depict a more holistic view of a man’s health,” explains Dr Michael Carroll, a reader in reproductive health at Manchester Metropolitan University.
A barometer of male health
Mental health is one area where a man’s penile health could be an indicator of something going awry.
“If he’s depressed or if he has anxiety, that can interrupt the neural signal that’s important for erection. That could indicate that a man has depression, anxiety, chronic stress or neurological disorders.”
Failure to ‘perform,’ as it were, could be down to these so-called ‘psychogenic’ causes. Men are often reticent to talk to medical professionals about either their mental or sexual health, but the two can be deeply connected. Addressing both with a doctor is often the first step for a man to reclaim his sex life.
Understandably, ED can also be a cause of depression. A 2018 meta-analysis found that it can increase a person’s risk of depression by 192 per cent, and the incidence of depression is almost three times higher in individuals with ED.
Up until the 20th century, poor penile health was often considered a cause of much more serious mental conditions as well. The instability that provoked presidential assassin Charles Guiteau, for example, into shooting US President James Garfield was thought to be derived from his suffering from phimosis, a tightening of the foreskin that prevents it from being pulled back over the glans.
Linkages between penile and wider physical health in men, however, were not fleshed out until the 20th century, partly because it took so long for scientists to understand how erections really worked.
That process, explains Carroll, begins with the brain sending a signal via the pudendal nerve in the pelvis to the penis and ends with the organ’s engorgement with blood arriving through multiple tiny arteries and capillaries. Failure to achieve liftoff, as it were, may indicate the hardening or blockages of these blood vessels, which are small and easily blocked.
ED, therefore, could be an early warning sign of trouble with a person’s blood vessels. This might be caused by anything from smoking – nicotine is a vasoconstrictor, meaning it triggers blood vessels to tighten – to cardiovascular disease and the hardening of arteries due to plaque buildup. Indeed, one recent study found that men with ED were up to 59 per cent more at risk of coronary heart disease.
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Diabetes, too, can be a culprit, through specific damage to nerves feeding into the penis and an inability to regulate blood sugar levels, leading to a buildup of plaque in the arteries supplying blood to the penis. “It’s also known to damage blood vessels [through the] increase of compounds known as advanced glycation end products, or AGEs,” says Carroll. This can cause cases of ED that, in some cases, precede the diagnosis of diabetes.
Fortunately, many of these issues can be treated, and the earlier interventions are made, the better the results are likely to be. It might be encouraging to note that the treatments for ED often have much wider health benefits. Viagra, for example, has been linked to better cardiovascular health and, according to recent studies, a slightly decreased chance of developing Alzheimer’s disease.
Age and hormones
Unsurprisingly, many of these problems, including ED, get more common with age, explains Dr Michael Eisenberg, a professor of urology at Stanford University. Around 40 per cent of men aged 40 experience ED, but that number rises to 70 per cent by age 70.
Some of the changes that men will see are more serious than others. For example, collagen – the material in the skin that keeps it tight – depletes as we age, which not only leads to wrinkles but also a general drooping of the penis and scrotum.
Peyronie’s disease – a condition wherein the shaft bends the erect penis into increasingly obtuse angles – also becomes more likely. While it is sometimes linked to a minor genetic condition that tightens muscles in the fingers so that they curl toward the palm, known as Dupuytren’s contracture, it’s more commonly associated with the steady accumulation of scar tissue under the skin from hundreds of tiny injuries to the penis over the years.
Ageing, too, sees men generally produce less testosterone – a big reason why night-time and morning erections tend to also decrease in frequency, adds Carroll. For those men in their late teens to their late forties, however, fewer cases of ‘morning wood’ could be a sign that the man’s testes are not producing enough testosterone because of ‘hypogonadism,’ itself a sign of hormone disruption.
Lots of things can impact hormone balance, explains Carroll, including stress, lack of sleep and anxiety. Identifying which might be at play is a vital part of treating ED.
There are other, vaster unknowns about how the health of the penis augurs the health of the body. In a 2023 study, Eisenberg suggested that the global average lengthening of penis size over the past three decades might, in combination with growing levels of male infertility, be linked to historically high levels of exposure to chemicals which disrupt our hormone-controlling endocrine system in our daily diets.;
“While the change in length may not necessarily be good or bad, the fact that there is a change should be examined,” says the Stanford professor.
The connection between the spine and the penis is also a seemingly underexplored area, with one study last year suggesting that damage to the former may induce premature ejaculation.
Healthy heart, healthy penis
All of this isn’t to say that ED is automatically a harbinger that there are worse things going on in someone’s body or their mind. In most cases, the underlying causes of ED are highly treatable. But it’s always worth going to your doctor just in case, says Eisenberg, especially in the event of a noticeable change in your penis.
In that event, some men are more curious to investigate than others. “Men often come in for erectile problems having never visited the doctor before,” says Eisenberg, but many others are “reluctant to visit” in the first place.
Often enough, the Stanford professor continues, patients just don’t make the potential connection between their penile health and overall wellbeing.
So, how should men keep on top of their penile health? While prescription drugs may be in order for specific issues, the best thing, argue Carroll and Eisenberg, is to live a healthy lifestyle. That means avoiding processed foods and, where possible, too much stress, exercising regularly, having a moderate stance toward alcohol and absolutely no smoking.
“To have a healthy heart is to have a healthy penis,” says Carroll. “To have a healthy penis is to have a healthy heart.”
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