Erection

An **erection** () most often refers to an 'erection of the penis.' Erections sometimes occur in the male fetus (the body before birth), and occur naturally in boys from birth onwards. It is normal for the penis to be erect when a male wakes up. This is commonly called morning wood. It is also normal for male teenagers and men to have an erection several times per night when sleeping and it is healthy for the penis.  It is widely believed that a man's penis needs to be erect in order for him to take part in sexual intercourse and penetrate his partner's vagina and to ejaculate semen, but all are possible without an erection. In a healthy male, an erection will usually occur if the man is sexually aroused (made sexually excited) or stimulated. This can happen if he is touched sexually, or even if he is not touched – for example, if he sees a naked person or thinks about having sex with someone else. Erections can also occur without thinking about sex or being touched. Most boy teenagers have unexpected erections. This is normal. Erections happen several times during the night. This happens to all healthy adult males of all ages. This also happens when a man wakes up. That is normal too. Tissues in the penis called the corpus spongiosum penis and corpora cavernosa penis fill with blood, causing the penis to become longer, thicker, harder and to stand upright. A man's erection usually stops if he is no longer sexually aroused, or after he has had an orgasm and has ejaculated. An erection will usually not be possible immediately following ejaculation, although adolescent males may be able to achieve erections immediately following ejaculation. The time period during which an erection cannot be repeated following ejaculation is called the refractory period. Animals can have an erection.

## Overview

Erect penises have appeared in erotic (sexually exciting) art for a very long time. Pictures of men with erections appear on ancient objects and in paintings. In the past, the erect penis was also a symbol or sign of health and fertility (the ability to give life). Ancient Egyptians, Greeks and Romans believed in gods that had erect penises. Today, erect penises do not often appear in artworks or movies because many people think that showing a man's penis when it is erect is obscene (not decent). Men with larger penises are often thought to be more handsome, manly and powerful. A lot of people also believe that men with bigger penises are better at making their partners feel good when they are having sex. However, this is not always true.

Like a man's penis, a woman's clitoris can also become erect. This happens in a similar way to an erection of the penis. The clitoris also has a corpora cavernosa, and when a woman is sexually excited this part of the clitoris fill with blood. This causes the clitoris and other parts of the woman's sex organs to become larger, harder, redder in colour, and very sensitive to being touched.

The nipples of men and women can also become erect. Women's nipples become erect when they are breastfeeding (giving milk to their babies from their breasts). Men and women may also have an erection of their nipples when they are sexually excited, or if they feel cold. Nipples do not have any tissue in them that fills with blood. Instead, the body's nervous system makes muscles in the nipples contract (become shorter), causing them to stand up and become slightly harder.

Blood flows out of the corpus spongiosum and corpora cavernosa penis, and the penis goes back to its normal size. A man who often has problems having or keeping an erection of his penis is said to have erectile dysfunction (ED). On the other hand, an erection that lasts too long is also a dangerous condition called priapism. Men who want to get less erections sometimes take anaphrodisiacs.

## Penis

The term _erection_ is most often used to refer to an erection of the penis. A man's penis is usually soft, quite short and hangs down. When the penis is like this, it is said to be flaccid (). In order for the man to take part in sexual intercourse by putting his penis inside a woman's vagina, his penis needs to become longer, thicker, harder. For many men it stands upright. It is okay if it points out or down. When the penis is hard, it is said that the penis is erect or that the man has an erection. The scrotum (the bag containing a man's testicles or "balls") will usually tighten during erection. The penis usually needs to be at least mildly erect before the man can have an orgasm and ejaculate semen.

The scientific name for an erection is _tumescence_ (which means "swelling"). Some slang terms for having an erection are _getting hard_, _getting wood_ and _having a hard-on_, and an erect penis is informally called a _boner_, _hard-on_, _stiffy_, _wood_ or _woody_.

### How it happens

The penis is shaped like a banana or sausage. It has a duct or tube called the urethra running right through it. Semen and urine pass along the urethra to get out of the body. Around the whole urethra is tissue called the corpus spongiosum penis (which is Latin for "body of the penis that is like a sponge"). It is near the lower surface of the penis. Also inside the penis near its upper surface are two cylindrical tissues called the corpus cavernosum (Latin for "bodies of the penis that are like caves"). (One of these tissues by itself is called a corpus cavernosum.) The corpus spongiosum penis and corpora cavernosa penis are filled with many blood vessels called arteries which carry blood.

When a man is sexually aroused or stimulated (made sexually excited) by touch – for example, if he masturbates or another person touches him in a sexual way – the touching is picked up by nerves in the arteries of the corpus spongiosum penis and corpora cavernosa penis. The nerves then cause a chemical called nitric oxide to be released into the arteries. This makes the arteries dilate (become wider), and they fill up with blood. Thus, the corpus spongiosum penis and corpora cavernosa penis all fill with blood and become larger and harder. This makes the penis grow longer, thicker and harder. The corpora cavernosa penis press against blood vessels called veins that let blood flow out of the penis. Since less blood can flow out of the penis through the veins, more of it stays in the penis, which remains hard. During an erection, a valve stops urine from entering the urethra so that only semen flows along it. This is why it is difficult for a man to urinate when he is having an erection.

A man can also become sexually aroused without being touched, for example, if he sees a naked person or thinks about having sex with someone. In this case, his brain sends messages through his spinal cord (which is inside his vertebral column or backbone) to his penis and makes an erection happen. The brain can also stop an erection from happening, even if the man is being touched sexually.

After a man has had an orgasm and has ejaculated, his erection usually ends. How long this takes depends on the length and thickness of his penis. A man can also stop having an erection without having an orgasm and ejaculating, if he is no longer sexually aroused. Nerves in his body cause the arteries in the penis to constrict (become narrower). This forces blood out of the corpus spongiosum penis and corpora cavernosa penis. As they go back to their normal size, they do not press so much on the veins leading out of the penis. This lets blood flow faster out of the corpus spongiosum penis and corpora cavernosa penis. The scientific term for this process is _detumescence_.

### Shape and size

The angle that an erect penis makes varies from one man to another. If it is imagined that a man is standing upright and there is a horizontal line stretching out from the base of his penis, most men's erect penises point upwards from the line at a certain angle. However, it is common and normal for an erect penis to point nearly vertically upwards, nearly vertically downwards. The angle depends on how long a man's suspensory ligament is. The suspensory ligament is a band of tough, stringy tissue that joins a man's penis to the front of his pelvis.

The following table shows how common various erection angles are for a standing male. In the table, zero degrees (0°) is pointing straight up against the abdomen, 90° is horizontal and pointing straight forward, and 180° is pointing straight down to the feet. An upward pointing angle is most common and the average erection angle is 74.3 degrees.
|angle (°) from vertically upwards|Percent of males||
| --- | --- | --- |
|0–30|style="text-align: right;"|4.9|
|30–60|style="text-align: right;"|29.6|
|60–85|style="text-align: right;"|30.9|
|85–95|style="text-align: right;"|9.9|
|95–120|style="text-align: right;"|19.8|
|120–180|style="text-align: right;"|4.9|

Few men's penises are completely straight when they are erect. It is common for an erect penis to have a slight curve in it. The curve can be up or down, or to the left or right. A curve of up to 30° is considered normal, and medical treatment is usually not needed unless the angle of curvature is more than 45°. A curved penis does not usually cause a man any problems when he is having sex. However, if the curvature of a penis changes, this could be caused by an illness called Peyronie's disease (see below). An erection that pokes through clothing is sometimes called a _manbulge_.

A survey of 300 men over the age of 18 carried out between 11 March and 17 March 2001 in Cancún, Mexico, found that among those men the average erect human penis was about 14.928 centimetres (5.877 inches) long, and that most of them had an erect penis length of between 14 and 16 centimetres (5.5 and 6.3 inches). The typical girth or circumference (the length around the outside of the penis) was about 12.63 centimetres (4.972 inches), and most erect penises had a girth of between 12 and 13 centimetres (4.7 and 5.1 inches). As this survey was only done in one city, its findings may not apply to men from other countries.

The size of an erect penis generally does not change after puberty, the time when a boy becomes sexually mature. Some people have surgery to make their penises larger. However, a study that came out in 2006 found that only 35% of men who had gone for such surgery were happy with the results.

### Erections when sleeping

An erection of the penis can also happen by itself when a man is asleep, often when he is dreaming. This normally happens several times per night. The scientific term for this is _nocturnal penile tumescence_ (which means "swelling of the penis at night"). It is also common for a man to wake up after a night's sleep to find that he has an erection. This is often caused by his bladder being full of urine, which presses on the tissues in the penis. Such an erection is sometimes informally called a _morning glory_ or _morning wood_.

### Unexpected erections

Most boy teenagers have unexpected erections. Sometimes adult men have unexpected erections. Unexpected erections are involuntary and are normal. People call this a _spontaneous_ (sudden or surprise) erection. Sometimes it happens in school. Sometimes it happens walking. Sometimes it happens taking clothes off for a shower or bath or swimming. This is normal. Such erections can be embarrassing if they happen in public. Erections can occur unexpectedly at any time of day.

#### Difficulty having an erection

A man who often has problems having or keeping an erection of his penis is said to have **erectile dysfunction**. Erectile dysfunction is also known as ED, impotence or male impotence.  The study of erectile dysfunction comes within andrology, the field of science dealing with men's health.

ED is not uncommon. For example, about 10% of all men in the United Kingdom will have ED happening to them regularly at some time in their lives. It can be due to both physiological and psychological reasons. Physiological reasons are those dealing with how the body works. Psychological reasons are those involving human behaviour and how people think. It is normal for male teenagers and men to have an erection several times per night when sleeping. If this does not happen, the person may have a bad medical (physiological) problem and should ask a doctor. If the man does have erections while sleeping, but can't get an erection to have sex, the man could have a mental health problem.

These are some common physiological reasons for ED:

- **Problems with the brain and nerves** – diseases affecting the brain, spinal cord and nerves, such as Alzheimer's disease, clinical depression, diabetes mellitus, multiple sclerosis, panic disorders, Parkinson's disease, schizophrenia and stroke.
- **Circulatory problems** – diseases that affect the way blood circulates (moves around) the body, such as hypertension (high blood pressure) and blood vessels becoming blocked. Such diseases can lead to less blood flowing into the penis. Smoking can lead to ED as it causes arteries to become narrower. Research shows that the number of men who have ED among those who smoke is about 85% higher compared to men who do not.
- **Hormonal problems** – diseases affecting the testicles or pituitary gland such as a tumor in the pituitary gland. (A tumor, also spelled _tumour_, is a bunch of cells growing out of control that can sometimes lead to cancer.) This can cause hypogonadism, which means that there are low levels of testosterone in the body. Testosterone is a hormone (chemical made by the body) that is important in libido (wanting to have sex).
- **Problems with the corpora cavernosa penis** – for example, Peyronie's disease (). When a man with this disease has an erection, his penis is very curved. The curvature is caused by scar tissue growing inside the penis. Peyronie's disease can make having an erection painful and lead to ED.
- **Problems caused by medical treatment and surgery** – the nerves and blood vessels involved in erection can be damaged by some types of medical treatment such as using radiation to kill cancer cells; and surgery of the bladder, colon (large intestine), prostate or rectum. For instance, if men have prostate and bladder cancer surgery they are more likely to suffer from ED because nerves and other tissue around tumors usually need to be taken out together with the tumors. Some drugs (medicines) may also cause ED. One such drug is lithium, which is made of chemicals called lithium salts. Lithium is given to people who suffer from bipolar disorder, a kind of mental illness. People who have bipolar disorder suffer from mood swings – they sometimes feel very happy and friendly, then become angry or very sad. Lithium helps to reduce the number of mood swings. However, it also seems to lower the amount of nitric oxide in the blood vessels of the corpora cavernosa.
- **Lifestyle and growing older** – ED is more common in people who take too much alcohol and illegal drugs, people who are obese (fat in an unhealthy way), and older people.

ED can also happen for psychological reasons. For example, a man can find it difficult to have an erection:

- if thinking about having sex with someone makes him feel anxious or nervous, because he is worried that his sexual partner will think he is not sexy or not good at sexual intercourse;
- if there are problems in his relationship with his partner, such as having arguments, no longer being in love, or facing a divorce;
- if he is feeling a lot of stress due to his job, or big changes in his life like the death of someone close to him; or
- if he is not sure about his gender identity (though he is a man he may feel like a woman) or his sexual identity – whether he is heterosexual (straight) or homosexual (gay).

Having erections is seen by many people as a very important part of being a man. Therefore, a man who has ED often feels that he is not manly enough and not successful in life. This can lead to him feeling ashamed and not as good as other men. The matter is made worse because men often do not like talking about their personal problems with other people, so they keep their unhappy feelings to themselves. However, talking to a doctor or psychiatrist (a doctor who knows a lot about mental problems) is helpful, as he or she may be able to suggest ways of dealing with the problem.

How ED may be treated depends on the cause. If it is caused by a disease, sometimes treating the disease will reduce the problem. For example, if a man is unable to have erections because his body does not make enough testosterone, he can be given pills to take which help his body to do so. If the blood vessels or nerves in the corpora cavernosa penis are damaged, a full cure may not be possible. However, there are some temporary treatments that allow a man to have an erection for long enough to have sex:

- **Medicines** – Medicines in the form of pills that are swallowed such as sildenafil (which is sold as Viagra), tadalafil (Cialis) and vardenafil (Levitra) make the arteries in the corpora cavernosa penis relax, which allows more blood into the penis. There are also other medicines in cream or liquid form that are put into the opening at the tip of the penis, rubbed on the outside of the penis, or injected into the penis using a syringe (a medical tool with a needle at one end that is poked into the body). An example of such a medicine is alprostadil, which also works by making the arteries in the penis become wider.
- **Vacuum pumps** – If medicines do not work, a vacuum pump can sometimes help. This device is made up of a plastic cylinder that fits over the penis, which is joined to a pump. The pump can be electrical or worked by hand. When the pump is used, it draws air out of the space around the penis. This causes more blood to flow into the penis, making an erection happen. Once the penis is erect, the device is taken off. To slow down the flow of blood out of the penis, a tight ring is worn around the base of the penis.
- **Surgical implants** – If other treatments do not work, a last method may be for the impotent man to go for surgery and have a penile implant put into his penis. Modern implants are made up of cylinders that are put inside the corpora cavernosa penis. The cylinders are connected by tubes to a pump that is put under the skin near the testicles. When the pump is used, it pushes fluid into the cylinders, which become hard and cause an erection. After the man has finished having sex, he can press a valve that allows the fluid to flow out from the cylinders.
- **Counselling** – If a man's ED is caused by a psychological problem, counselling can often help. This means talking to a psychiatrist to try and understand what is making the man feel anxious or worried and to find ways of dealing with the matter. Even if the ED is not caused by a mental problem but some disease, talking to a psychiatrist can also be useful if the man is very worried.

#### Symbol of sex and fertility

When an erect penis is shown in art, it is often called a phallus. Erotic (sexually exciting) art has shown phalluses for a very long time. Pictures of men with erections appear on ancient objects and in paintings.

The erect penis was also a symbol or sign of health and fertility (the ability to give life). The Hohle Fels phallus was found in a cave in Germany. It is a piece of stone carved to look like a penis that archaeologists believe is about 28,000 years old. (Archaeologists are scientists who study the past by looking for things that people have left behind.) From the fourth millennium B.C. (4000–3001 B.C.), Ancient Egyptians worshipped Min as the god of reproduction and the maker of all things. Min was shown in statues and on wall carvings as having an erect penis.

The Ancient Greeks believed in a god called Priapus who had a very large penis that was always erect. He was thought to protect livestock (animals kept by humans for food, milk, leather or wool), fruit plants and gardens, and men's sex organs. He was also seen as able to chase away evil, and as a protector of sailors, fishermen and others needing good luck.

Long after the Roman Empire ended and many people became Christian, Priapus was still seen as a symbol of health and fertility. A 13th-century book called the _Lanercost Chronicle_, which is a history of northern England and Scotland, talks about someone putting up a statue of Priapus to try and stop a disease from spreading among cattle.

Some Native Americans in the Southwestern United States believe in a fertility god called Kokopelli who is in charge of childbirth and agriculture (the growing of plants and animals for food and other uses). He also plays tricks and is a symbol for the spirit of music. Kokopelli is sometimes shown as a man playing a flute with a humpback (a back that is bent forwards), things like feathers sticking out from his head, and a very big penis.

## Infobox (disease)

- **name**: Erectile dysfunction
- **diseasesdb**: 21555
- **icd10**: ,
- **icd9**: ,
- **emedicinesubj**: med
- **emedicinetopic**: 3023
- **meshid**: D007172