Most men will experience some form of erectile dysfunction (ED) at some point in their life. It will usually be significant enough that they will visit a doctor to discuss treatment options. Unfortunately for many men, this becomes a chronic state that they will continue to live with. Depending on the presentation of ED, the treatment options are erectile pumps, injections, shock therapy and medications. These are not often directed at curing the mechanism but instead providing a work around treatment. Once the blood flow engorgement of the penis has been released or the medication has had its effect, the mechanism causing the erectile dysfunction often still remains. 

What processes are at play that affect the ability to have an erection, or simply put, how to get H.A.R.D.? 

Heart and circulatory system

The penis engorges with blood to become erect. If blood circulation is obstructed, or the muscles that hold the blood in the penis lose their integrity, the quality of erection will decline. Atherosclerosis, Diabetes, Hypertension, smoking and chronic inflammation all affect vessel health and have been associated with erectile dysfunction. Prevention and treatment measures directed at vascular health and longevity is a positive choice for erectile health as well as chronic illness management. 


Testosterone is the hormone most associated with male reproductive health and achieving erections. It is also essential for maintaining the structural integrity of the nerve network and smooth muscle function required for achieving, maintaining and releasing an erection. Inadequate sleep (less than 6 hours per night), being overweight, some prescription medications, thyroid dysregulation and steroid use can affect testosterone production. Addressing some potentially causative lifestyle habits and investigating for hormone balance is pertinent for any cases of erectile dysfunction. 


Not only does the erectile tissue require blood flow, it also needs to prevent drainage of that blood by relaxing and flattening the veins leaving the penis. The coordination of this is largely mediated by the nervous system and the smooth muscle tissue of the genitals. Trauma to the lower back, pelvis or genitals can sometimes result in a breakdown in communication of these systems. Maintain responsive and healthy pelvic floor muscles by practicing Kegel exercises regularly. 


This refers to the stimulus and also how open the mind is to the idea of sexual activity. The erectile tissue of the penis can be stimulated through direct or indirect means. Direct stimulation is through contact with the penis and the resulting nervous cascade that communicates this message via the lower lumbar nerves and that message is relayed to the brain (amygdala and hypothalamus). Whereas indirect stimulation starts from the brain and is relayed down to the genitals via the sympathetic nervous system and the lower lumbar nerves. This stimulus can be auditory, imagined or visually initiated. 

There are many factors that can interfere or suppress this process from occurring. Stress, anxiety, depression, relationship tension, fear of inadequacy, and desensitization can all negatively affect the signaling from the brain and impede erections from occurring. Mindfulness exercises, counselling or other forms of therapy and support can all be beneficial. 

We are here to help

There are several potential treatment modalities that could be quite beneficial. Discussing your concerns and addressing any underlying health issues with our men’s health focused practitioner would be a great first step. We can help!