The mental model that finally clicked for me: erections are plumbing with two switches.
- Switch 1 (parasympathetic “rest-and-digest”): brain/nerve release nitric oxide, smooth muscle relaxes, arteries open, the tunica traps blood (veno-occlusion).
- Switch 2 (sympathetic “fight-or-flight”): adrenaline tightens things, blood drains, game over.
Same pipes, different triggers.
A few things that weren’t obvious to me at first:
- Types of erections: psychogenic (brain), reflexogenic (touch/spinal), and nocturnal (REM) use different triggers but the same plumbing. If morning wood is solid yet sex is a struggle, that often screams “wiring is intact, but stress/performance loop or situational factors are interfering.”
- Pelvic floor: too tight and too weak look different. Tight signs: hesitant/stop-start pee, post-void dribble, perineum/testicle ache, “hard flaccid,” Kegels make it worse. That group does better with downtraining: diaphragmatic/belly breathing, “reverse Kegels” (gentle let-go like starting a pee), adductor/hip opener stretches, longer exhale. Weak signs: leaks with cough/laugh, can’t maintain rigidity, poor gas control; then add measured Kegels (quick flicks + 10-15s holds) but always restore full relax between reps. A pelvic floor physio was a game-changer for me.
- In-the-moment nerves: long exhale is the cheat code. Try 4-7-8 or just 6-8s out, 3-4s in, through the nose. Humming works surprisingly well (vagus nerve tickle). Cold water on the face for 10 seconds can flip off adrenaline (diving reflex). Also unclench jaw, glutes, and abs-those clench with anxiety and tug the pelvic floor tighter.
- Nose vs mouth: the nasal NO bump is real but small; the bigger win is that nasal, slow breathing keeps CO2 up and shifts you parasympathetic. Posturewise, neutral pelvis and soft belly > rigid “standing tall.” Bike seats can irritate the pudendal nerve-cutout/pressure-relief saddles helped me.
- Food/alcohol/timing: heavy meal or high booze = worse EQ right away (blood shunted to gut, endothelial function dipped). Dehydration shrinks plasma volume. What helped: light meal, 2-3 hours buffer, water + a little salt if I’d been sweating, minimal alcohol.
- PDE5s (Viagra/Cialis): they don’t start the party, they keep the doors open longer. If they help, your NO/nerve “on” switch probably works. If you still fade mid-way, think venous leak, pelvic floor overclench, or anxiety; a light constriction ring plus slower, arousal-first pacing made a noticeable difference for me.
- Tests that actually gave answers: NPT/RigiScan (good nocturnal rigidity = likely psychogenic/situational); penile duplex with injection (tells you artery inflow and venous leak); labs (A1c/fasting glucose, lipids, total + free T, prolactin, TSH); sleep apnea screen if snoring/daytime sleepiness.
Stuff that moved the needle the most:
- 30-45 min brisk walking most days + a couple short strength sessions (endothelial function improved).
- Sleep 7-8 hours; treating mild apnea mattered more than any supplement.
- Pelvic floor downtraining and switching from “try harder” to “relax more.”
- Cutting back porn and extending foreplay-more time in the parasympathetic zone.
- Nasal slow breathing during sex; long exhale whenever I felt “uh-oh.”
Simple analogy I keep in mind: arousal is a dimmer, not a light switch. Spend more time turning the dimmer up (safety, relaxation, sensation), and the plumbing usually follows.