Erectile Dysfunction (Part 1): Why it happens and treatment options
When people think about erectile dysfunction (ED), they often think of it as a blood flow problem.
And while blood flow absolutely matters, erections are actually far more complex than most people realize.
Erectile function depends on communication between multiple systems in the body, including:
The brain
The nervous system
Blood vessels
Hormones
Emotional health
The pelvic floor muscles
In a recent conversation with Kelowna-based urologist, Dr. Chris Bitcon, we explored the medical side of erectile dysfunction, how erections actually work, and why ED is rarely caused by just one thing.
For many people, erectile dysfunction can feel isolating, frustrating, or embarrassing. But understanding what’s happening physiologically often helps remove some of the fear and shame surrounding it.
Let’s break down what’s really going on.
First, how do erections happen?
Most people assume erections are simply about blood flow.
But erections actually begin in the brain and nervous system.
As Dr. Bitcon explained, sexual function involves several phases:
Desire
Arousal
Orgasm
Resolution
Before blood flow changes even occur, the brain has to interpret safety, interest, attraction, stimulation, and context.
From there, the nervous system signals blood vessels to relax and allow increased blood flow into the penis.
If everything is working well, this process feels automatic.
But when there’s disruption anywhere along that system—whether physical, emotional, neurological, hormonal, or vascular—erections can become more difficult.
The Nervous System Plays a Huge Role
One of the most important concepts we discussed is the role of the autonomic nervous system.
The body has two main nervous system states involved here:
The parasympathetic nervous system (“rest and digest”)
The sympathetic nervous system (“fight or flight”)
Erections occur most easily when the parasympathetic nervous system is active.
In other words, the body needs to feel relatively safe, relaxed, and regulated.
But when someone is stressed, anxious, overwhelmed, distracted, sleep deprived, or emotionally activated, the sympathetic nervous system becomes dominant and the body shifts its priorities.
As Dr. Bitcon explained:
“If you’re running away from a tiger, you don’t need to have an erection.”
This is often a huge realization for patients.
Sometimes the issue is not that the body is “broken.”
Sometimes the nervous system is simply responding appropriately to stress.
Stress and Life Circumstances Matter More Than People Think
One thing that became very clear during our conversation is that erectile dysfunction is rarely just physical.
When evaluating ED, Dr. Bitcon asks questions such as:
Are you waking with morning erections?
Can you get erections during masturbation?
Has there been a major life stressor recently?
Are you sleeping poorly?
Is there relationship stress?
Have there been changes in health, work, parenting, caregiving, or emotional wellbeing?
These questions help determine whether the issue may be more situational, stress-related, or connected to broader health concerns.
For many people, factors such as these can all affect erectile dysfunction:
chronic stress
anxiety
burnout
relationship difficulties
poor sleep
chronic pain
performance anxiety
Erectile Dysfunction Can Be a Warning Sign
Although stress and nervous system regulation are important, erectile dysfunction can also be an important health marker.
Dr. Bitcon explained that ED is commonly associated with cardiovascular risk factors such as:
High blood pressure
Diabetes
Smoking
Obesity
High cholesterol
Reduced cardiovascular fitness
Because penile blood vessels are relatively small, erectile changes may sometimes appear before other cardiovascular symptoms.
This is one reason erectile dysfunction should never simply be dismissed as “just aging.”
The Pelvic Floor also plays an important role in erectile dysfunction and this is an area I am regularly educating my patients about.
The pelvic floor contributes to:
Erectile rigidity
Blood flow control
Ejaculation
Pressure management
Breathing coordination
Nervous system regulation
Core, hip, low back function
One of the biggest misconceptions is that pelvic floor therapy simply means “doing Kegels.”
In reality, treatment is much more individualized.
Sometimes the pelvic floor needs strengthening.
Sometimes it needs relaxation.
Sometimes treatment focuses on:
breathing patterns
chronic pain
movement habits
nervous system downregulation
coordination between the diaphragm and pelvic floor
For individuals with pelvic pain, urinary symptoms, prostatitis symptoms, pain with erections, or chronic tension, pelvic floor physiotherapy is often an important part of treatment.
Medication Can Help—But It’s Not Always the Whole Solution
Many people assume treatment for ED automatically means medication.
These medications can absolutely be helpful as they improve blood vessel dilation and blood flow.
But they do not directly address:
chronic stress
anxiety
relationship concerns
pelvic pain
nervous system dysregulation
unrealistic expectations
emotional health
lack of desire
This is why medication alone is not always enough.
The underlying contributors still matter.
Lifestyle Factors Often Have a Bigger Impact Than Expected
One of the strongest themes from our discussion was the importance of foundational health.
Lifestyle factors can significantly influence erectile function, including:
cardiovascular fitness
regular exercise
sleep quality
smoking cessation
stress management
nutrition
reducing excessive alcohol use
reducing cannabis use
mental health support
These changes don’t just affect erections.
They affect energy, mood, cardiovascular health, nervous system regulation, and overall wellbeing.
Treatment Requires a Whole-Person Approach
Depending on the individual, treatment may include:
pelvic floor physiotherapy
counseling or sex therapy
medication
lifestyle changes
stress management
cardiovascular exercise
vacuum devices
injectable therapies
medical evaluation for underlying conditions
One of the most important things Dr. Bitcon and I discussed is this:
Erectile dysfunction is extremely common.
And experiencing ED does not automatically mean something is permanently wrong or irreversible.
Sometimes the body is responding to stress.
Sometimes it’s responding to pain, fatigue, illness, cardiovascular changes, medications, or nervous system overload.
Understanding why something is happening often helps people move away from shame and toward solutions.
Final Thoughts
Erectile dysfunction is far more complex than most people realize.
It’s not simply about aging. It’s not simply about testosterone. And it’s not simply about blood flow.
Erectile function reflects the interaction between physical health, nervous system regulation, emotional wellbeing, relationships, and pelvic floor function.
The good news is that many contributing factors are treatable.
And for many people, the first step is simply understanding that they are not alone—and that support exists.
Find a healthcare provider who can help you look at the full picture and guide treatment in a way that is individualized for YOU.
This blog is intended for educational purposes only and does not replace individualized medical advice.
About Dr. Chris Bitcon
Dr Chris Bitcon is a practicing Urologist in Kelowna. Dr. Bitcon grew up in Kelowna and is the epitome of a BC boy: involved in every sport under the sun and loves being outdoors. He completed medical school at UBC’s Island Medical Program in Victoria and urology residency at Dalhousie University in Halifax. He went on to complete a co-fellowship through the University of Toronto, specializing in both minimally invasive/robotic surgery as well as pediatric urology. Though he has two sub-specialties, he remains passionate about being a true general urologist and treats all urologic conditions.
