The erection mechanism is one of the more complex in the body. In short, impulses from the center in the brain travel along the spinal cord towards the pelvis. are further transmitted via the pelvic nerves to the penis. Under their influence, there is an opening of the channels with which blood touches into the spongy tissue of the penis. At the same time, there is a closure of the venous channels with which blood flows from the spongy bodies. Thus, blood retention occurs in the penis, which causes it to increase and stiffen. Various neurological diseases can lead to damage to the described nervous pathway and improper transmission of impulses. Damage can be located in the brain (e.g. condition after cerebrovascular insult, Parkinson’s disease, etc.), in the spinal cord (e.g. spinal injuries, disc prolapse) or in the pelvic nerves.
In addition to pelvic surgery, diabetes mellitus is one of the most common causes of their damage (the so-called neurogenic impotence). In addition to peripheral polyneuropathy, diabetes mellitus provokes the rotation of blood vessels, so the influx of blood into the penis can be significantly reduced (the so-called vascular impotence). Atherosclerosis, often accompanied by high blood pressure and pathological values of holesterol and lipids in biochemical blood tests, is one of the most common causes of blood circulation of arteries in the pelvis. Smoking is a predisposing factor. A recent study conducted in Sweden showed significantly weaker flow through blood vessels in even more potent smokers as opposed to non-smokers. In other words, smoking leads to a decrease in blood flow through the penis even before potency problems occur.
Reducing blood flow through the penis most often does not lead to shortening. It usually occurs with age, as a result of lowering the male sex hormone (testosterone) in the circulation. Peyronie’s disease (induratio penis plastic) in which lime deposition occurs in the envelopes of the penis, can lead to its deformation at erection and shortening of the limb.
The psychogenic factor can be the only cause of impotence and is usually seen after experiencing psychological stress, but more often it occurs as an upgrade to the existing neurological or vascular cause. Fear of failure can often block an erection. Some hormones, such as testosterone and prolactin are directly involved in the erection mechanism, so their disorder can also lead to impotence. Some drugs have a partial or complete loss of potency as a side effect, which usually disappears shortly after the cessation of taking it. From the described it is clear that several reasons can lead to lower potency, and therapy depends on the cause.
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