Stress, Relaxation and Erections (and the Chakra Myth)

Many patients tell me that when they go for a spa massage or on holiday, erections come much more easily than at home. Many are puzzled about why. The answer isn't mysterious; it is purely the nervous system. This article explains why relaxation matters and separates clearly what has evidence from what is belief.

Your body has to feel safe first

The autonomic nervous system has two sides:

• Parasympathetic: the "rest" system, which relaxes the penile blood vessels so blood flows in and an erection happens
• Sympathetic: the "fight or flight" system, which switches on when you are stressed, afraid or anxious, narrowing the blood vessels so the penis goes soft

When we are stressed, adrenaline and cortisol rise and the body goes into survival mode, which is not sex mode. That is why a spa, with dim lights, pleasant scents, slow music, a quiet room and no phone ringing, makes it easy for the body to switch into rest mode. The erection then follows on its own, without being forced.

Rest system

Parasympathetic

• Active when you feel safe and relaxed
• Penile blood vessels relax
• Blood flows in; erection occurs

Fight-or-flight

Sympathetic

• Active under stress, fear or worry
• Adrenaline and cortisol rise
• Vessels tighten; erection softens

vs

The anxiety loop (performance anxiety)

You fail to get hard once, and the next time you start thinking, "Will it work this time?" During sex you keep checking yourself. A brain on alert is a brain that has switched on the sympathetic system. The result is that you really don't get hard, and then you worry even more.

This loop is very common in young, physically healthy men, and often comes with premature ejaculation. Read more in Premature ejaculation (PE). The tell-tale sign is that morning erections and erections during masturbation are still good.

1. 1
   Soft onceHappens to everyone
2. 2
   Predict aheadWill it work this time?
3. 3
   Self- monitoringThe brain switches on fight-or-flight
4. 4
   Really softMore anxiety next time

Clue: erections in the morning or when alone are still fine.

Create a relaxing atmosphere at home

• Dim, warm lighting and soft music
• A clean bed, a comfortably cool room and a scent you like
• Silence your phone, the TV and work
• Choose a time when you're not rushed, exhausted or very drunk
• Agree with your partner beforehand that today there is no goal, and penetration is optional

The last point is the most important. Once the pressure is removed, many men find erections come back by themselves.

Evidence-based techniques

1. Slow diaphragmatic breathing

Breathe in through your nose for 4 seconds, letting your belly rise, then breathe out slowly for 6 seconds. Do this for 5–10 minutes. Long out-breaths stimulate the parasympathetic system through the vagus nerve and help reduce panic.

2. Mindfulness during sex

Instead of thinking about the outcome, pay attention to the sensations in front of you, such as the warmth of skin or the rhythm of breathing. A pilot study by Bossio and colleagues (2018) found that group mindfulness training helped men with situational ED. Read more in Mindfulness and sex (mindful sex).

3. Sensate Focus with your partner

This is step-by-step touch practice in which you agree that, at first, there will be no penetration, to reduce pressure and rebuild intimacy. See how in Sensate Focus: a technique to rebuild intimacy for couples.

4. Pelvic floor exercises

Squeeze the muscles as if stopping the flow of urine, hold for 3–5 seconds, then relax. Do this 10 times, 2–3 times a day. A randomised trial by Dorey and colleagues (2005) found that it improved erections in some groups of men, and it also helps with ejaculatory control.

What about chakras and tantra?

An older article from the clinic once said that focusing the mind on the root chakra (Muladhara) or the sacral chakra (Swadhisthana) helps "open life energy" and directly stimulates the nerves for erections. I want to correct that clearly:

• Chakras are a spiritual and cultural concept from India. There is no anatomical structure that can be found, and no research showing that "opening chakras" increases blood flow to the penis.
• What genuinely works in this kind of practice is slow breathing, focusing attention on the body and awareness of the pelvic floor muscles, which match the evidence-based techniques above.

If you enjoy practising within a tantra or meditation framework and it helps you relax, carry on. Just don't use it in place of checking for physical causes, especially if you have vascular risk factors.

When relaxation alone isn't enough

• You don't get hard in any situation, including in the morning and during masturbation
• You have diabetes, high blood pressure, high cholesterol, you smoke, or you are over 40
• Your sex drive has dropped a lot and you tire easily
• Stress or depression is affecting your daily life. If you feel very low, you can call 1323, Thailand's free 24-hour mental health hotline (Thai language; ask for English support)

In these cases, look for other causes. Read What causes erection problems.

How the clinic can help

At Dr. Kris Clinic I look after both body and mind, from checking for physical causes to sexology counselling about anxiety, communication with your partner and practising these techniques. Some men may use medicine for a short time to break the anxiety loop, as assessed by the doctor. You can see us in person in Surat Thani or online, and consultations in English are available.