The physiology of our emotions—stress, fears, sadness, and anxiety can all impact our health in huge ways. Often we look to solve our physical symptoms by addressing the physical problem, without acknowledging an underlying fear or anxiety that can not only make this physical sensation worse but also can be playing a role in the root cause of the issue.

Our emotional state can impact our sleep, digestion, energy, and ability to physically move our bodies in a desired way. As a urologist, I encounter countless men who express a physical manifestation of their anxiety, stress, and fears as having a difficult time getting and maintaining an erection, having testicular pain, and having urinary symptoms.

This guide is meant to serve as a roadmap to help you understand how your internal state can impact your physical body, and what you can do about it.

Simply the act of acknowledging that these emotions exist within us and that they can impact our physical health is such an important step. We can’t fix what we don’t acknowledge. Once, as men, we acknowledge that we have this anxiety, stress, sadness, or fear, we can begin to make changes and address the root cause of our symptoms.

Below are a few of the common questions that men in my medical practice will ask me…

Doc, why can’t I keep my erection during sex anymore? I used to be fine, but for the past few months, it hasn’t been working right. I’m in my 30s, why is this happening?

There are many reasons why men can’t get or sustain an erection– such as damage to the arteries and veins in the penis from years of uncontrolled diabetes, high blood pressure, and high cholesterol.

However, men in their 20s and 30s, by and large, do not suffer from these chronic conditions.

The vast majority of the time, there is a nervous system imbalance in our bodies that leads to poor blood flow in the penis.

Every human has two main nervous systems-- the parasympathetic nervous system and the sympathetic nervous system. The latter of the two is often referred to as your “fight or flight” nervous system. This system is what has kept us alive from predators throughout our evolution. When the body is in this state, our heart pounds and our blood pressure rises. When the sympathetic nervous system is activated, our bodies shunt blood away from our gut and penis and into our legs and arms so that we can run, fight, or escape a perceived threat. Once the threat passes, we are then supposed to return back to our normal resting nervous system, the parasympathetic nervous system. 

The parasympathetic nervous system is often referred to as our “rest and digest” nervous system. This is the nervous system that we are supposed to exist in the vast majority of the time. When our bodies are in this state, we have optimal blood flow to the digestive tract for digesting our food, and to our penis, so we can then have an erection– and have sex. 

Let’s say you’re being chased by a tiger. Your body, in this scenario, is not designed to want sex at this moment, and it’s certainly not designed to actually be able to have sex. 

One of the biggest issues I see in my practice is that men are chronically stuck in a sympathetic, fight-or-flight nervous system. This causes a system overload – an imbalance – and is terrible for a whole host of bodily functions, especially our ability to maintain an erection. Often, men are stuck in this sympathetic overdrive.

I see countless men who are going through a transition time in their life—entering a new relationship, just finishing college, having a baby, or even getting a new job. These major life transitions can cause a lot of internal anxiety or stress that pushes men over the edge and keep them stuck in a sympathetic nervous system imbalance. When we exist in this state, our body actually uses different neurotransmitters that make it harder to get an erection. 

Some men in their 30s come to see me because, for the first time, they are struggling in this way. There is no “medical” explanation for their issues. However, when I start to ask them about their life, they reveal that there are actually a lot of issues in their marriage, that they feel overwhelmed with their kids, or feel lost in their life. Sometimes they just feel that life and their relationship has lost its passion and excitement. 

When I begin this line of questioning with my patients, it becomes obvious fairly quickly that no one else has asked them how they are doing and what they are experiencing in their emotional world. Certainly, they are not used to hearing questions like this from their physician. It’s not surprising then, that they are now at the point of experiencing the physiology of their emotions in the form of physical symptoms. This is the pattern. 

Doc, why do I feel like I have to pee all day long??

We can carry tension and stress in a variety of places in our bodies. Some men will carry stress in their necks. They will complain of neck pain, stiffness, and headaches. For many men, they store stress and anxiety in their pelvic muscles. 

The pelvis is a bowl or hammock of muscles, fascia, and tendons. When our bodies suffer from a sympathetic nervous system imbalance our muscles in the pelvis are under constant tension and tightness. This tension in the pelvis can put pressure on the organs it supports such as the bladder. 

This tension and tightness give men the feeling that they constantly need to pee throughout the day. 

Most people know about the “nervous pee” or “stage pee”—the sensation that you need to go to the bathroom before going on stage for a performance because you get anxious before performing. The same physiologic response is happening for men who exist in this heightened state of nervousness or anxiety; however, instead of being related to a performance, a speech, or a particular event, their stress and anxiety are constant and present throughout the day. 

If we just focused on the physical symptom, we ignore the root cause of the constant state of stress that these men exist with.

“If we just focused on the physical symptom, we ignore the root cause of the constant state of stress that these men exist with.”

Doc, I have this low-level, dull ache in the balls. Sometimes it goes down my legs or back around to my back. What the hell is going on?

Just as the pelvic floor can be under an insane amount of tension from our stress on a daily basis and manifest as urinary symptoms, often men will describe a low dull ache in their testicles or lower abdomen. In the urological world, we call this pelvic pain.

Our internal emotional state can have a direct impact on the muscle tension of our pelvic floor. The more stress or anxiety we run through our body on a daily basis, the tighter these muscles can become. When these muscles tighten or are under chronic stress, it can lead to pelvic pain. Sometimes, this pain will show up as pain in the testicles, low back, or lower abdomen.

As life gets busier and more stressful—new job, new baby, financial pressure, relationship issues—unless we have healthy outlets for releasing this stress, our bodies get tighter and hold onto this tension, which can cause pain.

So what can I start to do about these issues?

The first thing that I help men do is make the connection between their emotions and physical systems. Just having the awareness of this connection can be revolutionary for men as they think about themselves—their body, mind, and how they carry themselves throughout the day.

Often men in my practice never imagined that the stress or unhappiness in their relationship can affect their erections. Or that the new mortgage has caused them so much stress that they constantly feel under pressure from the financial weight of their lives and that this can cause them to feel actual physical pain in their bodies. Simply providing men with this insight can begin to shift their internal state.

When we exist in a state of sympathetic nervous system overdrive, I believe it is crucial to start to de-escalate our system. While this can be done in a variety of ways, in my personal experience and what I have seen work, there are three tools that we can use to transition out of a sympathetic imbalance. 

1. Breath.

Through breath work (such as the 4-7-8 breath, cyclic physiological sighing, or even box breathing), we can activate our parasympathetic nervous system and help to begin to calm our nervous system. Breathwork can be used as a foundational practice in the morning to help lower the intensity of our nervous system throughout the day. I also use this practice to help me calm my system after a stressful event in order to get back to a more parasympathetic state. So many men take for granted the power that breath can have over our bodies. Breathing is something that is done unconsciously approximately 22,000 times per day—imagine the power this can hold for us if we place even a small amount of intention and focus on this simple and powerful act. 

2. Movement.

Movement is a key piece to emotionally regulating our nervous system and shifting out of a sympathetic overdrive. When men engage in physical movement, they move out of a thinking space and into their bodies. Through physical exertion, men are able to start to move, process, and release their emotions- stress, anger, sadness, and overwhelm. There is both the endorphin release that comes with physical movement as well as the psychological benefit of simply moving one's body. 

3. Identifying the root of your emotions.

It is paramount that men take stock and identify the root of their stress, anger, sadness, or anxiety. In my experience, while these feelings can be hard for men to admit, once they are acknowledged, the root cause is relatively easy to pinpoint. For example, it was hard for me to admit that I was unhappy in my life. However, once I came to terms with this reality, it was clear to me that I was unhappy with my current job and the state of my marriage. Once I was able to acknowledge these issues, I could begin to direct my energy and focus on addressing these issues.

Men, I hope that you have found this guide helpful. I want you to know that you’re not crazy. Your physical symptoms are real– and your emotions and your inner world, medically speaking, have a very real impact on your physical body. The emotional root cause for your physical symptoms is just as valid as the more commonly diagnosed conditions that are treated with pharmaceuticals or surgery. And there is a way to feel better.

Exploring the world of our emotions can feel overwhelming, especially in the beginning, and for men who have been conditioned to think that having emotions equates to weakness or threatens our masculine identities.

If you would like more support around this, I invite you to check out my 6-week foundational online group coaching program: Men’s Work: A Guy’s Guide to Growth. In this course, we explore deeper how these emotions can impact our life and how to begin to sort through some of these overwhelming emotions. Additionally, If you are in the Boston area, I would love to work with you in my urology practice at Greater Boston Urology. 

All the best,

Jonathan Brajtbord, MD