Effect of Estradiol on Penile Erection

A Cross-Sectional Study

Zhi-He Xu; Xin-He Xu; Dong Pan; Tong-Yan Liu; Ming-Zhen Yuan; Shan Jiang; Yong Guan; Sheng-Tian Zhao


Transl Androl Urol. 2019;8(6):574-582. 

In This Article

Abstract and Introduction


Background: Past studies have shown that elevated estradiol levels could inhibit penile erection, but the relationship between estradiol and erection of the penile tip or base has not been extensively researched.

Methods: We therefore investigated estradiol's effects on the erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction (ED), based on scores of ≤21 according to the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure (BP), serum glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E), and testosterone (T). Univariate and multivariate analyses were used to assess associations between estradiol levels and erection at the penile tip and base.

Results: We found no obvious relationship between erection time at penile tip and estradiol levels but did observe a negative correlation between base erection time and estradiol level [hazard ratio (HR): −0.11; 95% CI: −0.80–1.72]. With increasing estradiol concentration, multivariate analysis showed an obvious reduction in base erection time among patients with normal Rigiscan results (HR: −0.31; 95% CI: −1.63–1.29) (P<0.05) as estradiol concentration increased.

Conclusions: Our data indicate that estradiol inhibits penile erection, particularly at the penile base. Also, when the effective erection time of the penile base lasts longer than 10 min, estradiol has a more obvious inhibitory effect on penile base erection.


Erectile dysfunction (ED) is a common problem affecting more than 150 million men worldwide. ED is defined as the persistent inability to attain an erection sufficient to permit satisfactory sexual intercourse.[1] A meta-analysis consortium study reported that ED was present in nearly 17% of all European males in 2004 and that it will affect 322 million European males by 2025.[2,3] ED has biological, psychological, and social effects on the quality of life of men and their sexual partners.[4] ED can cause frustration, anxiety, and depression in men and therefore can affect job performance, social activities, and family stability.[5–7]

ED may result from psychological, neurologic, hormonal, arterial, or cavernosal impairment or a combination of these factors.[8,9] This study was performed to investigate the relationship between estradiol (E) and ED.

Estradiol is an important sex hormone and an important feedback regulator of the hypothalamo-pituitary axis and the serum levels of testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Estradiol biosynthesis is initiated by the synthesis of the 19-carbon steroid hormone pregnenolone from cholesterol. This compound is converted into testosterone and then into the estrogens estrone and 17b-estradiol. Estradiol biosynthesis is catalyzed by aromatase, a microsomal member of the cytochrome P450 superfamily that introduces the characteristic phenolic ring. In premenopausal women, the ovaries are the principal source of 17b-estradiol, which functions as a circulating hormone to act on distal target tissues. In men and postmenopausal women, when the ovaries cease to produce estradiol, 17b-estradiol is produced in several extragonadal sites (e.g., adrenal glands, adipose tissue) and acts locally as a paracrine factor.[10] Estradiol exerts most of its biological actions via estradiol receptors (ERs).[11] ERs are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. In human[12,13] and animal[13,14] penile tissues, ERα is abundantly expressed. An excess of estradiol has a detrimental effect on many facets of male health and has direct or indirect effects on male erection.[15]

Previous studies have shown that elevated estradiol inhibits penile erection.[16–19] However, few studies have shown a relationship between estradiol and erection of the penile tip or penile base. The potential relationship between ED and estradiol led us to investigate the relationship between estradiol levels and erections of the penile tip and penile base.