May is Mental Health Awareness Month, which you might find an odd thing for a urology practice to highlight on its blog. But here's the thing: Our mental health can affect our physical health. And we're not just referring to random pain, either, but specific conditions, like erectile dysfunction.

Today, we're joined on the blog by one of our board-certified urologists, Dr. Jonathan Brajtbord, who takes a holistic approach to his practice and believes in focusing not only on physical symptoms, but also the patient's mental health.

Below, Dr. Brajtbord discusses . . .

• What he's been seeing in his practice, especially among younger men dealing with ED and urinary issues.
• Common questions he hears from patients—and how he always digs a little deeper to see if an emotional connection exists between the physical manifestation
• Three key steps men can take if they do indeed find there's an emotional component to their physical ailment

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider regarding your unique healthcare needs. 

Now, here's Dr. Brajtbord, in his own words.

How Our Emotional State Can Affect the Physical

As a urologist, I see hundreds of men with a wide range of health issues. Throughout my years of medical school and residency training, and now as an attending physician and surgeon, I have come to fully embrace the truth: Our emotions can significantly affect our bodies and present as very real physical symptoms.

The physiology of our emotions—like stress, fear, sadness, and anxiety—can affect our health. Often, we look to solve our physical symptoms by addressing the physical problem without acknowledging an underlying fear or anxiety that might not only be making 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, or having urinary symptoms.

Simply acknowledging that these emotions exist within us and can impact our physical health is an important step. We can't fix what we don't acknowledge. Once 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 some common questions men in my medical practice will ask me.

Question #1: Why can't I keep my erection during sex anymore? I used to be fine, but it hasn't been working right for the past few months. I'm in my 30s. Why is this happening?

There are many reasons why men can't get or sustain an erection. These reasons include 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. In this population, the vast majority of men are dealing with a nervous system imbalance that leads to poor blood flow in the penis.

Understanding the parasympathetic nervous system vs. the sympathetic nervous system.

Every human has two main nervous systems: the parasympathetic nervous system and the sympathetic nervous system. The latter is often called your "fight or flight" nervous system. This system 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 supposed to return to our normal resting nervous system—the parasympathetic nervous system.

On the other hand, the parasympathetic nervous system is often referred to as our "rest and digest" nervous system. This is the nervous system that we're supposed to exist in most 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.

A good example illustrates the difference: Let's say a tiger is chasing you. 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 lives, like 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 keeps them stuck in a sympathetic nervous system imbalance. When we exist in this state, our body uses different neurotransmitters that make it more challenging 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 vital things, like issues in their marriage, feelings of being overwhelmed by their kids, or feeling lost in their lives.

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 experiencing the physiology of their emotions through physical symptoms. This is the pattern.

Question #2: Why do I feel like I have to pee all day long?

Tension and stress can be stored in various places in our bodies. Some men carry stress in their necks, complaining of neck pain, stiffness, and headaches. Many men 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, like the bladder, resulting in 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 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 focus on the physical symptoms, we end up ignoring the root cause of the constant state of stress that these men exist with.

Question #3: I have this low-level, dull ache in my testicles. Sometimes, it goes down my legs or around my back. What's going on?

Just as the pelvic floor can be under enormous tension from daily stress and manifest as urinary symptoms, men often 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 directly impact the muscle tension of our pelvic floor. The more stress or anxiety we experience on a daily basis, the tighter these muscles can become. When these muscles tighten or are under chronic stress, they can lead to pelvic pain. Sometimes, this pain will show up as pain in the testicles, lower back, or lower abdomen.

As life gets busier and more stressful—a 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.

What can men do about these issues?

The first thing that I help men do is make the connection between their emotions and physical symptoms. 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 could 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, which can cause them to feel actual physical pain in their bodies. Simply providing men with this insight can be enough to begin to shift their internal state.

When we are in a state of sympathetic nervous system overdrive, I believe it is crucial to start de-escalating our system. While this can be done in various ways, in my personal experience, I've seen three tools work that people can use to transition out of a sympathetic imbalance.

Tool #1: Don't underestimate the power of your breath.

We can activate our parasympathetic nervous system through breathwork (such as the 4-7-8 breathing technique, cyclic physiological sighing, or even box breathing) and help 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 to return to a more parasympathetic state.

So many men take for granted the power that breath can have over our bodies. Breathing 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.

Tool #2: Make time for daily movement.

Movement is critical 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 moving, processing, and releasing their emotions—stress, anger, sadness, and overwhelm. Physical movement releases endorphins, and the psychological benefit of simply moving one's body is also present.

Tool #3: Identify 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 men acknowledge these emotions, 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 them.

What should you do next if your emotional health is affecting your physical well-being?

I hope the above information has been helpful. I want men to know that their physical symptoms are real and that what goes on with their emotions and inner world, medically speaking, has a very real impact on their physical bodies. The emotional root cause for their 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'd like more support around this, I invite you to check out my six-week foundational online group coaching program, Men's Work: Inner Work for Professional Men. In this course, we explore how these emotions can impact our lives and how to begin sorting through some of these overwhelming emotions.

Additionally, I would love to work with you in my urology practice if you're in the Boston area. Click here to request an appointment with me in our Dedham Care Center.