Psychological Erectile Dysfunction


Psychological erectile dysfunction

It is not a secret that the relationships between partners are made up of interpersonal, psychological, and sexual relations. If between partners spiritual affinity is not found, they will be very hard to achieve a harmonious sexual relationships. Given that sexual activity of man and woman is closely interconnected with psychological health, in the lack of harmonious relationships a sexual disorder may occur in one or both partners.

It is noteworthy that women can hide the presence of sexual dysfunction from their partner for many years. They can lead an active sexual life even in the absence of sexual desire to the partner. Unlike women, men are much more difficult to hide sexual dysfunction. Because, its main sign is ED in which a man loses the ability to have sexual act. Erectile dysfunction is one of the most common forms of male sexual dysfunction. Erectile dysfunction is diagnosed in men who are unable to achieve and (or) to maintain erection, needed for satisfactory sexual act.

It should be noted that organic form of ED is most often diagnosed in elderly men. Cause of inability to achieve erection in adulthood is psycho-emotional disorder. The most unfavorable factors, contributing to the development of psychological erectile dysfunction are: tense relations between sexual partners, stress, chronic fatigue, troubles, traumatic events, depression, unsuccessful first sexual experience, fear of get infected with diseases.

Diagnosis of psychological ED

Diagnosis of psychological ED is carried out in several stages. Diagnosis of ED implies a medical consultation in order to determine the duration of erectile dysfunction, causes of its development and rate of symptoms development.

If erectile dysfunction is caused by anxiety and depressive disorders, the diagnosis of psychological erectile dysfunction is carried out together with psychotherapist. Psychological ED signs are the following:

* sudden onset of erectile dysfunction;
* episodic erection disorders;
* spontaneous erection during the sleep or in the morning;
* erection occurrence during sexual stimulation of the penis and weakening of erection while trying to have sexual act;
* selective onset of erection (erection is achieved only in certain situations or with specific sexual partner).

If one or several signs mentioned above are determined in men, he may be diagnosed with psychological erectile dysfunction.

Treatment of psychological ED

Main method of psychological ED treatment is psychotherapy. It is aimed at the elimination the reason of anxiety and fear of sexual intercourse. During psychotherapy sessions a man is convinced that he is able to have sexual act and the erection disorder has a temporary character. Both partners can take part in psychotherapy sessions depending on the severity of psychological erectile dysfunction and causes of its development. Duration of ED psychotherapy may vary from a few weeks up to several months. To a man could lead an active sexual life in the period of psychotherapy, he can be prescribed a medical therapy. Men with diagnosed psychological erectile dysfunction can be prescribed oral, intracavernous or intraurethral therapy.

Intraurethral therapy involves an administration into urethra transurethral micro-suppository, containing an active pharmaceutical ingredient Alprostadil. Just 10 minutes after the administration of micro-suppository Alprostadil, a man’s ability to achieve erection is restored. However, an hour after the administration of micro-suppository Alprostadil, erection again disappears. At pharmaceutical market transurethral micro-suppository Alprostadil is available for sale, as well as Alprostadil injections. After the administration of intracavernosal injection Alprostadil, erection is achieved within a few minutes. Herewith, duration of pharmacological effect of Alprostadil injections does not exceed one hour.

One of the most demanded treatment methods of psychological erectile dysfunction is concluded in the use of drugs, possessing peripheral and central mechanism of action. The most effective drugs for ED treatment are phosphodiesterase inhibitors sildenafil, Tadalafil, Vardenafil and Avanafil. Each of these drugs restores erection an hour after oral use (on the average). However, the pharmacological effect of phosphodiesterase inhibitors lasts significantly longer than that of micro-suppository and injections Alprostadil. For example, after the use of Sildenafil, Vardenafil or Avanafil drugs an ability to achieve erection is maintained at least 4 hours and after Tadalafil use – within 36 hours. If you have been prescribed drug therapy to treat psychological erectile dysfunction you can order a delivery of drugs for ED treatment on our online pharmacy. To order drugs for ED treatment, you will be offered to choose a method of their postal delivery. You will be able to offset your costs for postal services when purchasing medications for the treatment of psychological erectile dysfunction on our online pharmacy.

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for sexual function. It’s a common sexual problem, affecting as many as 30 million menin the United States. Most cases of ED have a physical cause, such as heart disease, diabetes, and obesity. Lifestyle choices like smoking and drinking excessive amounts of alcohol can also lead to ED. But for some men, psychological issues are the root of the problem.

Read on to learn about the psychological causes of ED, and how they can be addressed.

Psychological causes of ED

Countless men suffer from erectile dysfunction (or ED), the inability to get or maintain an erection. While many drugs, such as Viagra and Cialis, are available to mask the symptoms, they do not deal with the underlying causes of ED. For some men, these drugs are not an effective solution and for others, who have medical conditions that prohibit the use of performance-enhancing drugs, there can still be help. Also, there are some men out there who want to fix ED, but simply do not want to be reliant on a drug. While we are not against drugs as one possible pathway to greater confidence, we believe starting with more natural, holistic solutions should be first. We work with many men who deal with erectile dysfunction and want men to know that, for many of you, there are alternative solutions, especially when the root of erectile dysfunction is psychological as opposed to physiological.

One way to tell if you are dealing with psychological ED is if it is not across the board. In other words, if you feel comfortable and relaxed and have perfectly normal erections during masturbation but cannot get them with a partner, you are likely dealing with psychological ED. (Note: If you are having ED in all situations, even masturbation, make sure you get it checked out as it can be a sign of heart disease). We have found that psychological ED has at least 3 underlying roots and we are offering a short series explaining each of the roots and how to deal with them. It is also possible to be dealing with two or all three of the underlying causes at once. We believe you are the expert on your own life and sexual health. In reading these articles, you might consider which underlying causes of ED feel like they might apply to you. For partners of folks dealing with ED, take account of what you know about your partner, and see if any of these seem to fit. The three underlying causes that we have found are performance anxiety, impulse control (too much, not too little) and a functional response to a dysfunctional situation (where you have very good reasons NOT to be having sex with the person you are attempting to have it with and your penis knows better than you do). In our first installment, we will tell you about performance anxiety and how you can turn the tides. In our second installment, we will explain why too much impulse control short-circuits your body’s natural arousal mechanisms and how to get back in touch with and follow your instincts. In our third piece.

 we will talk about how your penis can sometimes be smarter than you and how to start listening and taking seriously what it says.

Identifying and Changing Beliefs About Sexual Performance

For starters, a lot of men carry the belief that sexual performance and having a firm erection is one of the most defining and important characteristics of every sexual experience. As men try to make sense of their ED, many traditional (and implicit) male values about sexuality are triggered. For example, the inability to maintain erection often leads to feelings of shame because many men believe that “real” men should be able to satisfy their partner. And the only—or best—way to satisfy their partner requires an erection. Some partners will hold similar expectations of the need for the satisfying partner that can serve to worsen the situation.

ED is often strongly linked to performance anxiety. Performance anxiety is a widespread psychological phenomenon that affects many aspects of life, not just sex. It occurs when men become fearful of failure or embarrassed that they cannot achieve or maintain erections. Common thoughts that run through the man’s mind are, “Do I have an erection yet?” or “Am I going to have an orgasm this time?” A vicious circle of anxiety can develop where the anticipated fear of not having an erection results in recurring difficulties actually having one.

Here’s how the cycle starts: Men may hold some imagined fantasy of good sex, which leads to pressure to perform. When men do not achieve the result they were hoping for (i.e., a firm erection), this leads to troublesome feelings—sadness, disappointment, guilt and shame—and a return to negative thoughts that are now compounded by performance anxiety in the company of self-criticism.

The cycle can go on for a long time. For men to break the cycle, they first need to recognize that it exists. Only then can men start to change maladaptive ideas about sexuality that are not entirely helpful. First, men need to appreciate that setting the bar too high is a recipe for failure. Men need to reassure themselves that they do not have to be hard enough to drive nails every time they are intimate. Research has shown that many men with ED actuallyunderrate their erectile response during sexual activity.

Secondly, men need to know that occasional sexual difficulties are normal and thus so are they. Research shows that most healthy men occasionally experience erectile dysfunction or failure. It does not mean you are necessarily impotent or that there is something inherently wrong with you. This can happen to anyone, and usually does at least occasionally. Third, in western society we see a trend towards “instant gratification.” We want everything right away and instantaneously. This trend influences our relationships and sexual performance by creating a pressure to have an erection instantly and to be outstanding sexual performers. This trend of instant gratification does not take into account the fact that sexual performance is a learning process that takes time. Achieving mastery in sexual performance is no different than achieving mastery in sports or other activities: it takes practice. Sexual performance is a life-long learning process.

Reframing sexual performance as an evolving process that changes over time can lower the pressure that may be causing ED. For example, in the beginning of his career Michael Jordan was a prolific dunker who dominated games with his athletic ability. But as he got older, he relied more prominently on jump shots. The results were the same: He was still able to score—he just did it differently.

Changing the Ways Couples Think About Sexuality

In too many cases, a man’s inability to reach a firm and enduring erection leads to the end of all sexual activity. Here’s a provocative idea for couples: Good sex does not have to involve sexual intercourse. Couples can learn many different non-intercourse forms of sexual stimulation. For example, oral sex, cuddling, sensual touching, sexual massage, role-play, introducing sexual videos, or even food creates new and interesting ways to achieve sexual intimacy and orgasm.

Couples can collaboratively identify novel ways of being sexual together. It is not always easy to start these conversations, but once the subject is introduced and a rule is established about refraining from judgments, people can begin to risk sharing something new they may want to try. One way to open up a supportive and non-judgmental dialog is by having each person write privately something the couple used to do sexually but rarely does anymore, then share these together. Partners can share their beliefs around what constitutes sexual intimacy. They can voice their frustrations about what is not satisfying them, validate and reinforce the activities that they enjoy, and make suggestions for different types of sexual activity they want to engage in.

It is also important for men to discuss the anxieties, pressures, and negative feelings (shame, guilt, etc.) they face when it comes to sexual performance. Vocalizing these fears can help increase empathy, understanding, and awareness. It also gives both partners an opportunity to examine how each of them may contribute to the ideas that exacerbate ED.

If there are negative relationship patterns that are not helping one’s sex life or relationship, there are ways to change them. A great starting point is for the couple to make the commitment to read together John Gottman’s The Seven Principles for Making Marriage Work. Reflect together on the chapters as they pertain to your relationship and complete the exercises contained inside. These exercises can help strengthen the relationship and lay a firm foundation for increasing sexual intimacy.

Getting Help for Your Erectile Dysfunction

We always recommend contacting your primary care physician first for a thorough assessment in determining the extent to which a man’s ED is physical or psychological. Many of the psychological difficulties that maintain ED are self-induced. This means that men have the ability not only to exacerbate sexual problems; they also have the power to overcome them. The old adage that you must always have a firm erection quickly followed by sexual intercourse to qualify for having good sex is unrealistic and simply inaccurate. Challenging these unrealistic beliefs, tempering unreasonable expectations, embracing sexuality as a life-long process, and being open to different forms of sexual activity can help men achieve diverse kinds of intimate moments with their partners.

Maneet Bhatia is a doctoral candidate in counseling psychology at McGill University in Montreal, Canada. His specializations are in the areas of psychotherapy research, emotions, and male psychology. He is also a practicing psychotherapist and author of a psychology blog entitled Psych State of Mind.

Chris MacKinnon is a psychologist and doctoral candidate in counseling psychology at McGill University in Montreal, Canada. He is currently completing his pre-doctoral internship in the Psychosocial Oncology Program at the Montreal General Hospital. He has written and presented in the areas of male psychology, sexuality and intimacy, as well as bereavement.


Psychological issues have real, physical effects. Anxiety, for example, is something that many people assume exists in your head. But anxiety can cause increased heart rate, blood pressure issues, and fatigue. This, in turn, can affect your sexual performance. In fact, anxiety is one of the most common psychological causes of ED.


Everyone experiences stress at some point in their life. Sometimes, stress can serve as a powerful motivator. But even simple stress — a presentation at work tomorrow, for example — can affect your ability to achieve and maintain sexual performance. You don’t have to be carrying a large load of stress for it to affect your sexual health.


Depression is often caused by a chemical imbalance in the brain. It can affect both sexual desire and sexual function. For men, however, depression isn’t always an easy diagnosis. Many men don’t recognize the symptoms of depression, and some are reluctant to seek help, according to the National Institute of Mental Health.

The good news is that most men will return to feeling normal, regain healthy sexual interest, and resolve their ED problem with proper treatment for depression.

Relationship problems

The silent treatment isn’t the only thing you’ll experience if you and your partner have been arguing. Troubles in your emotional relationship can affect your sexual relationship. Arguments, poor communication, and anger can affect your sexual desire and sexual function. Working through these problems with your partner can help ease your symptoms of ED.

If you have trouble resolving relationship issues on your own, seek out a counselor or therapist who can help.

Fear of sexual dysfunction

The first time you experience ED, you may become worried that you’ll never regain normal sexual function. This can lead to fear or low self-esteem. These feelings may affect your ability to achieve or maintain an erection in your next sexual encounter.

This cycle can continue until you see your doctor to find a treatment. Once you’ve found the right treatment, your fear of sexual dysfunction should subside.

Treatments for psychological causes of ED

Psychological causes of ED aren’t typically treated with medication. However, medications can help in cases where a chemical imbalance is causing an issue. For example, men who have depression may find relief for their symptoms, as well as ED, when they begin anti-depressant treatment.

Many of the psychological issues above require therapy, patience, and time. Your doctor can work with you to find the best course of treatment.

Make mental health a priority

Psychological issues can affect more than just your mental health. Depression, anxiety, stress, and relationship problems can have a tremendous effect on your sexual function. If you’re experiencing ED along with psychological issues, talk with your doctor. Together, you and your doctor can find a cause and a treatment to bring your sexual health back to normal.

Treating the couple

Many people, including doctors, will first go to the ‘physical’ treatments for ED (eg medication) and perhaps only consider the psychological ones if these fail. But erectile dysfunction affects the couple – not just the man. It shouldn’t be seen as an isolated problem that can be ‘fixed’ and then sex will successfully resume. There can be many associated issues, especially if there has been no sexual activity for years.

Failing to take into account both partners’ views about sexual relations and whether expectations about treatment are mutual can lead to problems. If there is disagreement, it can sometimes make the ED impossible to treat. This is why communication between couples is crucial to the successful treatment of ED. If communication is an issue, you and your partner may benefit from talking to a relationship counsellor. Sex therapy and counselling is a specialised area and access to properly trained counsellors in this field is very limited, or even absent, via the NHS. Most is carried out privately and this may mean some travel, especially for people who live outside the main cities.

Who to contact for sex therapy

Aside from being referred by your GP, there are a number of places that provide therapy.

  • Family planning clinicsare staffed by doctors who are trained in psychosexual matters. They are particularly good with problems such as low libido and delayed ejaculation. This treatment is free.
  • A number of Relatecounsellors have specific psychosexual training. Relate’s fees are relatively modest and are means-based.
  • The Institute of Psychosexual Medicine(private) is an organisation of doctors. Some will see you without a GP referral.
  • The College of Sexual and Relationship Therapy (COSRT) consists mostly of non-medical personnel, all of whom have had extensive training. To find a therapist in your area, email

Lifestyle and ED

Stress, overwork and drinking too much alcohol are common factors in many of the ailments that affect people today.

Sexual function is influenced by a person’s overall wellbeing. ED may be a sign that not enough attention is being paid to maintaining a healthy lifestyle. The most effective ED treatments can’t be expected to do much against a tide of constant fatigue, inadequate sleep and the effects these issues have in a relationship.

Keeping fit by taking enough exercise, stopping smoking, drinking moderately, avoiding recreational drugs and eating a healthy diet will improve your sex life – as well as bringing other health benefits such as reducing stress and sleep problems.

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