Therapy for erectile dysfunction

How to fix psychological ED


Erectile dysfunction is defined as the inability to achieve or sustain an erection long enough to have sexual intercourse. There are a number of physical factors that can cause ED but there are also a number of psychological factors that can cause or contribute to the problem.

In some cases, it may be that there is an underlying physical cause that causes the ED initially but psychological issues can develop as a result in the form of performance anxiety and effects on a man’s self-esteem.

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Physical causes of erectile dysfunction

Erectile dysfunction can sometimes be an early wearing of an underlying but serious medical condition. For this reason, it is extremely important that the physical causes of erectile dysfunction are ruled out in the first instance. The conditions that may be contributing to or causing the ED includes:

  • Heart disease
  • Atherosclerosis (hardening or clogging of the arteries)
  • High cholesterol
  • High blood pressure (hypertension)
  • Diabetes
  • Obesity
  • Smoking
  • Sleep problems
  • Peyronie’s disease
  • Metabolic syndrome - a condition which has the symptoms of high blood pressure, increased levels of insulin in the body, high cholesterol and increased body fat, particularly around the waist
  • Parkinson's disease
  • Multiple Sclerosis
  • Some prescription medication. This includes some drugs prescribed for heart disease, diuretics, antihistamines, drugs for hypertension and antidepressants among others
  • Excessive use of alcohol and other non-prescription drugs
  • Treatment for prostate cancer or enlarged prostate
  • Surgery or injuries to the pelvic area
  • Low levels of testosterone

If your doctor cannot find any obvious reason for your ED problems then it may be time to consider psychotherapy or ‘talk therapy’.


Primary psychological causes of erectile dysfunction

There are also a number of psychological issues that can cause ED. These include:

  • Anxiety or nervousness about sex. This may be purely as a result of having no experience or little experience; it may also be as a result of having lost confidence in your ability to achieve an effective erection as a result of trying and failing on several occasions
  • Stress at home or work
  • Relationship problems
  • Communication problems, particularly with your partner
  • Feelings of self-consciousness whilst having sex. This may present as worries about body image, sexual experience or being unsure about your sexual capabilities
  • High expectations either from yourself or perceived or actual expectations of your partner
  • Depression
  • General anxiety
  • Lack of interest in sex
  • Problems with self-esteem
  • History of sexual abuse


Psychosexual therapy and the treatment of ED

A psychotherapist can help to address psychological factors that may be causing erectile dysfunction but can even be used to treat physical problems such as premature ejaculation.

It will involve the exploration of a person's relationship and identifying areas that need attention, looking at sexual habits and preferences before the onset of ED.

When there is a problem with premature ejaculation it is almost always important to look at your relationship because if there were no relationship problems before the ED began it is highly likely that your partner may have developed some self-esteem issues as a result of it!

Whilst psychotherapy can be used to treat the individual with the problem it may be more effective if the treatment sessions are given as couples therapy.  It is most likely that the initial session is given to the couple and successive sessions may be given to each person separately. This will very much depend on the particular therapist and couple and the aim will be to eventually have the couple working together.

The point of this approach is that it will help the therapist reach ‘under’ the outward issue individually and so will be able to work out which issues need to be addressed together. It may be as simple as discussing with a couple what is a ‘typical sex life’’. When a couple is in therapy together they can learn how to let their defenses down so that they can discuss their needs, wants and desires openly. Basically, it is about learning to communicate on a sexual level.

The sessions may include communication in all aspects of a couple's life including work, home life and family life but psychosexual therapy can be a very long journey. At the same time, it may provide a useful platform on which to improve intimate and emotional communication within the relationship.


Sexual therapy

This form of therapy has a focus on shorter-term treatment than psychosexual therapy; it involves discussion with a sex therapist as well as ‘homework’ or assignments between therapy sessions.

This therapy is particularly useful when treating stress and communication issues related to ED. It lasts for approximately 20 1 hour sessions.

It involves talking about sexual attitudes and any problems as they are perceived by the couple. The therapist will provide advice on relation, stimulation and methods to improve the sex within the relationship.


Stress management to improve the effects of drug therapy

It may be that your doctor has prescribed one of the PDE 5 inhibitors of which viagra is one and there has been some degree of success in treating the ED.  A recent study has suggested that the use of a PDE5 inhibitor drug alongside 8 weeks of stress management showed improved stress levels and erectile dysfunction in the group who has stress management and the drug compared to those who only had the drug.


Cognitive behavior therapy

CBT is one of the most useful forms of therapy to use in the treatment of ED. If the ED is related to performance anxiety, loss of sexual arousal and low self-esteem, CBT is particularly useful as it is a proactive and actionable therapy that is designed to change the way you think and behave in certain situations. It is what is termed a ‘holistic’ therapy meaning that it considers that thoughts, feelings, and physical sensations are not separate but all work together as a whole.

CBT allows a person to work to understand that specific triggers can evoke certain thoughts, behaviour, feelings and sensations to come about and that this can be changed.

During therapy the therapist will work with the client to understand their thought processes, for example, negative and unrealistic expectations and misunderstandings regarding their partner's needs all of which may lead to erectile dysfunction as a physical reaction. It is necessary to this therapy that these thought processes can be changed.

In practice, an individual treatment plan will be worked out by the therapist and clients together to formulate goals that need to be reached so that there are clear guidelines as to how things are progressing. Between appointments, the clients will be encouraged to practice techniques and strategies to overcome particular issues. This therapy is very ‘in the moment’ concentrating on concurrent problems and feelings. This is very different from the traditional approach of looking back to the past to search for etiology or the basic cause of a problem.

The main advantage of cognitive behaviour therapy is that it is a form of talking therapy that can have a positive outcome relatively quickly if a couple is committed to it. CBT offers a very practical approach and can have amazing results in terms of breaking down what can be overwhelming sensations of being a failure, depression and anxiety.



It is doubtless that psychosexual therapy, sex therapy or cognitive behavioral therapy, whatever approach is the most appropriate, can be an invaluable help in the treatment of erectile dysfunction either on its own or concurrently with medication treatment.

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