Although erectile dysfunction (ED) is predominantly associated with physical causes, such as circulatory problems, psychological contributions to the problem are not given enough attention. This can occur when the functioning of the penis is actually completely capable of erection, but erection is inhibited by mental factors.
This is particularly surprising given the fact that almost all cases of ED will have a psychological component. Sex is an extremely subjective experience, requiring body and mind to work together.
It is often forgotten that achieving and maintaining an erection requires a man to be psychologically engaged, rather than being the mere puppet of a mindless physical response.
Below, we look at the psychological causes or ED, and assess the usefulness of the different types of therapy for ED available. To find out more about the cause of your ED, and to find out the best treatment options for you, you can complete a free online consultation with one of our doctors at the link below.
Psychological causes of ED
Between 10 and 20% of all cases of ED have psychological causes, which can include:
- Performance anxiety
- Loss of arousal and interest in sex
- Relationship issues
- Low self-esteem and body image
- Unrealistic sexual expectations
- Previous traumatic sexual experiences
If left unaddressed, psychologically-borne ED can lead to a vicious cycle, whereby fear of embarrassment and failure eclipse pleasure, sexual intimacy is increasingly avoided, and relationships breakdown.
It is important to understand the nature of your ED in order to get the right treatment. If the cause of your ED is psychological, using medication targeting physically-induced ED alone may not always be very effective. Viagra, for example, will only work if you are sexually aroused. Many men might also prefer a non-invasive means of approaching their ED, as an alternative to penile injections.
The good news is that there are a multitude of different therapies available for addressing ED. These can also be very beneficial for patients with predominantly physical ED, when used in conjunction with erectile dysfunction medication.
Cognitive behavioural therapy (CBT)
CBT is perhaps one of the most useful forms of therapy for addressing ED, especially related to performance anxiety, low self-esteem, and loss of sexual arousal. CBT is a proactive and actionable therapy targeted at helping you change the way you think and behave. It privileges the idea that thoughts, feelings, and physical sensations are all interlinked.
Following this method, you work to understand how specific triggers can evoke thoughts, feelings, sensations and behaviours. As a result, you can adopt a more positive and realistic approach to sex more generally, and take the focus off getting an erection.
What it involves
Your therapist will work to develop a shared understanding of how thoughts – such as negative predictions, unrealistic expectations and distorted beliefs about a partner’s needs – can lead to a physical reaction such as ED. Sexual education, developing communication methods, and undoing negative thought patterns are essential to this therapy.
Discussion is structured rather than free-form – as in the case with many other forms of therapy – so you can tackle specific goals and have a clear sense of direction and progress.
An individual treatment plan will then be worked out collaboratively, and between appointment sessions you will be encouraged to practice strategies and techniques to overcome certain issues. The focus is very much on current problems and feelings, as opposed to a more traditional therapy approaches of delving into your past.
CBT can be provided by the NHS or privately, and in case you do not wish to see a therapist face-to-face, you can always try internet-based CBT. Ask your GP for a referral to ensure you get the right therapist for you.
CBT is a shorter form of talking therapy than psychosexual therapy and can be completed relatively quickly if you commit yourself to it. The strategies for managing negative thought cycles are extremely practical and can affect real change in terms of breaking down overwhelming feelings of failure, hopelessness, depression and anxiety.
Armed with new structure and strategies, you can reach a point where you can deal with your issues without a therapist.
This type of counselling is a deeper-dive, relationship ‘talk therapy’ looking at the emotional, psychological, and sexual issues which may be influencing your ED. It offers a great opportunity for you and your partner to communicate and express very difficult feelings in a managed environment.
What it involves
It will involve exploring and talking about your relationship to identify trouble areas, and analyzing your sexual patterns and habits before the advent of ED. You can let loose about your personal sexual expectations, needs, and desires, as well as any anxiety you may feel.
The counselor can also provide you with activities and tips to improve trust and communication within your relationship.
This form of therapy can be great at building a more communicative, honest relationship, as well as helping to reduce sexual anxiety. Many find the opportunity to have an open conversion on their sexual life to be invaluable, and the increased communication can strengthen their feeling of connection as a result. You may even gain new ideas on how to approach future sexual issues together.
Psychosexual therapy needs to be slowly developed and can take quite a long time to work. Results have been mixed and are not at all guaranteed, although progress is more likely to be achieved if both partners approach sessions with an open-mind and willingness to share.
This form of therapy has a shorter-term focus and centers on the experience of sex itself. It will involve both discussion with a sex therapist and mini assignments between sessions. Sex therapy is particularly useful for addressing ED caused by stress and poor sexual communication, as opposed to deeper psychological or sexual issues. It can take the form of about 20 one-hour sessions.
What it involves
You can expect to talk about your attitudes to sex and any perceived problems, so that your therapist can recommend specific exercises to overcome or improve on these. A therapist can provide advice on how to boost the sexual experience, such relaxation and stimulation techniques, as well as ways of communicating.
The ‘senate focus’ exercise is particularly popular, where both partners agree to abstain from sex for a few weeks but increase non-sexual bodily contact and understanding. You gradually begin to incorporate sexual elements into your touching until you are both ready for sex, increasing the other person’s understanding of how you like to be touched.
Again, including your partner will make this form of therapy more effective. The therapy can be used to discuss sexual concerns, or for advice on how to approach conversations on ED treatment with a partner, especially when they are invasive measures, such as surgical treatment.
General sexual education around male sexual response, the context in which you have sex, the psychology of sexual interest, and the effect of age, medication and health problems are major benefits of this therapy.
This kind of therapy is unlikely to be very effective if a man or a couple stops the treatment after only have a few sessions. Again, dedication and investing time in the exercises outside of sessions are needed for maximum effectiveness.
Any man suffering from ED, regardless of whether psychologically or physically rooted, is strongly encouraged to be assessed by their GP. This is to exclude potentially serious underlying physical causes such as diabetes, high blood pressure, and high cholesterol.
If you’re stretched for time or don’t want to speak face-to-face, take our FREE online erectile dysfunction assessment.