By Stacey Nadelhoffer, LCSW, Sex Therapist
Erectile dysfunction (ED) is a common condition in which a man is unable to achieve and maintain an erection sufficient for sexual activity. Needless to say this condition frequently causes distress for the man experiencing it. The good news, however, is that erectile dysfunction is treatable with sex therapy, physician consultation, or both.
So what causes ED? Speaking generally, ED can be caused by medical factors, psychological factors, or both. Sex therapy can be helpful under any of these circumstances and we’ll discuss that more in a minute. First, let’s discuss medical concerns, the most common of which is Increasing age. As he ages, a man’s erections become softer and less consistent, and he may need increased genital stimulation during sexual activity. ED that occurs with aging happens when the blood vessels going to the penis become blocked or narrowed. Men experiencing ED should consult with a physician to rule out medical causes, including hypertension, heart disease, atherosclerosis, diabetes, multiple sclerosis, nerve damage, and hormonal imbalances, particularly low testosterone.
In addition to aging, unhealthy lifestyle factors can have a negative impact on erectile functioning, particularly obesity, consumption of alcohol, smoking, and use of other drugs. People with these habits are frequently under stress, which causes the body to release adrenaline and cortisol, which negatively affect erectile functioning. In addition, medications such as antihypertensives, antipsychotics, antidepressants, and tranquilizers can result in ED because these medications can affect hormones, nerves, and blood circulation. Finally, surgery, radiation, or injury to the penis, prostate, bladder, rectum, or spinal cord could provoke erectile dysfunction. Your physician can address medical causes and may prescribe medication, the most common being PDE-5 inhibitors, which causes vasodilation of the smooth muscle cells lining the blood vessels leading to the penis. A physician may discourage taking such drugs due to side effects or certain preexisting medical conditions. Also, these drugs are not effective if the man is not aroused or interested in sexual activity.
So why consult with a sex therapist if the problem is medical? Sex therapy can be a great form of treatment for medically caused or aging related ED because it provides a safe and comfortable environment in which to discuss how to expand one’s sexual repertoire. Behavioral exercises for ED can address performance pressure and help you view sex more positively, have more realistic expectations, and improve pleasure, relaxation, flexibility, sensuality, and communication with your partner. Of course, a sex therapist can also be helpful when physical causes do not play a role in the presenting problem. Psychological causes of erectile dysfunction include stress, fear, anxiety, sadness, and relationship problems. Stress and cortisol reduce the body’s ability to respond to sexual stimuli, as well as reduce sex hormones that play a role in sexual functioning and fertility. When a man is stressed or anxious, the stimulated part of his brain, the amygdala, produces a flight or fight response and an inability to relax. Although we are physiologically stimulated when aroused, erections come from a relaxed state. Other psychological contributors to sexual dysfunction in men can focus around intimacy fears, such as fear of dependency, expressing feelings, losing control or being controlled, being exposed, being abandoned or rejected, or being vulnerable or rejected. Other factors can include guilt or shame, fears about a negative outcome, or the inability to own one’s right to genuine sexual desire. Finally, performance anxiety can stem from intimacy issues or low self esteem. Relationship issues of course may also play a role, including increased conflict, anger, perceived loss of power in the relationship, or a perceived inadequacy within oneself as a companion or lover. An issue becoming more prevalent is ED resulting from an increased exposure to pornography and decreased stimulation in the penis. Due to the increased amount of dopamine released in the brain associated with increased porn use, partnered sexual interactions may suffer due to difficulties with arousal.
A trained sex therapist can help determine the psychological and relationship issues at play and work with the individual and couple to determine an appropriate treatment plan. Sex therapy interventions can include stress management, anxiety reduction, cognitive therapy, behavioral exercises, and couple communication. Be sure to consult with a sex therapist for more information on erectile dysfunction.