Erectile dysfunction often has a psychological basis

This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series here.

Many men experience erectile dysfunction. It might not be an exaggeration to say all men might experience it at some time or another. Erectile dysfunction can occur in various contexts, with various partners and at various stages of life.

About 80% of the time there is an organic or physiological cause. So, for about 20% of men, the major cause is psychological. Doctors who specialise in men’s health should be consulted first and, if necessary, they will refer patients for psychological help.

About one in five men over 40 will experience erectile dysfunction, as will two in every three men over 70. For some men it is very infrequent, but for others it occurs frequently enough for them to be concerned or distressed.

Psychological origins

The psychological origins of erectile dysfunction are varied. Some of the most common are depression, relationship problems, stressful circumstances and a history of negative sexual experiences.

However, whether the cause is psychological or organic, it is almost always the case that there is some accompanying psychological distress. The good news is treatment of the problem is available and typically successful. The sooner men seek help the easier it is to treat the problem.

For an issue that is so common it is perhaps peculiar that it is not the subject of much conversation. The reasons for this are located in the psychology of men and their sense of masculinity.

Many men are extremely uncomfortable discussing erectile dysfunction or any other issue that has the potential to disrupt their sense of themselves as men. To do so is interpreted as a failure of male functioning and evidence they are not “real men”. Men resist disclosing any experience of erectile dysfunction for fear of being mocked or ridiculed. As such, this is not a topic likely to be discussed at barbecues.

After the first experience of erectile dysfunction, it can pervade a man’s life. He will likely become anxious about it. This leads directly to interference with his subsequent performance. Erectile dysfunction is then likely to reoccur, and thus anxiety rises again.

At this stage it is likely his partner will start to question what is happening: is it their relationship, is she still attractive to him, is he having an affair? And all this could be just a result of him being highly stressed at work.

These relationship problems might be simply avoided if the man was open about his work situation and discussed this with his partner.

A couple could also experience relationship difficulties that then lead directly to sexual difficulties, and so the man experiences erectile dysfunction.

These kinds of situations are ones skilled psychological therapists are able to understand and treat.

Depression

We know depression is linked to many unhappy outcomes, but it can be particularly related to erectile dysfunction and is suggested as a common cause. There is no doubt the two are closely connected, but it’s not clear which precedes the other. If a man is depressed about, for example, his career prospects, this can be reflected in his lack of interest in his sexual relationships and an experience of erectile dysfunction.

Some antidepressant medications have been shown to increase erectile dysfunction, so this can compound the situation.

The most appropriate way to manage erectile dysfunction is for men to have a preliminary health check with their family doctor and then be referred to a skilled psychological therapist who uses psychologically based treatments. Andrology Australia is an excellent resource for men to begin to explore their erectile dysfunction problems.

Treatment

Erectile dysfunction can be treated both psychologically and pharmacologically. The prescribed medicines of Viagra, Cialis and Levitra can be effective but do present some side effects, so consultation with a GP or specialist andrologist is recommended. Avoid cheap deals on the internet as the content of what is being sold cannot be verified.

Psychological treatments are recommended when the cause of the dysfunction has emotional or psychological components. For example, a history of sexual abuse or other traumatic sexual experience may be helped by treatment by a psychologist.

These treatments usually explore the patients’ histories and might involve applying Cognitive Behaviour Therapy (trying to change the way one thinks) or focusing on the context of the problem. It is best to ask any potential treating professional exactly what he or she intends to do and how this might work.

Further reading:

Dads get postnatal depression too

Men more reluctant to go to the doctor - and it’s putting them at risk

Breast cancer campaigns might be pink, but men get it too

How’s your walnut, mate? Why men don’t like to talk about their enlarged prostate

Klinefelter’s syndrome: being unable to produce testosterone has serious implications for men

Hypospadias: the cause of penis malformation is still a matter of debate

Why do some old men have big red noses? No, it’s not alcohol

When the scrotum is empty: undescended testes don’t only affect kids