02 May Erectile Dysfunction by Dr Su-Yin Yap, Clinical Psychologist and specialist in Psycho-sexual health
Erectile dysfunction is the persistent inability to get or maintain an erection sufficient to complete sexual activity, and causes distress to the man. It is a common problem which affects at least one in every ten men. These erectile problems happen occasionally to many men; this is normal. There are many reasons this can happen occasionally such as stress, tiredness, or drinking too much alcohol.
When it is difficult to maintain an erection over a sustained period of time it is important to get this problem checked out as it can be an indicator of a more serious health problem, such as heart disease. For this reason, it is important that you visit your GP as a first step. Physical causes of erectile dysfunction include:
- Heart disease
- Heavy smoking
- High cholesterol
- Hormone levels
- Side effects of medication
- Heavy alcohol/recreational drug use
The Mind-body connection
The majority of men with erectile dysfunction experience a combination of psychological and physical causes. For example, Diabetic complications may have been the initial factor that contributed to the problem, however, as this continues, the patient may begin to worry more and more about being able to get an erection, and can become pre-occupied with erectile failure which can set up a vicious cycle where he is unable to focus on sexual stimulation, which reduces sexual arousal and may make getting an erection more difficult.
Even if you do not have any of the above health problems, psychological and social factors can cause and/or contribute to erectile dysfunction (and indeed any sexual problem). This does not mean that you are imagining the problem or that you can just tell yourself to make the problem go away. The mind and body are connected, so if you are for example experiencing a lot of stress, and spending time worrying or ruminating about problems in your life, this may get in the way of the sexual arousal system, which can make getting an erection difficult. This is also true for other issues such as
- Relationship problems
- ‘Performance anxiety’ regarding sex
- Stress and anxiety in personal or professional life
Following full investigations by a GP and/or sexual health clinic, and depending on the outcome, you may want to consider seeing a psychologist specializing in Sexual health.
Treatment for Erectile Dysfunction
There are many effective treatments for erectile dysfunction. Research shows that psychological therapy specifically focused on sexual functioning when combined with PDE-5 inhibitors (pills such as Viagra), is more effective for long-term gains for Erectile Dysfunction than PDE-5 medication alone.
What to expect when seeing a Psychologist specializing in Sexual health?
As part of the team here at the clinic, we have a Clinical Psychologist who specializes in Sexual health; she is also a qualified Psycho-sexologist, certified by the European Society of Sexual Medicine and the European Federation of Sexology. She will look at all the factors that have been identified as contributing to the erectile dysfunction. Although psychologists are not medically trained, she will work closely with your health care team to work in a holistic way and consider physical and psychological factors that may interact and contribute to erectile dysfunction. The focus of the session will be on sexual functioning and on how this is linked with other areas, for example, relationships, body image, worry and stress. Once you and your psychologist have built up an understanding of what is maintaining the erectile dysfunction, your psychologist may teach you some mental exercises and techniques that will help. You will go away and practice these skills by yourself and/or with a partner and use further sessions to ‘trouble shoot’ and continue to build new skills to address the problem. Significant progress is often possible in a relatively short number of regular sessions. Sessions are generally focused on the ‘here and now’ and usually last 50 minutes.
For further information, some useful websites include:
European Society for Sexual Medicine
NHS information page on Erectile Dysfunction: