Psychosexual Therapy for Erectile Dysfunction

Erectile Dysfunction

Erection problems are more common than you might think. In fact, approximately 52% of men who are 40 to 70 years old have erectile dysfunction (ED). Some erection problems only happen occasionally, but if they continue or happen more frequently, it may be a sign that you need to seek help.

The definition for ED is: “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” (Feldman et al, 1994). In other words, the penis doesn't get firm (erect) enough to allow you to have sex. An erection occurs when blood flows into, and remains in, the vessels of the penis, which causes the firmness. When there is insufficient blood entering or staying in the vessels of the penis, ED occurs. Although it is more common within older age groups, it is not an inevitable part of ageing, and ED can occur at any age. Symptoms of ED vary and can include: not being able to get an erection at all, not getting an erection firm enough to allow penetrative intercourse, getting an erection but not being able to maintain it, or not being able to get or maintain an erection with a partner but being able to do so when alone.

Some medical conditions can cause ED and these include cardiovascular disease, high blood pressure (hypertension), diabetes, high blood cholesterol, nerve diseases, surgery, injury, low hormonal levels. If this is the case, successful treatment of these conditions not only improves health, but can resolve the ED. Therefore, if you think you may have an erection problem, it is very important that you see your doctor as soon as possible for a medical assessment. Your doctor can help diagnose and treat your ED, as well as any underlying factors that may be at the root of the problem.

There may, however, be an emotional or psychological cause for ED, and this is where psychosexual therapy can help. Unfortunately, all too often we assume that our bodies are machines and that they will work independently of the mind and emotions. Our bodies are complex and, sexually, we require the body, brain and emotions to all be working together to be truly effective and for us to enjoy sex. As with an electrical circuit, if there are any breaks in the system it will not function as a unit. Part of the process of psychosexual therapy would be to think about what the underlying emotional and/or psychological issues are, and to attend to these with weekly counselling sessions. This realisation is an important first step for clients to begin to resolve their erection problem. Alongside this the therapist might then advise the client to follow a graduated, individually tailored cognitive-behavioural type programme that the client conducts at home, either alone or with their partner, between therapy sessions. This allows clients to begin to achieve and maintain an erection once more, gradually building confidence.

Partners are involved in the therapy process wherever possible and therefore it is not uncommon to see clients as a couple when one of them has erection problems. This is because problems with erections can lead to all sorts of relationship difficulties if not properly addressed. Often it is the partner with the erectile difficulties who feels responsible for these issues and therefore assumes that it is their problem to solve; however, if you are in a relationship, erection problems affect both of you individually and as a couple, and it is important that both partners feel equally supported in resolving the issues. 

If you are not sure whether the problem is due to an emotional, psychological or medical cause, it is both useful and important to rule out any underlying medical conditions that may be causing your ED either before starting psychosexual therapy or at the beginning of the therapy process. Part of the initial assessment phase of a psychosexual therapist should be to assess potential physical or medical causes for the erection problems by asking the appropriate questions, and then referring clients back to their GP if necessary. However, even if there is a medical cause for the ED, psychosexual therapy can still be of huge benefit to both you and your partner. Couples therapy can help you and your partner to think about new or different ways of being intimate together when penetrative sexual intercourse is more difficult or not possible. It can also help to relieve some of the pressure that either or both of you are feeling whilst undergoing treatment and to better manage the impact of that pressure on your relationship.

Whatever the cause of your erection problems, it is important to remember that there is help available to you through your GP and local healthcare services, and also through psychosexual and relationship therapy. If you are unsure whether you need help or not, discuss this with your GP, or contact a psychosexual and relationship therapist who will happily advise you of the best way of seeking support for your individual circumstances.

Reference: Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and ?psychosocial correlates: results of the Massachusetts Male Ageing Study. J Urol. 1994;151:54-61.