“In my practice, I work with men of all ages who are struggling with erectile dysfunction (ED) – from men in their 20s to men in their 60s. There can be numerous reasons why a man experiences erectile difficulty, and so one must take into consideration a number of factors that could be causing this to happen. The experience of ED is associated to numerous fears, anxieties, notions of identity, masculinity, health and well being for men. Many men associate their ability to perform sexually as directly related to their sense of worthiness as a man, and so when it doesn’t work the way he hopes and wants it to, it can be devastating. “
So, what is erectile dysfunction?
Almost all men will experience a soft penis during sex at some stage in their lives. This can simply be a once off, perhaps due to consuming alcohol, illness or stress, but this isn’t ED. Occasional ED is actually quite normal! However, if your loss of erection starts to happen more often (perhaps with a partner or when masturbating), it can cause you distress, and get in the way of your sexual functioning and overall experience of sexual pleasure. Then there’s the need to seek professional support.
For any man experiencing frequent ED, it’s important to consider the following: if this is happening in general (i.e. it happens when you’re alone and with a partner) or situational (just with a partner), and if the difficulty has always happened or it’s recently developed. All of these factors give an indication of what’s going on. It’s important, in my opinion, that all men see a medical professional as a first port of call, so as to rule out any hormonal or physiological reasons, like high blood pressure, for experiencing ED; ideally an urologist or a sexual health medical specialist. If a man experiences erectile dysfunction at times when he wants to be aroused, such as with a partner, if he is upset by this, and if this problem has persisted for some time, then he should seek professional support.
So, let’s talk about what can cause erectile dysfunction?
There are both medical and psychosocial reasons for ED.
Medically, there are numerous reasons behind ED, which could include.
- Low testosterone (T)
- High cholesterol (CHL)
- High blood pressure (BP)
- Depression and anxiety
- Numerous treatments for cancer, particularly if a man has suffered from prostate cancer
- An unhealthy lifestyle, which includes smoking, drinking and/ or substance use
- Certain prescription medication, such as antidepressants
ED is an early warning sign for cardiovascular or heart disease. We get it drummed into us that living a healthy lifestyle, where we eat healthy, exercise, don’t smoke or drink excessively is really important. If a man experiences ED, it can indicate that something more serious is happening in his body; thus the need to see a medical professional.In my clinical experience however, even if there is a medical cause for ED, there are nearly always feelings of inadequacy and anxiety too, which often relates to performance.
Psychologically, anxiety and ED go hand in hand. It is the most common reason for a younger man to experience ED. However, trauma (from something very severe to something as covert as a partner comparing him to another man), feelings of inadequacy, shame, rejection, depression, low self-esteem and self-worth, stress, or even becoming a parent and struggling to assimilate new roles into existing ones, can all lead to experiencing ED. Another common cause for ED that I see in younger men is risk of pregnancy and their partner falling pregnant; either the fear of her becoming pregnant or the pressure to perform in order for them to conceive.
A rather interesting and newer cause for ED is actually pornography! Young men, who are experiencing ED with a partner, are often doing so due to using porn when masturbating. What’s happening here is that the man is not reaching and experiencing those same levels of excitement during sex with a partner that he does when watching porn.
Men who have a spinal cord injury or who perhaps have a physical disability are still often able to get erections, even in the case of complete quadriplegia. With a spinal cord injury, the nerves and the brain no longer talk to one another, so the brain doesn’t receive the signal for the brain to start the arousal process and get an erection. In these situations, vacuum pump devices can generally be used quite effectively.
How do we treat ED?
Obviously we need to establish what’s causing the ED first and foremost, and that’s why it’s important to rule out any medical reasons first and treat those if need be. There are numerous options when it comes to medical treatments for ED, including pills and injections; all of these should only be used when prescribed by a medical doctor who has an understanding of what exactly you need. In extreme cases, such as post-prostate cancer treatment, a penile implant is a brilliant option for men who have lost all erectile functioning.
“Certain toys and devices can be used, such as pumps and cock rings.”
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Therapy assists by tackling the feelings, thoughts and behaviours associated to ED. Cultural and religious beliefs are important to consider, as is relationship and life stress. How a many thinks about and what beliefs he holds about arousal would be explored. And in between sessions, exercises would be prescribed that would assist a man in working towards regaining an erection in situations where he is struggling to get aroused physically. There is generally always some level of performance anxiety. Ultimately, if a man experiences ED consistently, he starts to then develop a fear of performance, and he often worries about things such as “will my partner leave me because of this” or “they must think I am such a failure!” Thoughts like this only activate anxiety further. Anxiety has a massive effect on anyone’s sexual functioning, and actually the part of the brain that activates during anxiety means that the part of the brain we need to work to get aroused actually shuts off. So when our brain senses or interprets a situation as ‘worrying’ for example, it shuts down sexual functioning. This is why when we experience anxiety, stress or worry; we will struggle to function sexually. Anxiety also feeds anxiety, and so the more a man feels anxious and pays attention to that anxiety, the worse the affect of the anxiety on him.
Why might younger men experience Erectile Disfunction?
Most older men experience ED as part of ageing unfortunately, but it’s actually very common in younger men too. Societal expectations placed on men to perform, on their sexual prowess as a sign on manhood, and the idea of being hard or firm being liked to the identity of a man, all mean that many men experience feelings of inadequacy.
A firm, hard penis is not a sign of manhood. It’s simply a part of a man’s body that has a function, and sometimes it doesn’t do what we’d like it to do. When we can move from the notion that manhood and sexual functioning are inclusive of one another, then we alleviate a lot of the pressure that men experience. And this, hopefully, means fewer men experiencing a sense of failure and inadequacy when they experience something like ED.
So what happens for the partner of a man who is concerned about erectile functioning?
For any partner who’s male partner has experienced ED during sex, certain feelings of inadequacy can also be triggered. Partners constantly worry “he’s not attracted to me”, “I’m doing something wrong”, or “his lack of a rock-hard penis is an indication that he feels a particular way about me”. But this is very rarely the case!
Sometimes, relational issues can cause the man to experience ED; for example, distress, anxiety, resentment and hurt. Relational issues are often avoided, and hence the partner may start to feel that it’s something to do with them. It’s so important to have an honest and open way of communicating in the relationship, so that you can raise concerns with your partner at times when you experience distress and worry. Conversations like this really help to manage expectations and alleviate anxiety about what’s going on. Approach these conversations with sensitivity, curiosity and openness to change.