Erectile Dysfunction : Medical Cause but Psychological Impact

So, you’re experiencing erectile dysfunction (ED), which motivated you to see your doctor and you’ve learned the cause is medical. Now what?

There is hope!

Although most ED issues are psychologically based, some are medical.  Generally speaking, medical causes mean medical treatments! Even though the cause of your ED is physiological – there is a possibility you can alleviate ED by treating the cause. For example, if your condition is diabetes, getting your blood sugar under control can help. Heart failure or other cardio-vascular concerns can be treated and may relieve or partially relieve some of your ED. Medications as well (particularly SSRIs) tend to have a strong impact on erections and arousal (in addition to desire).  If the medical condition is not treatable (e.g. nerve damage caused by accident or long-term alcoholism for instance) there are still medical interventions that can help. Medications such Viagra, Cialis, Levitra, and others can provide good quality erections that you may not be able to achieve on your own. Papaverine – administered by injection at the base of the penis is a vasodilator that allows blood flow to the penis, resulting in an erection. In more severe cases of ED, you might find relief in surgical penile implants. There are currently two different kinds of implants available: semirigid or inflatable.  Another possibility is penis prosthetics.

Erectile dysfunction (ED) today affects over 150 million men worldwide [Ayta et al. 1999]. The recognition of ED in literature dates back to 2000 BC, whereas treatment options were only first introduced in the early 1960s [Maggi et al. 2000]. [1]

Although ED has been around for centuries, it’s only recently that treatment options are starting to catch up. There are many fascinating treatments available and much progress being made in this area. If you want to learn more about these options – talk to your medical doctor, who can then refer you to a Urologist if needed. There are many other treatment options not listed here – the point is to talk with your medical professional to see if one of them will work for you.

How Does Having ED Affect Your Mental Health?

Medical cause or psychological cause – ED can have an impact on your mental wellness. Some men feel:

  • Like they’re not really a MAN. There is some view that society expects/believes that men are supposed to be ready for intercourse at any given moment.
  • Pressured by their partners who may either feel vulnerable themselves (“Is his ED because he’s no longer attracted to, or turned on by me”?) or pressured by their partners who may be aggressive (“What’s wrong with you? Why can’t you get it up? What kind of man are you?”)
  • Depressed
  • Lonely
  • Anxious about performing (ironically, leading to a decreased chance of achieving an erection)
  • Low self-esteem and self-doubt.
  • Isolated
  • Unlovable

 What Effects can ED Have on a Relationship?

There’s no question that intimacy can be negatively impacted when a partner is experiencing ED because it’s both partners that are affected. How you and your partner handle ED will determine the long-term impact on your intimacy, sex-life, and relationship overall.


If you have a partner, you are in this together with your partner. It’s not just you alone facing ED. Be aware of the impact this has on your partner, of course. Be supportive of what they are experiencing but don’t accept the burden of this by yourself. Talk about it! Share how vulnerable you both feel (sometimes just doing this makes a noticeable impact on improvement). Communication is extremely important for couples dealing with ED. It’s healthy to look at this as a team and have an open mind to trying new things.

What Exactly is “Sex” Anyway?

When most people think of sex, they think of intercourse, and maybe some foreplay that leads to intercourse. No wonder ED feels like a death sentence to a couple’s sex life. It’s unlikely that anyone would ever wish for ED or say “I’m so glad I have ED or that my partner has ED” but there is so much more to sex and intimacy than penetration if you take the time to learn. Take this opportunity to explore options and discover play and increase the intimacy in your physical interactions with your partner. There are many elements and tools involved in sex – and an erect penis in only one of them!

Explore and Expand Your Mind

You can make cookies lots of different ways! Intimacy and orgasm can be achieved in a variety of ways – so be creative and inventive, and have some fun trying out new ideas.

  • Look at other options for intimacy and sensuality. Penis play doesn’t need a fully engorged penis. There is nothing wrong with a soft penis and can be experienced differently than one that’s hard. It can still be fun to participate in oral, vaginal, or anal sex play with a flaccid penis (even though it may be different).
  • Touch and massage – of all parts of the body can provide a real sense of connection. In fact, not having the pressure to perform (become erect, lubricated, or even have an orgasm) can lead to relaxed exploration of yours and your partners entire body – which is very erotic.
  • If they don’t already, sex toys can have a place in your bedroom tickle trunk. Dildos, vibrators, strap-on’s and other interesting add-on’s can all take the place of a hard penis for penetration but don’t forget other aids and toys like external vibrators, lotions, and even erotica or pornography…if that interests you.
  • Use your own body! A penis is just one organ. You also have hands, fingers, a tongue, toes – whatever you’d like to use or experience for pleasure! Be creative.
  • Alt sex lifestyles (i.e kink, poly, furries, swapping etc) may work to expand some couple’s sex lives. Be sure that you are both aware of what you’re committing to before you try these options. Be well informed – do research into what you’d like to try so there are no surprises.

Expand your skillset and understanding of good lovemaking or sex and you’ll find that there is so much more to sex and intimacy than hard penises and penetration.

What if You’re Single?

Putting yourself out there in the dating world can be pressure filled at any time – but doing so with ED – especially if your previous relationship was very impacted by this – can make you feel incredibly vulnerable. It’s important to be honest with your new partner. Try making it playful. You can say something like: “When I get aroused, sometimes the engine floods or stalls (because I’m so interested in you/excited by you) but this is something I’m working on and I’d love to work on this with you.” Also realize that sometimes your ED is person or relationally specific and it may work fine with a different partner.

This is where your skills as a lover in other areas will come into play. Starting a relationship with a new person while experiencing ED is kind of a test for how your relationship might play out. If they are willing to explore with you – then you may have made a good relationship choice. If they bolt, then perhaps you’ve dodged a bullet.


Person sex is the hardest kind of sex to have. The very act of sexual or sensual play puts us in a situation where we may feel open and vulnerable, among other many complex emotions. Remember – you are loveable regardless of the quality of your erection.

If you’d like to talk to someone about ED, sexuality, or intimacy, contact us to make an appointment with one of psychologists who specialize in sex therapy.