Are you experiencing Erectile Dysfunction (ED)?
If you look at a lot of the medical literature exploring ED, they tend to quote that psychological factors are responsible for about 10%-20% of all cases. Interestingly, as a psychologist, and in my practice as a sex therapist, it is my experience that psychological factors are responsible for closer to 80% or 90% of ED issues. Certainly, there are a lot of medical causes for ED, and these need to be ruled out first prior to looking at psychological effects or causes. Common medical conditions that induce ED include: Diabetes, obesity, history of smoking or chronic alcohol use, certain medications (particularly SSRI antidepressants), aging, testosterone levels, vascular disease, and more. If you’ve talked to your doctor and feel you’ve ruled out a medical cause, then there is a good chance that your ED is psychological in nature.
You can easily rule out if your ED is caused by a medical issue by just testing and observing the general level of your erection by using masturbation and/or pornography to gain optimal levels of arousal to see how your erection functions under those circumstances. Under normal circumstances, erections should fully last until orgasm (unless you are maintaining an erection for a very long time or are going on round 2+). However, if you’re noticing that your erection is not lasting or is not as hard, even though you are able to achieve an orgasm, there is likely some medical or biological impact going on and you should see your medical doctor to diagnose, and solve or alleviate the problem. Remember you can have both a medical and psychological cause of ED as the same time.
Something important to note is that self-pleasure is much easier to accomplish (no pressure, and you usually know what works) than sex with a living being – as relational sex tends to be more complicated due to the many feelings experienced, the interactions that are occurring and the expectations that are directly or indirectly brought forward.
WHAT ARE SOME OF THE PSYCHOLOGICAL CAUSES OF ERECTILE DYSFUNCTION?
Sexual Abuse or Trauma
Some historical causes stem from childhood and can be a result of sexual abuse or trauma or even early sexual abuse or trauma experiences in your adult relationship. These can be emotionally dragged forward causing you to trigger or emotionally flood, thereby leading to ED. Interestingly, these effects can also be experienced by individuals who are a lot more emotionally sensitive. So, if your involved with your partner who has been sexually abused, you can be emotionally triggered by their emotional responses during your sexual activity. I’ve even had a case where an individual was involved in a car accident. The car accident shocked him enough psychologically that it impacted his sexual functioning. This was not directly related to anything sexual, but rather to his own level of vulnerability of being human.
Another facilitator of ED is stress, which can be related to your job, money, marital problems, unresolved emotional issues occurring in your relationship, or even unresolved emotional issues from things in other areas and relationships in your life.
Guilt can facilitate ED. You can experience guilt due to behavior or activities in which you’ve participated. Some of these behaviors can include the experience of other sexual activity, such as using pornography without consent, having an affair, or even not pleasing your partner to their level of satisfaction. As mentioned earlier, some of this guilt could have occurred as a result of something that was experienced during early relationships or childhood. Guilt can also happen as a result of strict religious or cultural upbringing regarding sexuality which can also lead to ED.
When you’re depressed, this can lead to increases in a lack of desire and/or interest which can commonly result in high levels of ED. This depression can be a result of biology or it could be a result of recent/past circumstances in your life such as grief or loss, or even environmental changes such as moving, buying a house, getting sick, etc. Medications (particularly SSRis and antipsychotics) used to treat depression can also have a negative on your libido and lead to ED.
If your relationship is problematic or experiencing conflict, this can lead to resentment, which tends to lead to a lack of desire with your partner, which can ultimately lead to decreased interest and sexual functioning. If you find yourself sexually attracted to and/or able to get full erection while thinking about someone else, than this also increases the likelihood that your ED is more of a psychological issue, not a biological one.
All of these factors that can cause ED, can lead to low self-esteem. Just dealing with ED itself can cause you to lose your confidence. A high level of psychological differentiation (being able to be strong enough to stand up for yourself and tolerate uncomfortableness while people are standing up for themselves) is required for a good erection to occur in a sexual relationship.
Some of these issues may also relate to anxiety, which is probably one of the more common ED facilitators. Anxiety can be a result of performance anxiety (feeling pressured and on the spot) or anticipatory anxiety (worried that you might not be able to perform) . It could be not knowing what the other person wants because of a lack of communication or conversation regarding sexual behavior. This can lead to a feeling of not being confident in that particular area or not feeling confident enough to be a “penetrator” if penetration is the activity desired.
Watch out for environmental influence. For some individuals, it can be very difficult to maintain an erection when the children are crying, the lights are on, you think someone may be watching you or your in-laws are in the next room. Interestingly, it is important to realize that for some people, these issues actually may facilitate a stronger erection.
High Porn use.
Although still somewhat controversial, in my experience working with clients, high porn use has been related to a lot of ED issues, especially in younger men. Non-problematic levels of porn use tend not to have too much of an impact, but some individuals spend a lot of time on pornography or even looking at high levels/intensity or taboo forms of pornography, and in my experience, certain individuals are more susceptible to having ED issues, especially when they actually engage with a partner (some individuals may not notice any negative effect).
People should be aware that all behavior that you engage in, can be related to, or impact other areas of your life and that “practicing with porn” could modify some of your arousal templates and/or impact your sexual functioning with individuals.
Although I can go on regarding other issues related to ED and penis functioning, the last one I will mention is boredom. Boredom is also a factor that impacts sexual dysfunction, especially if the activity you are engaged in is no longer exciting or stimulating enough – then erections will no longer work or work as well. Erections and arousal tend to like intimacy, novelty, or things being taboo,.
If you are dealing with ED, know that there is hope. Talking to one of our therapists with expertise in this area can be a great start to tackling your erectile dysfunction.
By Dr. Cory Hrushka,C.S. D.S.T.
Senior and Forensic Psychologist
Diplomate of Sex Therapy/Sex Therapist