Psychogenic erectile dysfunction: causes, diagnosis and treatment
Psychogenic erectile dysfunction is the most frequent type of impotence among young males. Before the age of 30 or 40 the mechanisms of erection are rarely impaired due to vascular risk factors such us smoking, hypertension, high cholesterol, obesity, diabetes and lack of exercise. The effect of these factors on blood vessels takes longer to decrease sexual function.
However, transient and sporadic erectile dysfunction episodes happen to up to 50% of young men at any time due to drinking alcohol or taking drugs, being fatigued, after a hard day or physical exercise, or having stressful emotions or a depressed mood. Young adults are more sexually active and thus more sensitive to a decrease in potency, or the odd failure to get an erection. Emotions related to low sexual performance are stronger at this young age, and usually lead to a marked anxiety status. This anxiety may perpetuate the problem and turn a transient erectile dysfunction into a consistent psychogenic erectile dysfunction.
In Men’s App we have previously spoken about “Mechanisms of erection and sexual desire”. Also about “General recommedations to improve sexual performance” Part 1 and Part 2, “Viagra and other oral drugs to treat impotence”, and “5 risks of recreational use of Viagra”. We strongly recommend that you read these articles to better understand today’s topic. Even though most cases of organic impotence also have a psychogenic component, we are talking about pure psychogenic erectile dysfunction, its diagnosis and its medical approach.
Causes of psychogenic erectile dysfunction
There are several possible causes for psychogenic erectile dysfunction. The most frequent is performance anxiety.
- Performance anxiety: Masters and Johnson first described this in 1970. Performance anxiety appears in young male after failing to achieve an erection. The individual will lose self-confidence the next time he has sex. He will focus on his penis, will lose his sexual arousal and will stop paying attention to his partner. Anxiety provokes an increase in adrenalin levels in blood, a vasoconstring agent which makes having an erection difficult. The negative emotion saved in the brain, completes the vicious circle and the problem worsens the next time.
- Partner related factors: communication problems, lack of confidence, power conflicts, loss of sexual interest in the partner, etc. It is sometimes difficult to know if the problem comes from the impaired relationship or if the relationship is impaired because of the sexual problem. Also women sexual dysfunctions may cause sexual dysfunction in men and vice-versa. Other partner related causes of psychogenic erectile dysfunction may be long sexual inactivity due to a partner’s disease, or due to the partner’s death. In the latter case when restoring sexual activity there could be a feeling of guilt or betrayal, or a fear of not being accepted by the social and family environment.
- Stress: family, social, work or economic conflicts may cause a loss of interest for having sex, or an inability to concentrate enough for arousal.
- Sexual education: absence of sexual education among young males, a too restrictive education due to moral or religious attitudes, or sexual abuse during infancy are also causes for psychogenic erectile dysfunction.
- Sexual preferences: today sexual relationships start at a younger age and promiscuity is higher in both homosexual and heterosexual experiences. Difficulties in finding sexual preferences can cause anxiety and erectile dysfunction.
- Lack of self-confidence: for example, men with little experience may feel inhibited or insecure when having sex with more experienced women.
- Fears: fear of pregnancy or fear of getting a sexually transmitted disease.
- Psychiatric diseases: 50-70% of male with depression develop erectile dysfunction due to the disease itself but also due to antidepressant medication. Other neurosis or psychosis may also lead to impotence.
- Other causes: wrong sexual beliefs, affective disorders, or secondary to other sexual dysfunction such as low sexual desire, premature ejaculation, etc.
Diagnosis of psychogenic erectile dysfunction
In clinical practice it is not difficult to detect psychogenic erectile dysfunction when the individual is able to have an erection during masturbation, with a different partner or with different stimuli. Equally evident are those cases when there is a clear traumatic event in life such as job loss, death of relatives, economic problems, etc.
Psychogenic erectile dysfunction usually has an abrupt onset, contrary to organic impotence. Another characteristic is the preservation of nocturnal or morning erections when waking up, or spontaneous erections in response to certain stimuli or circumstances.
Treatment of psychogenic erectile dysfunction
Once the problem and its triggering circumstances have been identified, psychological help is necessary to reduce anxiety. Counselling to overcome performance anxiety by a professional is very important in these situations. The following are useful tips:
- Be honest with yourself and your partner. Do not hide your fears. Talk about them.
- Focus on pleasure, sensations you enjoy, and your partner’s desire. Be playful, keep things light, and get swept away by pleasure.
- Exercise non-genital non-intercourse intimacy such as eye gazing, hugging, touch, partner communication, massage. They teach you to be present and mindful of pleasure with your partner.
- Have realistic expectations, do not think you are like a porn actor, and expect a few sexual difficulties.
- Avoid substances, drugs or alcohol.
- Take the emphasis off erection. Do not rush into intercourse, and take your time… Sex is not about the destination, it’s about the journey.
Together with psychological support, sometimes your doctor will recommend you to take a low dose of oral medication for erectile dysfunction during a few weeks, so you have an aid to break the vicious circle of performance anxiety and you can recover your self-confidence.
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