When The Cause Of E.D. May Be Psychological

Understanding Causes of E.D.

When a man starts to experience difficulties maintaining an erection it can be very distressing for him.
There are many causes of E.D and it is important to understand the cause and differentiate as to whether it has a physiological cause such as disease, medication, surgery, or a psychological or as a result of excessive alcohol or recreational drug use. It is always important to consult a GP to rule out medical conditions, medications and low testosterone.


How to identify if the cause could be psychological

There are some simple questions that help to indicate if the cause of the E.D. are in fact psychological –

  • Do you get morning erections?
  • Are you able to maintain an erection to orgasm when alone?

If your answer to these is yes, then it is worth exploring the causes with a psychosexual therapist. It is important to consider that even in clearly organic cases, secondary psychogenic issues often develop. For example, a man may have low testosterone which is affecting his erections but the emotional toll of being unable to maintain an erection during intercourse may impact the erection even when he receives testosterone therapy.

Erectile dysfunction can affect general confidence as well as sexual confidence. Secondary problems may include relationship difficulties, anxiety and depression as well as affect  desire or attribute to another psychosexual problem.


Arousal Circuit

A psychological cause of E.D. can be identified by considering the process of what happens when a man becomes aroused. We can think of it in terms of an arousal circuit. That circuit starts from desire, moving to arousal, plateauing before reaching orgasm. The arousal may be triggered by visual stimulation, thoughts or fantasy, or by physical stimulation/sensations in the body. An erection needs to be maintained, at least to a reasonable degree, to achieve orgasm. The arousal circuit has three potential break points, whereby when a break occurs, the arousal circuit is broken and the erection is affected.

  • Pain – physical pain, inappropriate/uncomfortable stimulation. N.B. In cases of physical pain, medical issues need to be ruled out.
  • Emotional – Performance anxiety, pressure to perform, other emotional issues eg. grief, anger.
  • Distraction – when the mind is too busy to relax and allow arousal E.g. worrying about things, having unarousing thoughts, spectatoring (when the mind is focussed on the performance of the penis to the exclusion of all else).


Perpetuating problem

A common occurrence is the more it is thought about, the more often difficulty in maintaining the erection. As an example, it may be the case that a fit and healthy male with no physiological/medical causes for E.D. may have experienced on one occasion being unable to maintain an erection due to having drunk too much alcohol, but may then find on subsequent occasions he is having erection difficulties due to performance anxiety as a result of the previous occasion. Another example may be an occasion of premature ejaculation during intimacy with a partner. Worrying that this will happen again may affect the maintenance of an erection on another occasion if distracted by thoughts of it during sexual intimacy.



Psychosexual therapy can help to understand the cause of the E.D. and use a practical approach to overcoming the problem through exercises, therapy tools and looking at thoughts processes, feelings and precipitating factors. Where a man is in a relationship he may find it more useful to have his partner present in therapy so that the difficulty can be worked through as a couple. This can help to break through anxieties quicker, recognise it is not just one partner’s problem and enables the therapist to work through issues that are present for both partners as a result of, or as the cause of the problem.

Erectile Dysfunction is not something men have to put up with – there are many treatments available depending on the cause. Men can refer to a GP, Sexual Health Specialist or a Psychosexual Therapist in order to start identifying the origin and seek the right treatment.

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