Psychological factors are the root cause of erectile dysfunction in about 10%--20% of cases. In such circumstances, a patient is said to have psychogenic erectile dysfunction. Stress, relationship problems, or psychological illnesses can impair the signals from the brain that initiate the chain of biological events needed for an erection. Often, the fundamental problem is anxiety or depression. One study found that erectile dysfunction is nearly twice as common among depressed men as it is among those who aren't depressed (see "Erectile dysfunction and depression"). Other causes include stress, guilt, low self-esteem, and fear of sexual failure.
Keep in mind, though, that psychological factors play a contributing role in most cases of erectile dysfunction. Even if the cause is purely physical or medical, erectile difficulty is almost certain to have an emotional and psychological impact. These emotional consequences can lead to the kind of performance anxiety that triggers more severe erectile dysfunction. When this happens, a man may begin to avoid his partner or make excuses for not having sex -- actions that can perpetuate anxiety or depression. At this stage, the role of the psychological difficulties may in fact overshadow the original medical or physical cause. To cure the problem, you'll need to address the physical problem and the psychological one.
When psychological disorders alone are to blame, there are some clear signs (see Table 2). For one thing, erectile dysfunction tends to emerge suddenly. And it's likely to occur with just one partner, often because of tension in the relationship. Another sign that the problem is mainly psychological is the ability to achieve an erection with masturbation and, perhaps most importantly, while sleeping. Most healthy men have three to five erections during each night's sleep. Nocturnal erections are impaired by physical problems, like disease or nerve damage, but not by psychological disorders.
Keep in mind, though, that psychological factors play a contributing role in most cases of erectile dysfunction. Even if the cause is purely physical or medical, erectile difficulty is almost certain to have an emotional and psychological impact. These emotional consequences can lead to the kind of performance anxiety that triggers more severe erectile dysfunction. When this happens, a man may begin to avoid his partner or make excuses for not having sex -- actions that can perpetuate anxiety or depression. At this stage, the role of the psychological difficulties may in fact overshadow the original medical or physical cause. To cure the problem, you'll need to address the physical problem and the psychological one.
When psychological disorders alone are to blame, there are some clear signs (see Table 2). For one thing, erectile dysfunction tends to emerge suddenly. And it's likely to occur with just one partner, often because of tension in the relationship. Another sign that the problem is mainly psychological is the ability to achieve an erection with masturbation and, perhaps most importantly, while sleeping. Most healthy men have three to five erections during each night's sleep. Nocturnal erections are impaired by physical problems, like disease or nerve damage, but not by psychological disorders.
Relationship problems, such as anger or distrust, can also contribute to erectile dysfunction. If either partner is unhappy with the other, it can dampen sexual desire, an important component of erectile function. Inhibitions that result from undisclosed sexual fantasies or preferences can also be at the root of the problem. If a man feels too embarrassed to tell his spouse or sexual partner about his preferences, he may have trouble becoming aroused. As all these examples illustrate, intimacy and open, honest communication play a vital role
Premature ejaculation
Doctors used to think that young men with premature ejaculation had an increased risk for erectile dysfunction later in life. Although doctors now know that there is no cause-and-effect relationship, the two conditions do share a common treatment.
Unlike men with erectile dysfunction, those with premature ejaculation are able to maintain an erection long enough to have intercourse. The problem is that they climax too early, either during foreplay or just after penetration. Premature ejaculation is common, affecting about 25%--40% of American men. Some men ejaculate early whenever they have sex, while others experience this only in certain situations, such as when they're anxious or overstimulated. Men who fall into the second category are more likely to have erectile dysfunction, too.
Many men can learn to control premature ejaculation with the squeeze technique. The method is simple -- if you feel an orgasm coming on during foreplay, you use a thumb and two fingers to squeeze the area just below the head of your penis for 20 seconds. This inhibits ejaculation and slightly reduces the erection. After about half a minute, resume sexual foreplay to regain your erection. Use this technique as often as necessary until you can enter your partner without ejaculating too soon. With practice, your body will learn to delay ejaculation without the squeeze.
If this technique doesn't work for you, the PDE5 inhibitors used to treat erectile dysfunction might be helpful. If you don't respond to those drugs, you may find that one of the selective serotonin reuptake inhibitors, a class of antidepressants, will help.
Doctors used to think that young men with premature ejaculation had an increased risk for erectile dysfunction later in life. Although doctors now know that there is no cause-and-effect relationship, the two conditions do share a common treatment.
Unlike men with erectile dysfunction, those with premature ejaculation are able to maintain an erection long enough to have intercourse. The problem is that they climax too early, either during foreplay or just after penetration. Premature ejaculation is common, affecting about 25%--40% of American men. Some men ejaculate early whenever they have sex, while others experience this only in certain situations, such as when they're anxious or overstimulated. Men who fall into the second category are more likely to have erectile dysfunction, too.
Many men can learn to control premature ejaculation with the squeeze technique. The method is simple -- if you feel an orgasm coming on during foreplay, you use a thumb and two fingers to squeeze the area just below the head of your penis for 20 seconds. This inhibits ejaculation and slightly reduces the erection. After about half a minute, resume sexual foreplay to regain your erection. Use this technique as often as necessary until you can enter your partner without ejaculating too soon. With practice, your body will learn to delay ejaculation without the squeeze.
If this technique doesn't work for you, the PDE5 inhibitors used to treat erectile dysfunction might be helpful. If you don't respond to those drugs, you may find that one of the selective serotonin reuptake inhibitors, a class of antidepressants, will help.
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