Treatment of Psychological (Psychogenic) Erectile Dysfunction
Psychogenic erectile dysfunction is an expression which means a man has a case of erectile dysfunction caused by psychological or emotional factors rather than physical ones. For example, stress is obviously a common cause of erection problems.
In many cases, men with erectile dysfunction caused by stressful life events will see the problem gradually disappear over time as the event which caused it fades into the past.
How long such erectile difficulties last is usually related to the intensity of the trauma of the event which caused the erectile dysfunction.
The way forward depends on how long the erectile dysfunction lasts: if the problem continues for an unduly long period of time, cure by a specialist sex therapist may be helpful. The treatment methods which such a therapist would use are the ones described on this website.
Of course, if a man’s erectile dysfunction has a physical cause, that must be treated medically as well; and since the origin of erectile dysfunction can be complex, involving both physical and psychological issues, a combined treatment encompassing both ways of approach is often the best.
And even men with an emotionally or psychologically based case of erectile dysfunction often find Viagra helpful as a temporary cure, no matter what the underlying factors happen to be.
Many men with primarily psychological causes to their erectile dysfunction, such as a recent life event, perhaps the death of a family member or excessive stress at work or in their relationship, will see their erections return once the source of the stress has been removed or reduced, or in the case of a loss, once sufficient time has passed.
The way to cure psychologically based cases of erectile dysfunction is to make sure a man’s partner is supportive of the treatment. So not only counseling and psychotherapy, but also self-help treatments for erectile dysfunction like the ones described in detail on this website, all require the involvement of a man’s partner.
Psychotherapy for Psychogenic Erectile Dysfunction
In general, there are two types of psychotherapy: psychodynamic therapy and counseling. Psychodynamic therapy assumes that erectile dysfunction is a sign of an underlying subconscious problem or sexual conflict, and revealing this and resolving it will cure the erectile dysfunction.
Part of this approach is to ensure that a man is reassured, encouraged, and given the opportunity to say what is on his mind. Counseling will follow a similar path, again involving both a man and his partner, but with perhaps less exploration of the deeper issues. In both cases, it is actually rather important to have the partner involved in therapy.
Sex Therapy For Erectile Dysfunction
In the 1970s Masters and Johnson developed an approach for the treatment of erectile dysfunction which involved putting the focus of attention during sex on what one was feeling in one’s body rather than on what one was doing (or how one was doing).
The sex therapist would give the client a series of instructions on what to do during sex, especially on how to have physical contact only for pleasurable physical sensation, not for sexual arousal and intercourse.
This non-goal-oriented approach gives a man and his partner the opportunity to focus on what they feel rather than on their sexual performance.
Also, not having to focus on sexual activity helps to alleviate performance pressure: the aim is to make sexuality something separate from performance anxiety, inhibition, and guilt, that it to say, the emotions surrounding sex.
This is called sensory or sensate focus, and as a man and his partner gradually get used to this different way of having sex, they can move towards genital stimulation without stressful goals like orgasm and intercourse.
This non-demanding and non-goal-oriented approach to sex means the man is probably going to get an erection. Without going into too much details about the treatment methodology, we can make a few points (the full method is described in the members’ area of this website).
Once a man has an erection, he can stop enjoying his partner’s touch and allow his erection to subside before he and his partner continue with sex. In this way it becomes clear that getting and keeping an erection is a natural process and no conscious effort is required. Why is this important?
Simply because men with performance anxiety are often goal-directed and think they must somehow cause an erection to happen rather than just letting events take their course. Gradually, a man will find he is getting more and more reliable erections, and intercourse becomes easier.
Many men with psychological erectile dysfunction will improve if they simply stop having sexual intercourse for a while and instead focus on enjoying the physical sensations of pleasure rather than sexual arousal.
So intercourse would not be permitted, for example, and any erections that did occur would be allowed to subside before sexual / sensory stimulation was resumed. The man would concentrate on the physical sensations he’s feeling and keep his awareness on his partner’s responses rather than his erection. Once he knows his erection is reliable, he and his partner can once again resume intercourse .
If there are relationship problems, these need to be addressed before the erectile dysfunction. If a couple have interpersonal difficulties, it’s unlikely they’ll find it easy to cooperate in psychosexual therapy.
Erectile Dysfunction and Sexual Performance Anxiety
Difficulty with your erection may mean that you have an anxiety problem, which can stem from bad experiences such as being overheard or seen when having sex, fearing pregnancy, not really liking or wanting to make love to your partner, and loss of erection when putting on a condom.
All of these events may make your level of anxiety rise, so that when you come to have sex next time, there is some anticipatory anxiety which predisposes you to loss of your erection: then you have a developing case of erectile dysfunction. But there are treatment methods which you can use to help yourself…..
The link that makes anxiety such a prominent cause of erectile dysfunction can be broken by the use of relaxation exercises or by using a series of exercises which combine to form a technique called sensate focus.
Another cause of erectile dysfunction is the fact that a man isn’t sensitive enough to what his body is telling him about his level of arousal.
In other words, if this were something relevant to you, it might be that you spend a lot of time during sex thinking about what is happening rather than just enjoying the experience.
You might, for example, spend a lot of time wondering if your partner is getting the right stimulation, or if she is going to have an orgasm, or if your erection is going to disappear.
Any and all of these factors are actually more likely to make your erection disappear than it would be if you simply enjoyed sex and stopped the anxious, worrying thoughts that might be floating around your head.
So the sensate focus exercises are designed to take you gradually from a state of uncertainty about your erection, with the threat of erectile dysfunction on hand all the time, to a place where you can stay relaxed, stop worrying about losing your erection, accept that it may disappear during sex, and realize that if it does so this is no big deal anyway (erections do come and go during sex!).
Although these exercises are effective against erectile dysfunction, some men have a challenge with ejaculating too quickly as well as losing their erection. You can’t tackle the problem of coming too quickly until you have cured your erectile dysfunction!
Start by relaxing as you or your partner touches your genitals
There are three stages to this exercise. You begin by learning to relax and focus on what you feel as you masturbate. If you use porn or you use fantasy while you masturbate, you may find that this is actually quite an unusual experience for you!
But to cure your erectile dysfunction, you will have to be in touch with your body, and this is the first step of the process.
Find a private place and time where you will not be disturbed. Do not use porn, and do not fantasize – simply enjoy the physical pleasure of stroking your penis (use some lube if you prefer) and focus on what you are feeling. This may be a new experience for you – but as we said above, getting in touch with your body is crucial if you are to enjoy good sex with a reliable erection. After all, erectile dysfunction occurs because you lose touch with the chief stimuli that keep your penis erect – that is to say, physical arousal. Believe it or not, it is physical touch that gets and keeps an erection – especially as you get older.
You may be wondering how we can say this when young men so clearly get erections from the slightest stimulation. Well, that is true, but the fact remains that fundamentally, for men, touch – especially to the genitals – is what gets us physically aroused.
Masturbate until you are close to orgasm, even if you feel that your penis is not as hard as it normally would be when you use fantasy and / or pornography. You will be able to get sufficiently erect to enjoy the physical pleasure. If your erection goes, don’t worry! Simply use your hand again to stimulate your penis until you have your erection back. The real point of this exercise is to show you that you can get your erection back if it goes away!
Now, this means that you may feel some anxiety as you start on the process – it’s important to make this an effective cure for erectile dysfunction by using some kind of relaxation technique until you have relaxed again and your anxiety has gone down.
If you simply can’t get an erection, then the best answer is to use as little fantasy as you can to get erect. What you certainly should try and avoid is allowing your anxiety to rise – the process is in essence about associating sex, relaxation, confident control of your erection and knowing what you are feeling in your body. Together, these are the components that will allow you to beat erectile dysfunction.
Once you’re a bit more confident about the process, and you’ve had success in producing an erection when you want one and not being worried about losing it (even if it does disappear from time to time!), you should know what touch you like, what turns you on, what feels good and what feels less good for you.
2 Get your partner to touch you but without any expectation of becoming erect
Once again, the idea is to take the pressure off yourself by coming to accept that touch does not have to be exclusively or mainly sexual in nature. It may or may not be arousing: but if you are touched on your penis or balls by your partner, and you don’t become erect, does that really matter?
The answer may be that it matters to you if you have a lot of performance pressure, and you see sex as something that you have to succeed at – or “be good” at.
Let your partner touch you all over, but without any expectation of sexual touch. She can stroke you, caress you, pat you, run her fingers over you – whatever, but remember that your objective is to be fully present in the here and now, aware of what you are feeling, but still relaxed and enjoying the sensuous nature of her touch.
You do not have to get an erection. It does not matter if you do or you don’t. Just relax and enjoy. That way you’ll be able to stop worrying about your erectile dysfunction a lot sooner!
3 Get sexual!
Have your partner touch the whole of your naked body with any part of hers (she too will be naked) as you lie on the bed. Try seeing how this feels on both sides of your body. Abandon any expectations of an erection – just let whatever happens, happen. If you get erect, watch your erection come and go.
When you’re happy with how you’re doing in this part of the exercise, move on so that you both touch each other. Your arousal will come mostly from being touched by her, so the whole focus of the exercise is to allow this to happen without feeling pressure or anxiety.
Being able to touch your partner means you don’t have to worry quite so much about your erection – but remember also that this is not some kind of contest where you have to sport an erect penis for the entire time you and your partner are getting sexual!
4 The cure for erectile dysfunction
The real point of all this is whether or not you can keep an erection as you make love.
Your penis needs to “meet” her vagina in a relaxed way, where it (and you) don’t feel they have to “perform!” If you have had a lot of erectile dysfunction, you may find that even putting your penis near her vaginal opening produces a lot of anxiety. So at each stage of this process, relax and keep breathing deeply to dispel any anxiety you feel. Use lube if you wish, but above all, relax and accept that you may or may not maintain your erection as sex progresses.
Get your partner on top of you. Let her rub her vagina against your penis and balls. You may or may not find this sexually arousing, but the more you can relax into the experience and the more you can abandon any self-checking, to see how aroused you are, the better. The whole idea is to relax into the sexual experience and watch your erection get harder and softer as the exercise proceeds.
You can move to the next stage of the exercise by gently inserting your penis into your partner’s vulva, between her labia, and just stimulating the entry to her vaginal passage. Once again, don’t expect anything to happen, just relax and take it as it comes: there’s no pressure to have intercourse, no pressure to give your partner an orgasm, and no pressure to keep an erection. You’re just trying to maintain contact with your body, so that you know how you feel at each stage of sex.
If you do lose your erection, just lie back and relax. You’ll never solve your erectile dysfunction by worrying about what’s going on – you need to take yourself out of your head and into your body – just enjoy the wonderful feelings of physical pleasure that come with sexual stimulation.
Next, as you may expect, you insert your penis into her vagina.
As always, if you feel any discomfort, stop and relax. You should use plenty of lube and take it slowly. Masturbate or stimulate yourself, or have your partner do it, until you have an erection sufficiently hard for penetration. Let your partner take the female superior position for sexual intercourse, and have her gently place your erect penis inside her and withdraw it – do this two or three times, relaxing, deep breathing, and making sure that if your anxiety begins to develop, you stop, breath deeply and wait until you are relaxed before you continue.
If your erection disappears, stop, let her dismount, relax, then have her masturbate you until your erection is back again, then carry on until you are confident that your erection is going to be maintained.
Should you find that you just can’t keep an erection, then try and find out why not – is it the position, the degree of stimulation, the way you move? Is it because you can’t fall back on fantasy to keep yourself aroused?
Try moving from sex position to another. You might find that some positions are more arousing than others. As you proceed through the exercises, you should find that your erectile dysfunction gradually diminishes.