Difficulties with obtaining and maintaining an erection are a common phenomenon that is experienced by most men at some point in their lives.
In fact, it’s estimated more than 50 percent of men complain about some form of erectile function struggles by the age of 50 (Metz & McCarthy, 2004).
We are raised in a society in which men’s masculinity and self-esteem are directly correlated with their sexual prowess and abilities, and the penis is touted as a symbol of power and major source of a man’s identity and feelings of worth.
The message that’s sent is men should be able to have sex with anyone at any time and any place with an ever-ready, raging hard-on that is sure to please, and this is reinforced in the gay community.
This, of course, is a rampant sexual myth that creates a huge disservice to male sexuality. As such, when a man does experience challenges with sexual arousal, this can create a significant personal crisis for the man and his relationship.
In part one of this clinical article series, we’ll address four different causes of erectile dysfunction. Next time, we’ll focus on how to treat these challenges to help restore a satisfying sex life filled with firm stiffies.
What is the definition of erectile dysfunction?
When erections become consistently unpredictable, when it is difficult to achieve and maintain a hard-on sufficient for sexual play and if a man seldom gets an erection and avoids trying to have sex out of fear of being unable to obtain one, this is likely indicative of a problem situation.
Such circumstances often produce distress, anxiety, self-blame and relationship stress for the man involved. However, if a man is usually able to experience erections and only has occasional challenges, this actually falls within the range of normal sexual response.
You’ll want to assess whether the difficulties are lifelong or more acute, as well as if it occurs in all situations, including masturbation, or only in some situations.
What are the causes?
So why might your anaconda be limping out on you when you don’t want it to?
Metz and McCarthy (2004) have identified the causes of erectile difficulties fall into four general groups: physical, psychological, relational and psychosexual skills deficits.
However, pinpointing a specific cause is not a cut-and-dry process, as sexual disorders rarely operate in isolation. There are usually several different causes occurring at the same time to simultaneously produce and maintain the erectile issues.
This, in turn, can create a lot of turmoil for the man, his partner and the relationship. What follows is a breakdown of the various causes of erectile difficulties in each of the specific groups.
1. Physical causes
Anything that impacts the physiological functioning of the body, whether it be structural, neurological or hormonal, can negatively affect the sexual response cycle and cause problems with erection.
Medical illness of all types can undermine erections. Some examples include diabetes, high blood pressure, multiple sclerosis, tumors, heart and lung disease and prostate issues (Wagner & Green, 1981).
Erections are blocked because of the role these conditions have on the sexual response cycle and the systems involved in the physiology of erections.
Physical injury or surgeries also can be a cause, whether the damage to the body is temporary, permanent, direct or indirect to its effects on the physical systems.
Lifestyle issues also are common causes. Consumption of alcohol and drugs, cigarette smoking (secondary exposure as well), obesity, an inactive lifestyle, fatigue, excessive exercise and busyness and chronic stress all negatively impact sexual function.
The use of medications for medical and psychiatric reasons has also been identified as significant due to side effects (Metz & McCarthy, 2004).
Contrary to popular belief, age is not a cause of erectile dysfunction. While it’s true many older guys struggle with erectile issues, this is more often attributed to the fact men tend to have more problems with illness as they age, and hence the utilization of more medication and their side effects is a more realistic explanation.
Low androgen or testosterone levels may also be a factor for men in general struggling with ED.
2. Psychological causes
The presence of a mental health disorder or emotional distress can both be a cause and effect of erectile functioning and sexual desire.
Sexual function also can be compromised under situations of stress and emotional struggles associated with decreased confidence and low self-esteem, self-doubt, disappointment, irritability, remorse, embarrassment, poor body image, unrealistic expectations about sexual performance, boredom and reactions to one’s partner’s distress.
In my practice, I see things like performance anxiety, guilt, sexual phobias, fear of sexual failure, inability to abandon oneself to sexual feelings, sexual orientation conflicts, fear of HIV or other STDs, religious inhibitions, sexual abuse victimization and holding on to sexual misinformation as big contributors.
3. Relationship causes
It takes two to tango when it comes to sex, and complicated relationship dynamics, such as communication breakdowns and mistrust, can cause, maintain and result in erectile difficulties.
Power struggles, lack of intimacy and emotional closeness, loss of a feeling of comfort and safety, anger/resentment and diminished attraction can all kill sexual desire and arousal.
Additionally, if a man’s partner is suffering from a sexual disorder, this can negatively affect his sexual functioning.
4. Psychosexual skills deficits causes
Having inaccurate knowledge or awareness about sexual physiology or about his or his partner’s body can be a deterrent.
Having unrealistic expectations about sex and performance, lacking sensual skills for arousal and lacking interpersonal skills (being able to engage in sexual communication, being assertive, working cooperatively with a partner, etc.) are all additional examples of skill deficits that can impair healthy sexual response and the experience of erections.
You’ll want to do a thorough assessment of all these issues, and the most important step you can take is to schedule an appointment with your doctor for a full medical exam to rule out any possible organic causes. Working with a therapist can be helpful in sorting out all these other complex dynamics.
Stay tuned next time for how to get hard more often and with longer staying power!
References: Metz, Michael E. & McCarthy, Barry W. (2004). Coping with Erectile Dysfunction: How to Regain Confidence and Enjoy Great Sex. Oakland, CA: New Harbinger Publications Inc. Wagner, Gorm & Green, Richard (1981). Impotence: Physiological, Psychological, Surgical Diagnosis and Treatment. New York: Plenum Press.