Erectile dysfunction is one of the common concerns I see as an individual, couple, and sex therapist. Thanks to the appearance of Viagra in 1998, there has been an increase in discussion and awareness of erectile dysfunction. However, many people are still in the dark about what it means to have this condition, and the causes and available treatment options. In this post I will provide some information about the condition and its causes. In the next post I will discuss treatment options.
Erectile Dysfunction is defined as the consistent inability to obtain or maintain an erection that is sufficient for sexual activity. With this definition, we can see that there is some variety in the appearance of erectile dysfunction. It may be the complete inability to obtain an erection, or it may be that the man is able to obtain a full or partial erection but it is not strong enough or does not last long enough for sexual activity. These characteristics of erectile dysfunction may vary from man to man, or from situation to situation for each man.
What causes erectile dysfunction? There have been several shifts in the conceptualization of erectile dysfunction over the years. In the 1950s erectile dysfunction was thought to be a result of childhood psychological problems. In the 1970s, Masters and Johnson’s work on sexual dysfunction shifted the focus to performance anxiety as the cause of erectile dysfunction. In 1998, with the introduction of Viagra followed by similar medications, there was a shift to physiological causes. The proliferation of advertisements for these medications, combined with the attraction of a simple solution, has helped to maintain this understanding of erectile dysfunction as a physiological problem. After all, who wouldn’t want to just take a pill to cure a distressing problem?
Viagra and other similar medications have been invaluable to the treatment of erectile dysfunction. They provide an effective treatment for many cases of the condition, and have also greatly increased the dialogue about erectile dysfunction. Countless men were encouraged to discuss this problem with their partners and doctors, based on the advertisements for medication to treat erectile dysfunction. But is it true that erectile dysfunction is always caused by physiological problems?
In fact, there are a variety of physiological, psychological, and social factors that can both cause and maintain erectile dysfunction. Physiological factors include anything that affects the vascular, neurological, or hormonal systems in the body. For example, diabetes, high blood pressure, and heart disease can cause erectile dysfunction. Alcohol consumption, medication, smoking, dietary habits, exercise, and sleep can also impact erectile function.
Psychological factors in erectile dysfunction include anxiety, mental distractions (thoughts that take the man away from the sexual experience), a goal-oriented mentality (a focus on an erection, orgasm, or length of time for the sexual experience instead of on pleasure), and negative emotions such as anger, grief, or sadness. Social factors can include the context of sexual activity (time, privacy, and relationship status), self and partner expectations about sex, and relationship conflict, mistrust, or lack of emotional intimacy.
Even in cases in which there is a physiological cause, psychological and/or social factors may contribute to erectile dysfunction or even maintain the problem after the physiological cause has been treated. In my next post I will discuss treatment options that address the physiological, psychological, and social causes of erectile dysfunction and the role of sex therapy in treatment.