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| Psychological aspects of erectile dysfunction |
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Reviewed by Dr John Dean, specialist in sexual medicine
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Erectile dysfunction (ED) can be caused by many things.
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Physical causes, such as the narrowing of the arteries that supply blood to the penis as a result of long-term medical conditions like diabetes or heart disease.
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The effects of substances on blood flow and libido, such as alcohol or certain types of medication, eg antidepressants.
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Psychological causes such as anxiety, fear, depression, previous bad experiences and both partners' attitude to sex.
For diagnostic purposes a doctor may separate the physical and psychological causes of erectile dysfunction, but in practice the types often overlap.
However, the availability and high success rates of medication for ED, regardless of what causes it, have made it possible for doctors without specialised training in sex counselling to prescribe effective treatment.
In the process of deciding treatment, your GP should ensure that psychological factors, if present, are explored and dealt with.
Lifestyle and ED
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ED treatment should address underlying
psychological and relationship issues as well as the
physical problem. |
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Stress, overwork and drinking too much alcohol are common factors in many of the ailments that affect people today.
Sexual function is influenced by a person's overall wellbeing. ED may be a sign that not enough attention is being paid to maintaining a healthy lifestyle.
The most effective ED treatments can't be expected to do much against a tide of constant fatigue, inadequate sleep and the effects these issues have in a relationship.
Keeping fit by taking enough exercise, stopping smoking, drinking moderately, avoiding recreational drugs and eating a healthy diet will improve your sex life - as well as bringing other health benefits such as reducing stress and sleep problems.
Depression, anxiety and ED
Depression and anxiety are more common in men with ED. All forms of psychological illness still carry with them a degree of stigma and a reluctance to admit that they exist.
Men are particularly prone to ignore or suppress depression, but it is also true that depression might only show itself as a physical condition such as ED.
Almost all men with severe depression will have ED, and any degree of depression needs to be treated before ED treatment is likely to be successful. Most people with depression and anxiety are successfully managed by their GP.
Treating the couple
Many people, including doctors, will first go to the 'physical' treatments for ED (eg medication) and perhaps only consider the psychological ones if these fail.
But erectile dysfunction affects the couple - not just the man. It shouldn't be seen as an isolated problem that can be 'fixed' and then sex will successfully resume. There can be many associated issues, especially if there has been no sexual activity for years.
Failing to take into account both partners' views about sexual relations and whether expectations about treatment are mutual can lead to problems. If there is disagreement, it can sometimes make the ED impossible to treat.
This is why communication between couples is crucial to the successful treatment of ED. If communication is an issue, you and your partner may benefit from talking to a relationship counsellor.
Sex therapy and counselling is a specialised area and access to properly trained counsellors in this field is very limited, or even absent, via the NHS.
Most is carried out privately and this may mean some travel, especially for people who live outside the main cities.
Who to contact for sex therapy
Aside from being referred by your GP, there are a number of places that provide therapy.
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Family planning clinics are staffed by doctors who are trained in psychosexual matters. They are particularly good with problems such as low libido and ejaculatory incompetence. This treatment is free.
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A number of Relate counsellors have specific psychosexual training. Relate's fees are relatively modest and are means-based.
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The Institute of Psychosexual Medicine (private) is an organisation of doctors. Some will see you without a GP referral. Web: http://www.ipm.org.uk or phone 0207 580 0631.
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The British Association for Sexual and Relationship Therapy (private) consists mostly of non-medical personnel, all of whom have had extensive training. To find a therapist in your area, email info@basrt.org.uk.
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Based on a text by Dr Dan Rutherford, GP
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Last updated 19.06.2006
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