SMSNA receives and publishes journals ‘guest editorial‘ by sexual medicine specialists. Current article submitted by Mark Goldberg, LCMFT, CSTboard certified sex therapist and SMSNA member specializing in sexual medicine in Maryland and hosting the Erectile Dysfunction Radio Podcast. Content has been reviewed by the SMSNA Site Committee for accuracy.
Erectile dysfunction (ED) is a complex medical condition that involves both physical and mental components. The paradigm of what causes ED and how it is treated has shifted over the last 50 years from a mental focus to a physical one.
This is due in part to the advent of non-invasive, oral medications and a more complete understanding of the natural components of DM. However, the mental components of erections and ED continue to play an important, but often underestimated, role, and many men can resolve ED by addressing these factors.
While some erections seem to just “happen,” many require the mind to be activated, engaged, or interested in sexual activity. For some men this remains a subconscious process, meaning that a man does not have to actively think about sex, but his mind is open and receptive to stimuli or subconscious thoughts. For this reason many men overlook the role of the mind in the erection process until ED occurs.
Psychogenic ED
Erectile dysfunction is different from many other medical conditions. Some physical ailments can be attributed to psychosomatic causes. In other words, physical illness itself can actually be caused by a person’s mind. This concept is often misapplied in ED, causing confusion and creating barriers to proper treatment. While some men will experience ED as a manifestation of underlying mental health conditions such as stress, the mind’s role in erections is more extensive.
Erections are facilitated by what the mind thinks and how it processes the external environment. Without proper stimulation and desire, erections will be difficult, if not impossible, to achieve. Even when external stimulation is provided, the mind must process it in a way that signals to the body that an erection is needed for sexual engagement. When this doesn’t happen, ED can result: not because the mind is blocking an otherwise natural process, but because an important component of erections (ie, mind involvement) is missing.
Psychological causes of erectile dysfunction
There are a number of mental health conditions that can contribute to erectile challenges, including anxiety, depression, performance anxiety and relationship problems. These are normal experiences that most people will encounter, if not on a regular basis, at some point. More importantly, understanding how these normal human experiences affect erections is essential.
Distraction. A man must be interested in and engaged in a course toward sexual activity in order to reliably obtain and maintain an erection. If he is thinking about other things or if his mind is preoccupied with anxiety or worry, it can be more difficult. Otherwise, direct sexual stimulation may have less impact if the mind is not receptive and engaged.
Advertising. A man should be open and receptive to pleasure. However, the mind also needs to process and interpret what is happening, whether mental or physical, as sexual arousal. A number of mental health challenges can lead to anhedonia, which is the loss of pleasure in previously enjoyable activities. Even without distraction or anxiety, previously arousing thoughts, sounds, visuals, and activities may lose their effectiveness as facilitators of sexual arousal through habituation, anhedonia, and other mental factors.
beliefs. What a man thinks about himself, his partner, and sex can affect both distraction and frustration as well as sexual desire and motivation. Problems can arise when men feel underserved or have low self-esteem, low self-esteem, or experience body image issues or insecurities in their relationships. Each of these can be deeply seated and interfere with erections in both individual and sexual activity.
Unrealistic expectations. Many people develop unrealistic expectations when it comes to sex. Expectations for men are often about partner performance and responsiveness. When experiences do not meet expectations, performance- and relationship-based anxiety can arise. For some men, a basic reset of expectations may be helpful, while others will benefit from a more in-depth cognitive restructuring.
The bottom line
Many men with ED are uncomfortable with the idea that their mind is part, if not the main driver, of not achieving an erection. Often, psychogenic ED can occur even in the absence of any current mental health concerns or distress, which can make understanding and acceptance more difficult.
These men may be quick to dismiss the possibility of psychogenic ED and ultimately ignore an important component of healthy erections. However, when men experiencing ED can recognize that their mind is always involved in erections, seeking help becomes easier and ED treatments may ultimately yield better results.
