Erectile dysfunction is very common in the United States with approximately 18% or 18 million men over the age of 20 living with this disorder (Selvin, Burnett, & Platz, 2007). Erectile Dysfunction is defined as an inability to attain or maintain an adequate erection (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). Erectile dysfunction occurs during the first phase of the sexual response cycle, the excitement phase. In order to be a diagnosable psychological condition, the disturbance must cause significant distress to the individual or interpersonal difficulty. In addition, the dysfunction must not be a result of direct physiological effects of a substance or a general medical condition.
Physical contributors to erectile dysfunction include:
Lack of physical activity
Cardiovascular risks including diabetes
Nerve and brain neurological diseases
High blood cholesterol levels (Selvin, Burnett, & Platz, 2007)
Injury to the spinal cord, penis, pelvis or bladder
Side effects of medication
Low levels of testosterone
Alcohol and substance abuse
High cholesterol and blood pressure
Masters and Johnson (1970), known as the founders of sex therapy, found that roughly 90% of sexual dysfunctions were psychological in cause and 10% organic (Kleinplatz, 2004).
Psychological causes of erectile dysfunction may include:
Because many causes of erectile dysfunction are mental, sex therapy can be extremely helpful in resolving erectile dysfunction.
Erectile dysfunction should be treated utilizing a systemic approach focusing on all factors relating to the individual.
Mr. X was referred to psychotherapy by his general practitioner due to erectile dysfunction problems “causing him extreme stress and compromising his relationships” (p. 364, Popovic, M., 2007). Mr. X experienced erectile dysfunction issues on and off since adolescence. To cope with his erectile difficulties, Mr. X often avoided sexual activity. Mr. X and his wife had not had sexual relations for several months prior to therapy and he did not self-masturbate. During therapy, Mr. X shared that he had several operations at the ages of eight, ten and eleven to correct an undescended testes. It appeared as if Mr. X was suffering from body image problems, poor self-esteem, communication issues, family-of-origin problems and anxiety as well as erectile dysfunction. Sex therapy was an appropriate treatment for Mr. X as his erectile dysfunction was caused by psychological issues and not physical.
Mr. X’s treatment consisted of both individual and couples therapy as well as experiential at-home assignments. These at-home assignments helped produce more intimacy, communication and self-exploration. Mr. X reported it would take 50 successful sexual intercourses to start believing his erectile dysfunction problem was cured. Mr. X reported achieving this goal within ten sessions of therapy.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Selvin, E., Burnett, A. L., Platz, E. A. (2007). Prevalance and risk factors for erectile dysfunction in the US. The American Journal of Medicine, 120, 151-157.
Kleinplatz, P. J. (2004). Beyond sexual mechanics and hydraulics: Humanizing the discourse surrounding erectile dysfunction. Journal of Humanistic Psychology, 44(2), 215-242. doi:10.1177/0022167804263130
Popovic, M. (2007). Psychosexual treatment of erectile dysfunction in a man who had reluctance to couple therapy: A case report. Sexual And Relationship Therapy, 22(3), 363-377. doi:10.1080/14681990701235722