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Erectile Dysfunction

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
  • Kidney disease
  • Nerve and brain neurological diseases
  • Hypertension
  • 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:

  • Stress
  • Anxiety
  • Depression
  • Guilt
  • Poor self-esteem
  • Interpersonal conflict

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.

Treatment options include:

Case Study:

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

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