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A closer look at erectile dysfunction: Causes and solutions

Updated: Jun 30, 2021

Male erections are extremely complicated, both psychologically and physiologically. Because of this, erectile dysfunction, also known as ED, is one of the most common sexual dysfunctions I encounter as a sex therapist. Clients with ED report that they have difficulty getting an erection or maintaining one. In the United States, roughly 18 million men over age 20 report struggling with ED, according to the Johns Hopkins Bloomberg School of Public Health.

What causes erectile dysfunction?

Physical components of erectile dysfunction:

Erectile dysfunction can be the result of physiological issues. Often, it is associated with age, cardiovascular disease, diabetes or lack of physical activity. A study conducted by the Johns Hopkins Bloomberg School of Public Health found that almost 90 percent of men with ED had at least one risk factor for cardiovascular disease (diabetes, hypertension, poor cholesterol level, smoker). There also are many other physiological issues associated with ED, including endocrine abnormalities and the effects of certain medications.

If erectile dysfunction is related to physiological problems, a medical doctor can help determine which lifestyle changes will be beneficial, such as dieting, exercise, stress reduction or smoking cessation. A medical doctor also may prescribe medications that help treat ED, such as Viagra, Levitra or Cialis. These drugs work by increasing blood flow to the penis during sexual stimulation. The National Institutes of Health reported that roughly 35 percent of men with ED are unresponsive to this type of drug. In those cases, other treatments, such as penile injection therapy, in which a drug that increases blood flow is injected into the penis, may be recommended. The NIH found that this therapy aided with erection in up to 80 percent of men with ED who tried it. An erection usually occurs 10 to 20 minutes after the injection. The injections are limited to 12 times per month.

Another notable treatment option for men with erectile dysfunction is a vacuum constriction device often referred to as a penis pump. A man's penis is placed in a plastic tube connected to a pump and the air is removed, creating a vacuum and causing blood to rush into the penis. Once the penis is filled with blood, a plastic ring is placed at the base, preventing blood from leaving. Research on vacuum devices reports varying results of men's satisfaction, ranging from 35 to 84 percent.

Psychological components of erectile dysfunction

Psychological components, such as depression, anxiety or stress, also can cause ED, and they can be broken down into two main categories: a generalized psychological block and a situational psychological block. Generalized issues relate to the person as a whole. For instance, an aging man could have a reduced sex drive due to declining levels of testosterone. If his problem were situational, his ED could be attributed to a lack of interest in his partner or problems at work.

Figuring out why

When a man visits a sex therapist for erectile dysfunction, the first thing the therapist will do is determine the root of the dysfunction by asking questions about his relationship with his partner, his sexual history, his work life, his stress level and his health. Once a detailed outline of the man's life is complete, the therapist should have an idea as to the cause of the erectile dysfunction. If the problem is physiological, a referral to an urologist or another medical doctor will be made. Even when there are physiological issues causing the erectile dysfunction, it is likely that the man has experienced some anxiety in regards to erections and intercourse. Therefore, it is crucial that he resolve those issues in therapy while, at the same time, working with a medical doctor on physiological factors.

Seeing a therapist

Psychotherapy is often the easiest place to start if you are struggling with erectile dysfunction. Sex therapists use a variety of strategies to reduce sexual anxiety, if that is the heart of the problem. If a couple seeks counseling, often the sex therapist will use an approach called sensate focus. Sensate focus works by assigning couples "homework" designed to increase intimacy and reduce anxiety. If a man would like to work on his ED independently, a variety of cognitive-behavioral strategies may be used to lessen the level of anxiety surrounding his work, relationship or sexual function.

Dr. Katie Schubert has master's and doctorate degrees in sociology and gender studies from the University of Florida and a master's degree in clinical mental health counseling from Adams State University in Colorado. She completed her postgraduate studies at Florida Postgraduate Sex Therapy Training Institute and is a certified sex therapist, providing therapy to individuals, couples and families on issues related to sexuality, sex and gender in St. Petersburg. Contact her at

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