Dr Kat says: ED can cause so much distress - understandably! - but it says absolutely nothing about your worth as a person: it’s just a symptom that there’s something going on in your body, mind, or relationship that needs looking at, and there are so many things we can do to help.
If you or your partner are struggling to achieve or maintain an erection during sexual activity, try not to worry - you are most certainly not alone. A recent study into the prevalence of erectile dysfunction, published in BJU international journal of Urology found that this common condition affects up to one in five men across the UK. (1)
In addition, it’s estimated that, by 2025, more than 300 million men worldwide will be affected. That makes erectile dysfunction one of the biggest sexual dysfunctions for men, and probably the biggest cause of sexual desire discrepancy (SDD) from the man's side.
Erectile dysfunction (ED) can be defined as difficulty getting or maintaining an erection, either in specific situations (e.g., just by yourself, or only with a specific partner or sexual activity) - or generally, i.e. in all situations. Some men struggle with erections throughout their lives whereas for others ED can occur at different points in time for different reasons. Whether generalized or situational, ED can be caused by a number of different medical, emotional, psychological, and lifestyle factors.
It’s not uncommon for a man to have a problem in this area from time to time, particularly as they get older and testosterone levels reduce. But if you find that your erectile dysfunction happens routinely or is causing you distress, you should speak to your GP or healthcare provider. Try not to panic though - there's every chance you'll find the right treatment for yourself and get back to a happy, healthy sex life in no time.
It’s useful to understand what’s happening inside your body during an erection, so that you know what might be going on when difficulties occur.
On receipt of sexual stimulation, whether through touch, sight or even thoughts, signals are sent from the brain, down through the spinal cord to the nerves in the penis. This signal causes the release of chemicals that cause the muscles to relax and blood flow to increase to the penis.
As the blood rushes into the penis, the tunica sheath around the penis begins to tighten, cutting off the veins and preventing blood flow out. This fast increase in blood pressure causes the penis to harden, resulting in an erection. Once ejaculation has occurred, hormones are produced in the penis, causing relaxation of the muscles and allowing the blood to begin flowing out through the blood vessels, returning the penis to its non-erect state.
However, if you're experiencing any anxiety about performance or body image, if there's unresolved conflict in your relationship, if you're stressed, or you're just worried that the kids might suddenly barge into the room, the signals that the brain sends to the penis - causing the muscles to relax and allow increased blood flow - will be blocked by the stress, meaning that it's almost impossible to become erect while you're anxious.
As with many issues of sexual function, there are a number of different reasons erectile dysfunction can occur. Finding the cause of yours will help you to seek the right treatment and take steps to improve your sexual health. From what we learned above, it’s understandable that issues can occur with various parts of the process causing disruption to the chain of events leading to an erection.
If an injury occurs, for example to the pelvic area or spinal cord, signals from the brain may not be able to reach the nerves in the penis. This means the message to increase blood flow simply doesn’t get through and the right chemicals are not released. Prostate, bladder, or colon cancer treatments such as surgery or radiation therapy in this area can often leave men with ED.
Blood supply, too, can be a contributing factor. There are many health conditions that can reduce blood flow to the penis, such as coronary heart disease or cardiovascular disease, coronary artery disease and diabetes mellitus. But the opposite problem can be an issue too, if the penis is unable to trap blood during the erection, an issue that can happen at any age.
Like any sexual dysfunction, erectile difficulties can be caused by a number of physical factors, but often the cause is psychological. Physiological problems tend to affect all erections, so if you still have nocturnal erections or you’re able to achieve an erection when you’re alone, it’s more likely that the cause of your ED is to do with sexual performance anxiety, relationship issues, or other psychological or emotional issues.
For example, struggling to be in the moment, feeling anxious about sex, feeling self-conscious about your body or your performance, putting pressure on yourself, or negative self-talk: all of these can interrupt the sexual response cycle, and interfere with your erection. It may also be that the sex you’re having isn’t quite what you want it to be, and doesn’t provide you with enough stimulation to become aroused - not just physically, in terms of genital stimulation, but also mentally, in terms of other erotic stimuli, i.e. the things that you might need to see or hear, or think about.
Relationship satisfaction can also be a factor when it comes to erectile dysfunction. If there are underlying issues between you and your partner that haven't yet been resolved, and those issues are causing either of you stress, then you might not feel psychologically 'safe' enough to allow an erection to happen, which will interfere with your sexual relationship. The same thing applies to sexual desire and orgasm disorders, including premature ejaculation, retrograde ejaculation, and anorgasmia.
The problem here is that, even for people who feel like their relationship is really strong, erectile difficulties can cause a vicious cycle, in which the erectile dysfunction causes you to feel self-conscious, but your partner takes it personally and also feels self-conscious, so the sex isn't very enjoyable - which causes you both anxiety about sex in general. This can make sex even harder to talk about, so you avoid it more, and become more anxious about it, which leads to more sexual difficulty - and so it goes on. If this sounds familiar to you, the first thing to do is to talk to your partner openly, honestly, and kindly about your experience to prevent the cycle from continuing.
Your general mental health can also impact your erections, particularly if you suffer from anxiety, depression, or other psychological conditions. Unfortunately, some prescription drugs for depression and anxiety, predominantly selective serotonin reuptake inhibitors (SSRIs) can have a wide range of side effects, including creating temporary sexual dysfunction, or exacerbating existing sexual dysfunction, making it harder to become aroused, creating a vicious cycle where sexual dysfunction and the mental health condition reinforce each other. If you think your medication might be having an impact on your sex life, don't stop taking them without talking to your doctor first.
Your mental health can also include more subtle things that you might not realize, such as low self-esteem, concerns about body image, or unhelpful beliefs about sex that you learned from society, the media, or your family, and then internalized. All of these could contribute to your erectile difficulties, as well as to any number of sexual issues, including low sex drive, premature ejaculation, and orgasm difficulties.
If you’re concerned about any of the symptoms you’re experiencing it’s always best to see your GP or healthcare provider as they’ll be able to give you the most up-to-date information and talk you through your options.
In the case of erectile dysfunction, your doctor may wish to perform a physical examination and perhaps blood tests to rule out the possibility of any underlying conditions before putting together a treatment plan that best suits you and your medical history. This could include suggestions about reducing saturated fat and increasing fresh fruit and vegetables in your diet, quitting smoking, and taking part in regular exercise or physical activity. If you are already on medication that your doctor suspects is having an impact, it may be possible to offer an alternative to see if things improve.
There are, of course, drugs available to help with erectile dysfunction. Viagra is the one everyone has always heard of, but there are several others. Your doctor will be able to talk to you about common side effects versus benefits. Penile injections, a penile implant, and even vascular surgery are other options that might be right for you.
If you believe your erectile dysfunction might be caused or worsened by anxiety, stress, or a lack of sexual confidence, sex therapy could be the answer. A sex therapist will talk with you about your experiences and your sexual history in a safe, compassionate, and confidential environment to help you work through your sexual difficulties. As well as talk therapy, they might also provide exercises for you and your partner to do at home, either alone or together.
A really important part of sex therapy - particularly when it comes to ED - is about debunking sexual myths. For example, myths about how often men 'should' be having sex, how firm their erections 'should' be and how long they 'should' last - all of these can be actively harmful for your sex life. For example, did you know that it's completely normal for erections to go up and down during the course of sexual activity and that most men don't sustain an erection through the sexual encounter, especially if the experience lasts a while?
Another particularly damaging myth is that sexual intercourse (i.e. penetrative sex) is the only thing that counts as sex and is considered the 'main event' of a sexual encounter. It's really important to counter this belief, because it's absolutely possible to have a great and satisfying sex life with ED if you broaden the definition of sex beyond penetrative sex and allow for a wider range of sensual and sexual activity.
At Blueheart, as well as providing the latest in sex psychology and debunking sexual myths, we use a therapeutic technique called Sensate Focus, which is perfect for cases where relationships are being impacted due to sexual desire differences or sexual anxiety in one or both partners. Using a series of mindful touch exercises, Sensate Focus from Blueheart is designed to provide opportunities for you to explore your own and your partner’s body without an end goal of intercourse. By focusing only on the sensations you feel, you learn to get out of your head and into the moment, which gives your body space to respond naturally just as it was intended to do. You go entirely at your own pace, doing only what you feel comfortable with, and touch for your own curiosity, without trying to force any kind of response from yourself or from your partner. And it really works; in a 2015 study of the effectiveness of Sensate Focus as a treatment for a variety of sexual difficulties, therapists found it to be 83% effective, including for erectile difficulties. (2)