Impotence (known diagnostically as Erectile Disorder) involves a marked difficulty in obtaining an erection during sexual activity and/or a marked difficulty in maintaining an erection until the completion of sexual activity. Impotence may also involve a marked decrease in erectile rigidity during sex. Erectile Disorder is only considered a psychological condition if it persists for a minimum of 6 months and is experienced on all or almost all occasions of sexual activity (i.e., more than 75% of the time).
Like many other psychological problems, Impotence can result in mild, moderate or severe levels of emotional distress depending on the individual and couple concerned. Erectile Disorder is only diagnosed if the above symptoms cause significant distress for the individual and if the difficulties are not better explained by a medical condition, substance/medication use or a non-sexual mental disorder. Other factors include whether the difficulty is lifelong or acquired. If the problem has been present since the individual became sexually active it is considered lifelong. If the problem commenced after some months or years of normal sexual functioning it is considered acquired. The problem may also be situational or generalised. If situational, the problem only occurs with certain types of stimulation, situations or partners. If generalised, the problem is not limited to specific types of stimulation, occurs in different situations and/or with different partners.
What causes Erectile Disorder?
Erectile Disorder can be caused either by psychological or physical factors or a combination of both. It’s important to speak with your GP first to rule out any potential physical causes.
Physical causes of Erectile Disorder:
Physical causes of importance can include Cardio-Vascular disease, Diabetes, Endocrinopathy (diseases that affect the Testes or Thyroid in men) and Neurological disease (diseases that affect the nervous system, such as nerves in the penis). Other physical causes for this problem include physical injury to the genitals or prostate due to accident or medical operations (which may include the prostate gland, spine, lower bowel or bladder) and some prescription medications.
Acquired erectile problems (i.e., problems that occur after a long period of normal sexual functioning) are often associated with physical causes such as Diabetes and Cardiovascular disease. Erectile problems also become more common as men age due to vascular degeneration. Heavy Nicotine (Tobacco) use may reduce the blood flow to penis making it difficult to achieve an erection. Erectile Disorder is not diagnosed if the problem occurs only in the context of alcohol or other substance use.
Psychological counselling may still be important even if the cause of impotence is physical or medical. A psychologist will be able to provide you with information and support to manage the effects of impotence on your relationship and ensure each of you can still enjoy a fulfilling sex life.
Psychological causes of Erectile Disorder:
Relationship factors can play a role in Erectile Disorder and involve such issues as recurrent arguments or misunderstandings on either partner’s behalf regarding the causes of their sexual problems. Other influences include individual factors such as poor body image or a history of sexual or emotional abuse. Cultural or religious influences may also affect sexual functioning – for example religiously based values and attitudes toward sexuality or certain activities can influence a person’s ability to experience sexual pleasure.
Many men who experience Erectile Disorder also describe low-self-esteem or low self-confidence, a decreased sense of masculinity, or symptoms of depression. Many men also describe an understandable fear and/or avoidance of sex due to concerns they won’t be able to satisfy their partner. Other factors may include fears on the partner’s behalf that he no longer finds her attractive, or no longer loves her, which in turn creates further problems and fears in the relationship. These fears and worries can create anxiety for men which in turn can make the problem worse. Psychological therapy plays an important role in resolving these worries and in turn reducing the severity of Erectile Disorder and it’s effect on the quality of the couple’s relationship.
Anxiety can have a substantial impact on a man’s ability to achieve and/or maintain an erection. Impotence in an otherwise physically healthy man is caused by physiological changes that are experienced as a result of anxiety or fear during sexual activity. Sometimes, these fears are based on unrealistic expectations that either the man and/or his partner has regarding his sexual performance.
An example of unrealistic expectations that result in sexual problems: Some men and couples watch pornography as part of their sex lives and some then assume that what they are watching represents ‘real life’ sex. Some men may conclude that they should be able to maintain an erection and have complete control over when they come, which is an unrealistic expectation for them to hold (sex research has shown that most men have sex for between 3 to 6 minutes before achieving orgasm – men in pornography are chosen for those roles precisely because they have an unusual ability for sexual control over orgasm). If men have an unrealistic expectation they should be able to have sex for very long periods of time but can’t, this then creates anxiety about performance that can make achieving an erection difficult. A broad goal of psychological therapy then aims to work though potential causes of anxiety and fear regarding sexual performance to treat Erectile Disorder.
Other psychological factors that may lead to impotence included low libido, fear of the outcomes of sexual contact (e.g., pregnancy, sexually transmitted diseases), depression, grief, sexual boredom or a partner’s sexual problems.
How common is Erectile Disorder?
Erectile Disorder becomes an increasingly common problem with age. Approximately 2% of men under the age of 40 to 50 years report frequent difficulties gaining or maintaining an erection. Approximately 40% to 50% of men older than 60 to 70 years have significant problems with erections. Almost 10% of young men will experience difficulties with erection with their first partner, however this is often a normal part of sexual development and the problem will resolve itself as the man becomes more sexually experienced. Research in sexual functioning has provided the following rates of Erectile Dysfunction by age:
Age 40-49; 13.1% of the male population experience difficulties achieving an erection.
Age 50-59; 33.5%
Age 60-69; 51.5%
Age 70-79; 69.2%
What are the steps in treatment for Erectile Disorder?
Drug treatments play a common role in the treatment of Erectile Disorder. Commonly prescribed medications include Viagra (also known as Sildenafil), Levitra (Vardenfil) and Cialis (Tadalafil). It’s important to note that these medications do not increase desire for sex (or feeling ‘horny’). Rather, they increase a man’s ability to achieve an erection during sexual activity. Hence, physical stimulation, forplay and sexual fantasy still play important roles for men using drug treatments for impotence as part of their normal sex life.
Other drug treatments include Alprostadial (Prostaglandin E1) injections into the penis or the insertion of a small dose of Alprostadial into the end of the penis with a small disposable applicator after urination and a short time before sexual activity. Low-Intensity Extracorporeal Shock Wave Therapy is a very recently developed non-drug treatment that uses sound waves sent through the penis to increase blood flow and increase ability to achieve an erection. Your GP will/should speak with you about each of these options to find a treatment most effective for you.
Psychological counselling for impotence will cover several important areas. Causes of impotence are firstly covered as well as the exploration of any worries and/or performance anxiety that might be causing sexual problems. Therapy helps men stay focussed on what makes sex enjoyable and hence an erection more likely. Such things can include relaxation and stress reduction activities (e.g., breathing exercises), mindfulness and erotic thinking, elimination of worries that may create anxiety and pelvic floor exercises (a physical exercise designed to strengthen the muscle controlling blood to the penis that may in turn enable an erection).
Psychological counselling is also useful for partners too. Men may feel anxious if the couple haven’t discussed the impact of Erectile Dysfunction on their relationship or sex life and this often worsens the problem. Men and their partner’s need to understand the causes of impotence, more often than not men are sexually attracted to their partner, they enjoy sexual activity and want sex even though they experience impotence. It’s important for partners to understand it’s not the man’s fault or choice that he can’t achieve or maintain an erection and neither is it their fault (e.g., some women conclude their partner no longer finds them sexually appealing, but this isn’t always the case). Psychological counselling for impotence can be conducted individually or with each partner in the relationship present (even if the man’s partner is present for just 2-3 sessions).
Disclaimer: The information covered on this website is for educational purposes only. A diagnosis of any psychiatric or medical condition must only be made by a medical or mental health specialist. Diagnosing a psychiatric concern is a complex process that involves formal training, do not ‘diagnose’ yourself. If you have concerns that a particular disorder or condition applies to you, please speak with your General Practitioner for further assessment and medical/psychological care.
Individual counselling appointments are 50 minutes long.
Charge: $195 per session for a Clinical Psychologist ($126.50 Medicare rebate).
$155 per session for a Generally registered Psychologist ($86.15 Medicare rebate).
Clients with a pension or health care card are bulk billed.
Private health insurance rebates also apply.
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