Erectile Dysfunction

Question : I am a 22 year old boy. And I have just started dating someone. We have tried to get intimate a few times and unfortunately I was not able to have an erection when it was time. I am quite worried I have Erectile Dysfunction. And I am quite embarrassed about this. I have a feeling that my Erectile Dysfunction is in some way emotional in nature. I would like to have some kind of understanding about what can be done about this condition.

Answer : It is so brave of you to even consider talking about this subject. Our society has placed such a premium on “being a man“, that often Erectile Dysfunction is seen as a threat to masculinity itself. 

This post is about understanding Erectile Dysfunction from a therapist’s perspective. And this is to give you some very basic information to approach Erectile Dysfunction. I believe in this post you will find some helpful tips to start figuring out what might be happening in the system.

Broadly there are 2 kinds of Erectile Dysfunction :

1. Due to a Medical/Biological Dysfunction

2. Due to an Emotional/Psychological dysfunction. (The reproductive system in both men and women are very very intricately connected with emotions and mental health)

A Medical Dysfunction can happen because of some kind of constriction to the blood vessels carrying blood to the penis, or sometimes even a muscular damage in the penile muscles. Smoking, certain medications and their side effects, Psychotropic drugs, steroids and some kinds of supplements used in sports/muscular enhancements, excessive masturbation (penile fatigue), high sugar levels and some other health conditions could actively contribute to Erectile Dysfunction.

It is important to ensure that there is no physiological reason for the ED. This is best done by consulting an Andrologist and getting the doctor to rule out any Physiological reason for the ED.

How do we recognise a Psychological form of ED?

1. If you are able to sustain an erection while masturbating (alone) in the way that feels safe and comfortable to you, and if you only struggle to have a healthy erection with a partner, then this could be one major sign that your erectile dysfunction is Psychological. It could indicate some kind of Performance Anxiety that comes up when with a partner.

2. More importantly, if you are able to have the “morning wood” – an erection that men tend to have in the mornings just as they are waking up – that again is a clear sign that your erectile dysfunction is psychological, and not medical as the erectile function of the penis as such seems to be alright.

Assuming that your ED is Emotional / Psychological, what are some of the things that you could work on.

1. Healing ED is a process by itself. Most times we see that Psychological forms of ED are caused by Emotional Trauma (especially in vulnerable moments). And therefore, the system goes into some kind of a trauma response in the vulnerable moments of intimacy as well.

2. Discuss with your counselor the nature of past relationships, especially intimate relationships to understand what has caused your trauma and how you need to work through it. Sometimes, when we have gone through very controlling and abusive relationships/encounters, we carry the residue of the abuse in our sexual system.

3. Sometimes, ED is a manifestation of an Anxiety Issue. Some people unconsciously carry a lot of Anxiety within their system – of a constant need to perform, a constant need to prove they are worthy, a constant need to get validation, a constant need to be the best, etc. This anxiety manifests even in their sexual life as a need to Perform far exceeding expectations and be exceptional. This kind of anxiety can stem from emotional wounds coming from childhood and the teen years too.

4. If these factors listed above ring true to you, then healing this kind of ED is best done with the help of a loving partner — a partner who will travel with you through this journey of finding your lost confidence and lost connection with your own sexuality. It would be helpful for a partner to patiently and lovingly ease the anxiety and your unconscious need to prove that you are “man enough” (by constantly reassuring you that you are loved even when you do not “perform”) This is very effective in slowly and gently healing the trauma of the Anxiety (and/or abuse). Often times, this is a process and can take multiple attempts to slowly bring up the confidence and ease the trauma/anxiety from the system.
Some therapists prescribe that the couple first focus on merely exploring each others’ bodies and enjoying the touch and intimacy. They do not recommend intercourse until the person with the ED is able to feel comfortable and relaxed enough to sustain an erection without the pressure of intercourse. This can take a few months to happen sometimes. But this process plays a huge role in bringing up confidence in the person with the ED and overwriting old, conditioned patterns of trying to be the best, trying to be perfect and so on. Over a period of time,this can organically lead to intercourse when the person feels ready. Patience is key.

5. Sometimes I have met young men who are taking their early steps into Sexual Intimacy with a partner, and I find that they experience a lot of overwhelm with the whole experience. They get overwhelmed with all the things that they have read or heard needs to be done in order to have “good sex”. And therefore they find it hard to sustain their erection the moment they hear their partner give them any kind of feedback or even ask for something to be done. They go into their overwhelm and assume that they are doing something wrong.

6. Many people with ED are also emotionally sensitive people and want to ensure that they are not hurting their partner. However, the moment they experience this fear of hurting their partner, they get overwhelmed and lose their erection.
If you are someone who seems to experience this in some way, I would recommend that you go slow once again. It is quite normal to have a few “failures” in the beginning. Many men experience that in their early sexual encounters. This is as much a process of connecting to your own body as much as it is about connecting to your partner’s body.

7. Of course, working through the subtler and deeper aspects of all of these areas of your life with a therapist/counselor will also be of tremendous help. Do remind yourself that your Erectile Dysfunction in this scenario is really an extension of an emotional pattern, and not so much a Physical condition.

8. Lastly, many cultures inherently wish to keep Sexuality secretive. And therefore there is a lot of Shame associated with having Sexual struggles.

Thankfully because of the Feminism movement, many women have come out of their shells of shame to talk about issues that they go through with frigidity and vaginismus, the inability to conceive, struggles with their menstrual cycles, PCOD and other challenges with the female sexual/reproductive system.

Unfortunately, men still haven’t been freed of the stigma to talk about and accept sexual health as openly as many women in our society do today. Visiting a Gynaecologist has been normalised.  Visiting an Andrologist is not yet a thing in Indian society.

In case you are someone struggling with Shame regarding your Sexual Health, that is also an aspect to look into with your counselor and with your partner. Just like Physical health and Mental Health, Sexual health is also not something to be ashamed about.

Best wishes with your healing journey.  

NOTE : The questions and answers in this series are compilations of discussions during therapeutic sessions with my clients. These are not generic pieces of advice.  I am deeply aware that these answers can seem way too simplistic for people actually going through similar situations. Please comment or connect with me if you find yourself grappling with something I have expressed.