Male impotence or what is now known in sexual medicine as erectile dysfunction (ED) is a common condition where an individual cannot get or maintain a penile erection. This difficulty may lead to a loss of sexual intimacy and usually effects the mental health of both partners in a relationship. According to the American Urological Association, ED effects close to 30 million males causing difficulties with self-esteem, relationships, depression, and anxiety.
A literature review carried out by Anna Kessler and colleagues in 2019 noted that most of the studies carried out on the incidence of erectile dysfunction suggested that it increases with age. However, erectile dysfunction can occur in men of any age. From a biological, medical or lifestyle perspective this condition can be linked to cardiovascular disease, diabetes, prostate problems, low testosterone levels and obesity. ED can also occur after injuries effecting the pelvic area and spinal cord and excessive alcohol and drug consumption. Medical treatment for example SSRIs prescribed by doctors to treat depression, can also affect erectile functioning.
On the other hand, erectile problems can happen because of psychological, cultural, or relational factors. Performance anxiety is one of the major causes of erectile dysfunction. A very common scenario would involve a man that loses his erection during sexual intimacy due a highly stressful situation at work, for example. This creates a level of anxiety and shame which can instill fear that this situation will happen again. At times ED can become a cyclical problem: penetrative sex is attempted, anxiety precipitates erectile problems and this process starts happening on repeat.
Sexual Intimacy And Erectile Dysfunction
Sexual intimacy is usually an important part of a relationship so difficulty with erection can cause feelings of loss and anxiety for all partners involved. Moreover, ED is still very much associated with shame, de-masculinisation, and stigma today, and this can in turn lead to lack of open communication about the subject.
Treatment Options For Erectile Dysfunction
Medical treatment:
In many cases ED can be treated. Initially a medical assessment is carried out by a Urologist to understand if the individual is suffering from primary ED, which happens when a man has never experienced an erection or secondary ED where erectile functioning was initially normal but due to stress, anxiety, health difficulties or relational problems has become problematic. A medical assessment is also important to establish if there are other health problems that can be contributing to the erectile dysfunction.
The medical treatment of choice for erectile dysfunction is usually the prescription of a PDEi5 inhibitor mainly Viagra, Cialis, or Levitra. Depending on the drug and dose prescribed, this treatment is either taken daily to establish a therapeutic dose or 15 minutes to 32 hours before having sex. Other medical options for treating erectile dysfunction include the use of penile injections and penile pumps.
Lifestyle changes:
Lifestyle changes including eating a healthy diet, increasing exercise, decreasing alcohol intake and drug use can help increase erectile functioning. Kegel or pelvic floor exercises can also help improve blood flow to the penis and maintaining erections.
Counselling and sex therapy:
Since this subject can be a difficult one to talk about some men might avoid have any form of intimacy to avoid disappointment and a feeling of shame. This can be interpreted from the partner as a form of rejection. Moreover, research indicates that when erectile dysfunction is long term, partners can develop their own sexual problems. Open communication and partner support are very important when facing a sexual difficulty such as ED as this can help reduce anxiety and increase connection and understanding.
Couple counselling and sex therapy can help the couple re-negotiate their sexual activity and find ways to explore forms of intimacy that do not focus on penetrative sex and performance but on pleasure and connection. Focusing on pleasure and sensuality and increasing non-genital touching including kissing, hugging and message can help increase affection and does help reduce stress especially during the initial stages of medical and psychological treatment.
References
Althof, S.E., Rubio-Aurioles, E., Kingsberg, S., Zeigler, H., Wong, D.G., Burns, P. (2010). Impact of Tadalafil Once Daily in Men With Erectile Dysfunction: Including a Report of the Partners’ Evaluation, Urology, 75 (6), 1358-1363.
Boddi V., Castellini G., Casale H., Rastrelli, G., Boni, L., Corona, G. & Maggi, M. (2015). An integrated approach with vardenafil orodispersible tablet and cognitive behavioral sex therapy for treatment of erectile dysfunction: a randomized controlled pilot study. Andrology. 3(5), 909-918.
Buck K., Stratton J.& Hodgson J. (2020). Erectile dysfunction: How to help patients & partners: This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED. Journal of Family Practice, 69(5), 251-254.
Conaglen H.M, O’Connor E.J., McCabe M.P., Conaglen J.V. (2010). An investigation of sexual dysfunction in female partners of men with erectile dysfunction: how interviews expand on questionnaire responses. International Journal of Impotence Research. 2010; 22(6):355-362.
Kessler, A., Sollie, S., Challacombe, B., Briggs, K. & Van Hemelrijck, M. (2019). The global prevalence of erectile dysfunction: A Review. BJU International. 124, 587-599.
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Anna Catania (M.Cons. PG(Dip) Psychosexual and relationship therapy is a warranted counsellor specialised in the area if sex and relationships. She provides counselling to individuals and couples who are having difficulties with sexuality, relationships and intimacy.
Click here to check out Anna’s full bio as well as a list of all her Wham published articles
