By Dr John Barry
About a third of men experience difficulty in getting or maintaining an erection, and this percentage increases in older men. Around 85% of men find that sildenifal (Viagra) improves their erections. This is a good success rate, but it doesn’t address any underlying psychological issues the man might have in relation to sex or relationships. In fact the success of Viagra has led researchers to focus almost entirely on organic factors in erectile dysfunction (ED) rather than psychological factors.
Research shows about 40% of cases of ED are caused by psychological (psychogenic) factors alone, though psychological and physiological (organic) causes can interact. If you can achieve an erection through masturbation but not with a partner, then the cause is probably psychogenic. If you can’t achieve an erection at all, the cause is probably organic.
The main causes of psychogenic ED are depressed mood, low self-esteem, anxiety, and stress. The causes can be grouped into three categories: performance anxiety, recent stressful life events, and vulnerabilities from childhood and adolescence.
The main organic causes of ED are: cardiovascular disease (blood pressure, cholesterol), diabetes, surgery to prostate (prostatectomy), loss of T (e.g. due to ADT androgen deprivation therapy in prostate Ca), drug & alcohol intoxication or side effects.
We know that Viagra has a good success rate, but how well does ED respond to psychological therapies? Well, hypnotherapy has been found to be successful in 70% of cases of ED. A meta-analysis of 11 randomised controlled trails (RCTs) of 398 men found that group therapy improves ED compared to no-treatment, and combining Viagra with group treatment caused a significant improvement in ED compared to those who received Viagra alone. Psychological interventions also compared well to local injection and vacuum devices for ED. The success of group interventions echos evidence that group therapy and educational (information-sharing) interventions a sometimes more successful in ED than more traditional one-to-one psychological approaches, and this would be in line with other research on gender differences in preferences for therapy.
So what should you do if you experience ED? First of all, try not to worry about it because effective therapies are available, and worry can become a vicious cycle. Try to establish the cause by asking yourself questions such as: can you achieve and erection by yourself but not with a partner? Do you have an undiagnosed medical condition such as heart disease or diabetes? Are you under a lot of stress at work? If in any doubt visit your GP. And remember that although most men don’t exactly brag about it, ED is a pretty common condition, and one that can be successfully treated.
About the author
Dr John Barry is a Chartered Psychologist and co-founder of the Male Psychology Network and Male Psychology Section of the British Psychological Society. He is one of the editors of, and contributors to, The Palgrave Handbook of Male Psychology and Mental Health
The Palgrave Handbook of Male Psychology and Mental Health will be released in April 2019.
From the back cover:
“This handbook brings together experts from across the world to discuss men’s mental health, from prenatal development, through childhood, adolescence, and fatherhood. Men and masculinity are explored from multiple perspectives including evolutionary, cross-cultural, cognitive, biological, developmental, and existential viewpoints, with a focus on practical suggestions and demonstrations of successful clinical work with men”.