Erectile dysfunction (ED) not only has the potential to impact a man’s sexual satisfaction and self-esteem, but also his partner’s sexual satisfaction and their intimate relationship. 

The majority of men who seek treatment for ED through medical intervention alone — specifically medication — do not receive any guidance or support with regard to how to improve emotional and sexual intimacy dynamics around having ED or how interpersonal dynamics may contribute to or maintain the issue.

ED Varies and Is Different For Everyone

There is variation in which erectile symptoms start and how often they occur. 

ED can be lifelong, or it can be acquired, which means at some point during a man’s life, erectile problems start to occur for a variety of reasons which at the time are usually unknown to the man. It is much more common for men to have acquired ED. 

ED can be generalized, which means it happens in any context (solo-sex, partner sex or a variety of different sex acts with or without a partner). ED can also be situational, which is more common. In cases where ED symptoms are situational, many times men report they are able to masturbate successfully but have issues maintaining an erection during partner sexual activity. 

Another factor to consider is that ED varies in degree. For example, some men with ED are not able to have any form of erection, others are able to get partial erections but not enough for complete penetration, and others can gain enough erection for penetration, but lose erection during some point.

Partners are Essential for ED Treatment

Given the complex dynamics under which ED symptoms can occur, it is usually essential for effective treatment outcomes to involve the partner in couples and sex therapy as part of treatment. It is extremely helpful to help both a man and his partner understand all the nuances and varying conditions in which ED can occur and why at times it may not be an issue. 

As sex therapists, our role isn’t to gain explicit details for the sake of knowing all the literal ins and outs of a man’s or couples’ sexual life, but it is critical to understand the specific circumstances and dynamics in which symptoms occur to select the appropriate treatment interventions. This part of sex therapy is quite narrative, giving both the therapists, the man and his partner the opportunity to understand for the first time how and why the ED is occurring for reasons that are not due to medical problems.

Performance Anxiety Is A Common Stressor

Performance anxiety is the most commonly reported psychological stressor men with ED report when it occurs during partner sex. 

Men with performance anxiety have difficulty staying in their bodies and letting the natural sexual arousal and response cycle happen. They often are flooded with anxious and critical thoughts like: “Will it stay hard?” or “What will my partner think if I can’t get it up?” or “I hate my body and feel like a loser in bed.” 

What typically happens is that men who have several situational ED issues with a partner may then develop a negative feedback loop where they anticipate and fear ED symptoms and experience increasing performance anxiety, which obviously just makes it more difficult to relax into the body and get and/or maintain an erection. Beginning interventions in sex therapy and couples counseling are aimed at helping men stay in their bodies and work with their partner to break this cycle of performance anxiety that perpetuates ED.

Relational Factors Contribute to ED

Any number of relational factors can lead to or contribute to ED. Some men lose attraction to their partners, have ongoing unresolved conflict in their relationship, or their partner may also have a sexual dysfunction or history of sexual abuse that compromises the sexual intimacy in a way that lowers a man’s sexual arousal during partner activities. 

ED can also occur in couples who have different erotic turn-ons or incompatible sexual orientations. ED can also appear after an infidelity in which critical trust and secure attachment bonds are disrupted or broken. In any of these cases, working with the man and his partner is essential to truly treating and overcoming the negative impact of ED.

Find Help Today

At Kimberly Keiser & Associates, our team has been training and specializing for years in both couples counseling and sex therapy. We’re uniquely poised to help not only men with ED, but their partners and relationship.

Our webinar, When I Say Yes, but My Penis Says No, offers insight into:

• Common themes and risk factors in men who have ED when presenting for treatment

• The role your history, the quality of your relationships, emotional intimacy, and security play

• Treatment options available through sex therapy and trauma therapy that can provide more long-lasting effects than medications in men who don’t have ED due to a medical reason

Watch the free webinar here. Let’s listen to your penis and let your body’s wisdom lead the way to the sex you are ready to have!