What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is when a man cannot get an erection hard enough for intercourse. Causes of ED can be medical or age-related – but there are also many men who suffer from psychological erectile dysfunction. While it is completely normal to have a difficult time getting or maintaining an erection once in a while, if it happens often or always, it can negatively impact a man’s sex life. Paying attention to the signs of erectile dysfunction and finding the causes of ED will help you focus on the right approach for ED solutions.

Signs of Erectile Dysfunction

One way to know if you are dealing with medical or psychological ED is to pay attention to the signs of erectile dysfunction. Medical ED is often across-the-board. Across-the-board means you cannot get an erection during any activity – including masturbation or partner sex, and you do not wake up with an erection.

Please note: across-the-board ED can be an early warning sign of heart disease. It is important to take note of the signs of your erectile dysfunction, find the causes specific to you and get prompt medical attention. Medical ED can be the result of diabetes or prostate surgery. It can also be caused or exacerbated by many drugs, including antidepressants and antihistamines. If you are dealing with ED and are taking medications, check with your physician whether they might be the cause, and ask if alternative options are available.

What Causes Psychological Erectile Dysfunction?

Psychological ED on the other hand is often activity-specific and  happens mostly in relation to partner sex.

Many men feel their ability to have and keep an erection should stay the same throughout their lives –  but this is far from reality. During the course of a man’s life, his erection will decrease in firmness and most men have difficulty getting an erection at some point or another. Most men have heard of losing their erection during sex and are scared of it happening to them. So at the first sign of a change in erectile ability – or even after a single experience of losing their erection during intercourse – a viscous cycle of psychological erectile dysfunction can begin.

Here are the main 6 causes of psychological ed:

1. Performance Anxiety

Performance anxiety is when you start worrying about whether or not you are going to get an erection. This causes you to be in your head instead of enjoying the physical experience – and can in turn make it more difficult to actually get an erection. This creates a self-fulfilling prophecy wherein the more you worry about erection, the less likely you are to get one. And the less likely you are to get one, the more you worry. Many men end up with psychological ED because of this cycle.

Performance anxiety can also come from worrying too much about your partner during sex. You fear you are not arousing enough to your partner, or that your partner won’t keep wanting to have sex with you if you are not able to get an erection. Even worse, you feel pressure to perform on cue any time your partner wants sex.

2. Lack of Attraction

Another sign of erectile dysfunction is when you’re trying to have sex with someone you feel you should want to have sex with, but aren’t actually attracted to. Men are told by society they are supposed to want sex all the time, from anyone. They often don’t even ask themselves if they feel any chemistry, simply thinking something is wrong with them if they cannot get an erection. In this instance, reclaim your erectile ability by listening to yourself and ignoring what society is telling you.

3. Emotional Reasons

Many men experience psychological erectile dysfunction when they have had a difficult emotional setback in some other area of their life. Men can have psychological ED as a result of losing a job, given that they often rest their self-worth on the ability to provide a living. Other major negative life events like experiencing a death in the family or the stress of divorce can also cause performance issues. Some men have trouble with erectile dysfunction as a result of depression. 

4. The Sex You are Having Doesn’t Arouse You

You might have psychological erectile dysfunction because the kind of sex you are having is not actually the kind of sex that turns you on. You may not know what turns you on the most. Alternatively, you may know what turns you on – but your partner is not interested in the same kind of sex you are. Some men experience psychological ED when their partner is not responsive or doesn’t seem aroused during sex.

5. You Have Too Much Impulse Control

The key to staying aroused during sex is being able to follow your sexual impulses as they arise so that you are staying immersed in the experience. You may have been taught women don’t want sex and are afraid to do anything your partner doesn’t like – so you don’t follow your sexual impulses. This can cause your desire to drop off in the middle of a sexual situation and the momentum of your arousal gets cut off.

6. Relationship Problems

Psychological erectile dysfunction can also arise when you and your partner are fighting a lot or are distant. Often in long-term relationships, conflicts emerge. If you and your partner are not good at resolving conflicts, you might begin to build resentment and have less motivation to have sex with your partner. In this instance, your body might be trying to tell you something – and you should listen. This is particularly common if you are dealing with a partner who is very critical or verbally abusive.

ED Solutions

Medical Solutions to Erectile Dysfunction

Whether the causes of ED are psychological or medical, doctors often approach the problem by simply prescribing medications such as Viagra, Cialis or Levitra. Medication can be helpful to some men, and some even end up finding pills to be good ED solutions for them. However, medication does not help deal with the underpinnings of psychological ED, nor does it improve your skills as a lover.

Some men are simply not responsive to medication. Others have trouble enjoying sex because of painful or distracting medication side-effects, such as headaches or an inability to breathe through their nose due to congestion. Since the response to the pills is not immediate, medication forces you to plan sex in advance and can destroy the magic of spontaneity. Finally, the high expense of ED medication can be a detrimental factor.

Sex Coaching Solutions to Psychological ED

If you’re looking for a non-medial solution to your ED, you might want to consider engaging a sex coach, sexological bodyworker or even a sex surrogate. Though they all have slightly different approaches, their focus will rest on getting you connected to your physical body and relieving your ED through knowledge, communication and hands-on practice.

Your Somatica sex coach teaches you to:

  1. Enhanced Embodiment. Your Somatica coach teaches you how to stay connected to your desire, and being in your body instead of in your head.
  2. Follow Your Impulses. They train you to follow your desires and impulses, staying immersed in the erotic experience so your arousal does not plateau or dip down.
  3. Understand Attraction. They help you sort out who you actually want to have sex with, and what kind of sex will be most arousing for you. It is important to remember that the quality of sex and kind of sex you are having can have a huge impact on your ED.
  4. Revise Expectations. You will gain a realistic expectation of what your body is capable of and learn to maximize your erotic potential.
  5. Arouse Your Partner. If you are turned on by arousing your partner and enjoy experiencing their moans and sexual response to you, a Somatica sex coach can teach  you how to successfully seduce your partner. Their orgasms and noises can help keep you fully engaged in sex and focus less on your ED issues.
  6. Resolve Feelings. Many men avoid feeling their emotions and sink into depression. By learning how to get in touch with and express your feelings, you can move through emotionally challenging life events and reconnect with your sex drive.
  7. Communicate about ED. One way to expunge erectile dysfunction is to take the pressure out of sex. You can do this by talking with your partner about your erectile dysfunction. This can be particularly helpful at the beginning of a relationship – taking pressure off can sometimes help you function better. Also, you learn to reassure your partner that your ED is not about them.

The Sexological Bodywork Approach

  1. Stay Engaged. A sexological bodyworker will teach you breathing techniques and focus on sensation. Receiving touch can demonstrate how to stay engaged with the sexual  experience instead of getting stuck in your head.
  2. Increase Embodiment. They may also ask you to practice sexual yoga and mindful masturbation to get you more connected to your body, your arousal, and your pleasure. This in and of itself may help you with losing erection during intercourse.

The Surrogate Partner Therapy Approach

It is important to note that you must be referred to a sex surrogate by a licensed therapist and must be seeing the therapist concurrently. If your surrogate tells you they will see you directly without a referral from a licensed therapist, they are not a real surrogate and are likely doing some form of sex work.

  1. Lower Anxiety. Sex surrogates help alleviate erectile dysfunction by taking you slowly through a set of exercises to lower anxiety around sex. One of the exercises is called sensate focus. Sensate focus is an exercise where you give and receive touch in a relaxed, non-goal-oriented way. It is meant to help you focus on sensations and pleasure, instead of your erection.
  2. Arouse your Partner. They will teach you other tools to satisfy your partner, such as practice with manual and oral stimulation.
  3. Practice Intercourse. They may also help you practice intercourse and learn to start or continue intercourse with a less erect penis.
  4. Communicate about ED. Similar to working with a Somatica coach, your surrogate partner will teach you all about communicating about your functionality, as well as communicating about sex in general.
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Celeste Hirschman
Celeste Hirschman, MA is the Co-Creator of the Somatica® Method and Co-Founder of Somatica® Institute. She trains coaches in the Somatica® Method of Sex and Relationship Coaching. She has her own private practice in San Francisco, where she works with clients to have profoundly pleasurable and fulfilling lives. She has co-authored multiple academic articles published in peer-reviewed journals and is the co-author of two books, Cockfidence - The Definitive Guide to Being the Man You Want to Be and Driving Women Wild and Making Love Real - The Intelligent Couples Guide to Lasting Intimacy and Passion. Celeste has her MA in Human Sexuality Studies from San Francisco State University (SFSU) and her BA in Women’s Studies from the University of California, Santa Cruz (UCSC). Celeste has taken the Hakomi Pro-Skills Training as well as multiple other trainings on sexuality and relationships. Celeste also has a Certification in Sexological Bodywork from the Institute for Advanced Study of Human Sexuality (IASHS).