Erectile dysfunction involves difficulty getting or maintaining an erection, not being able to get an erection, or experiencing less rigidity than usual. It can make penetrative sex difficult and may also affect self-image and sexual self-esteem.
Symptoms:
It is common to experience difficulties getting or maintaining an erection from time to time, which is not usually a cause for concern. For clinical diagnosis, these difficulties should occur most or all of the time for at least six months and cause distress. Erectile difficulties may be lifelong or acquired, and may also lead to reduced sexual desire over time.
Difficulty maintaining an erection may occur when changing positions, putting on a condom, when sexual momentum changes, during some sexual activities but not others, with some partners but not others, or during masturbation and/or partnered sex.
Causal factors:
Stress, shame, sexual insecurities, and anxiety are common contributors to erectile difficulties. These can create mental distractions that make it harder to stay connected to desire and arousal. Other possible factors include relationship concerns, mental health difficulties, and lifestyle factors such as smoking, alcohol use, lack of physical activity, or poor sleep.
As erectile difficulties can also be a sign of underlying health concerns, it is important to rule out possible medical causes with a health practitioner.
How Therapy Helps:
Sex therapy can help address the thoughts, emotions, and experiences contributing to erectile difficulties. This may involve working through anxiety, insecurity, and overthinking around sex, while developing healthier sexual expectations and narratives.
Normalising and destigmatising sexual function can also help reduce shame and negative self-talk. Sex therapists can provide education to correct misinformation and address relevant gaps in sexual health knowledge, supporting clients to develop the type of sex life they want.
Strategies to build greater bodily awareness can help clients focus on pleasurable sensations rather than self-judgement or goal-oriented sex. Therapy can also broaden the sexual repertoire, reducing pressure around getting or maintaining an erection.