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Definition of psychological erectile dysfunction
Psychological erectile dysfunction is a condition that arises due to abnormal psychological states during sexual intercourse, such as high-stress levels, lack of self-confidence, low desire, couple tension, bad mood, or aversion to intercourse. When a man has a psychological disorder, the erection of the penis will often be greatly affected, resulting in difficulty getting or maintaining an erection, or the inability to have an erection – all of which is collectively referred to as psychological erectile dysfunction.
Etiology of psychological erectile dysfunction
Erectile dysfunction can be caused by various psychological factors. Some of them are:
Negative sexual experiences
Individuals who have had negative sexual experiences in the past (such as guilt over a history of masturbation, humiliation after being ridiculed for early sexual behavior, or experiencing erectile failure) may develop feelings of fear, embarrassment, or shame around sex. Family attitudes and interpersonal relationships, especially family relationships, that children are exposed to as they grow up may also negatively affect later sexual activity.
Problems with their partner
A lack of communication, fear, mistrust, hatred, or a difference in sexual values or attraction towards their partner may lead to psychological erectile dysfunction. For example, the man may have an unpleasant mood during sex, the woman may have a lover, causing the husband to have hostility towards her, or the man may have an affair and lack of love towards his wife.
Negative feelings about themselves
Individuals who lack self-esteem, self-confidence, an inferiority complex, depression, or negative body image often find it difficult to perform sexually. For example, they may worry about the size of their penis, fear not meeting their partner’s sexual requirements, or think being responsible for their partner’s sexual satisfaction is an obligation.
Secondary psychological reaction to organic erectile dysfunction
In some cases, traumatic events, diseases, drugs, or organic erectile dysfunction can cause secondary psychological abnormalities. While individuals who are psychologically well may find some satisfaction in sexual life despite sexual hypogonadism due to age or other factors, those with poor psychological quality can often find it difficult to leave their past psychological shadow and experience persistent disease that is difficult to cure.
Being aware of these psychological factors, and identifying and dealing with them can help in treating psychological erectile dysfunction.
The dangers of psychological erectile dysfunction
Affects the relationship between husband and wife
As we all know, a good sex life can also enhance self-confidence and make a person relaxed and happy physically and mentally. As a result male erectile dysfunction leads to sexual life can not be normal, sexual partners’ long-term sexual satisfaction, and sexual apathy phenomenon, thus affecting the sexual harmony between the couple, serious when it will also lead to the rupture of the couple’s feelings.
Affect individual health
According to clinical research, most patients with erectile dysfunction will suffer from other chronic diseases at the same time. The factors that cause erectile dysfunction are many, unhealthy physiological conditions, psychological states, and unscientific lifestyles can lead to impotence to varying degrees and manifest through erectile dysfunction first.
In terms of etiology, organic diseases such as diabetes, hypertension, and heart disease may cause erectile dysfunction. It can be said that the appearance of erectile dysfunction indicates that the patient’s health has lit up with a red light.
Because of its special warning role, erectile dysfunction is called “the crossroads of men’s health problems”. The male science community used to compare erectile dysfunction to the tip of the iceberg, in the deep sea hides more problems that are not yet visible. If erectile dysfunction is not effectively treated and alleviated in a timely manner, then one day, all of these latent problems will erupt.
Affect male fertility
Patients with erectile dysfunction have difficulty getting an erection and cannot deliver sperm to the cervix of women, which naturally makes it difficult to have the next generation. For patients with milder conditions, the common symptom is an erection that is not hard enough to complete sexual life. However, at this time, the patient’s physiological function is in a non-healthy state, and the quality of sperm is poor, which makes it difficult to ensure the birth of a healthy baby.
As you can see, erectile dysfunction not only affects the fertility of the patient but also may affect the health of the next generation.
Heavy psychological burden
Men because of erectile dysfunction and some psychological pressure, that is a man’s shame, long-term in the shadow of this bad psychology, will directly affect the work and life of men, insomnia, sleeplessness, restlessness, mental weakness, emotional instability, leading to men to lose their passion for life, negative depression, thus inducing psychological diseases, endangering the physical and mental health of men.
Diagnosis of psychogenic erectile dysfunction
Understanding medical history and symptoms
The doctor will ask about the patient’s sexual history in detail, whether there are sexually transmitted diseases, seminal emission, and masturbation habits, and patiently follow up on the patient’s husband and wife relationship, family environment, and nature of work, to understand the past medical history, medication history, tobacco and alcohol habits and mental state, etc.
Physical examination
A comprehensive and systematic physical examination is necessary to diagnose psychological erectile dysfunction. The purpose is to exclude the developmental defects and abnormalities of the nervous system, endocrine system, cardiovascular system, and reproductive organs related to erectile dysfunction, etc. If the above abnormalities exist, then organic erectile dysfunction should be considered.
Laboratory tests
The laboratory examination of erectile dysfunction is the so-called laboratory examination, which is also aimed at understanding the existence of systemic diseases that affect erectile function. The general items to be examined include blood and urine routine, blood sugar, urine sugar, blood lipids, liver and kidney function, thyroid function, sex hormones, etc. The above tests are often normal in patients with psychogenic erectile dysfunction.
The erectile function index score
When you go to the hospital for an examination because of erectile problems, your doctor may first ask you to fill out a scoring form – the International Index of Erectile Function score (IIEF-5).
Diagnostic treatment
Since the introduction of safe and effective oral PDE5 inhibitors (Viagra, Cialis, Elidel), most patients can choose to use oral medications for diagnostic treatment before undergoing special tests. If the treatment is effective, the medication can be continued, and if the treatment is not effective, some necessary special tests are still required.
Special tests
Commonly used special tests: Nocturnal penile distension hardness test (NPTR): is one of the methods to identify psychological and organic ED.
The current normal reference criteria for the NPTR test (Rigiscan) are more than 3 or more erectile events (usually 3-6) in more than 8h of recorded (sleep) time, an increase in the circumference of the penile head greater than or equal to 3cm and an increase in the penile body greater than or equal to 2cm during erection, and an erection of more than 70% hardness for a total of greater than 10min.
However, the majority of the current literature uses the criterion of “a single erection of more than 60% hardness for more than or equal to 10 min” to identify ED.
The NPTR test should generally be monitored for more than two nights. After the body has fallen asleep, the cerebral cortex is at rest, which eliminates the effect of tension on erections. If the hardness and frequency of erections at night are normal, this indicates that the cavernous body of the penis and the erectile center located in the spinal cord are functioning normally. The presence of erectile dysfunction is caused by the brain sending, downstream, inhibitory messages, which are often referred to as psychological in nature.
Differential diagnosis of erectile dysfunction
Erectile dysfunction (ED) is a common male sexual disorder that causes the inability to attain or maintain a sufficient erection for satisfactory sexual intercourse. ED can be classified into two types: psychogenic and organic. To make an accurate diagnosis, a physical examination, laboratory tests, and specialized diagnostic tests are necessary.
Characteristics of psychogenic erectile dysfunction
Psychogenic ED is characterized by a sudden onset in specific situations or occasions, with obvious psycho-psychological triggers such as conjugal, emotional, and social factors. Patients often maintain good spontaneous and normal erections through masturbation or other sexual fantasies. Patients with psychosomatic trauma, fear, anxiety, depression, and stress can develop psychogenic ED. There are no systemic diseases affecting the erectile function of the penis, and patients have not taken any medications that affect penile erection. The vulnerable group includes men who have sexual intercourse for the first time, have insufficient sexual experience, introverted personalities, and have conservative family concepts.
Characteristics of organic erectile dysfunction
Organic ED is characterized by an unintentional onset that gets progressively worse after surgery, trauma, or the administration of certain medications. There is an absence of morning and nocturnal spontaneous erections or erections that are present but markedly diminished. Patients experience an inability to achieve a satisfactory erection with abnormal ejaculation and decreased libido. The causative factors involve cardiovascular, endocrine, and neurological problems, but no clear psychiatric and psychological causes are present.
Treatment of psychogenic erectile dysfunction
If psychological ED is not detected and treated early, long-term anxiety, tension, and other mental stress can aggravate the disease and cause it to progress toward the organic type. Therefore, comprehensive screening should be conducted to detect and deal with early organic causes potentially lurking behind the ED. Treatment should be based on the specific etiology, the experience of the doctor, and the patient’s and their spouse’s wishes. Psychotherapy is an important part of the treatment, including sex education, psychological counseling, and sex therapy.
Psychological guidance to overcome excessive concern about an erection
Patients with erectile difficulties often experience anxiety about the possible fading of the erection at the beginning of the erectile response. To address this, a training method is to pause the fantasy when an erection is produced during the stroking training, then start the fantasy again after the erectile response has subsided without stopping the stroking during the whole process. This training makes the patient understand that it is normal for the erection to fade and that they have the confidence and ability to initiate another erection soon and easily.
Combining fantasy and self-stimulation
Fantasy provides psychological stimulation and expands receptivity to physical stimulation. Training experts recommend a daily nude meditation and sexual fantasy along with light touching of the body, without targeting the genitals or regular masturbation methods, focusing on the body’s response. When the stroking is insufficient, using lubricants can enhance the effect.
Acquiring sexual knowledge and communication with a partner
After understanding the natural occurrence of erections and withdrawal, the patient should communicate and cooperate with their partner. Trying to understand each other’s sexual response processes and cooperating can improve sexual harmony.
Self-encouragement and building positive attitudes and beliefs
Patients should reduce worries and combine imagination with positive psychological evaluations through self-imagination. By changing the “self-test prophecy,” a positive self-evaluation is built.
Recharging fantasies
Fantasies are an important source of sexual sensation. Patients should shift their focus from “Can it work?” or “Will it fail again?” to enjoyable and stimulating experiences. Imagery should include inviting the partner to join, focusing on one’s arousal and physical sensations, stopping the partner if anxiety arises, and continuing the stimulation if it goes well.
Physical exercise
Participating in sports can improve a patient’s mental state, enhance self-confidence, physical fitness, libido, and erectile function. Patients should choose sports that are suitable and enjoyable for them and that can be shared with their partners.
