Overcoming Problems With Anxiety-Related Erectile Dysfunction (ED)

Anxiety-related erectile dysfunction is a common problem for men regardless of sexual orientation, age or race (see my article: What is Sexual Anxiety?).

What is the Link Between Anxiety and Erectile Dysfunction?

Most men experience occasional problems with maintaining an erection and most of the time these occasional problems aren't a cause for concern.

Anxiety-Related Problems With ED

Occasional problems can be related to not getting enough sleep, drinking too much or other factors.

Occasional problems are different from ongoing problems with erectile dysfunction.  

Assuming medical problems have been ruled out by a urologist or a sexual health doctor, erectile dysfunction (ED) is often caused by stress and anxiety, especially when men worry about their ability to please their partner (see my article: The 5 Most Common Male Sexual Insecurities).

Anxiety and stress-related ED can include one or more of the following problems:

• Problems with Body Image: For many men body image problems involve worrying that their penis is too small.  There can be a lot of variation in penis size, however, the average size of a flaccid penis is 3.5 inches and 5.1 inches for an erect penis.  Men who compare the size of their penis to male actors in pornography can develop a distorted view of what an average penis looks like, especially if they don't realize that male actors in porn are chosen for their unusually large penises.  

• Shame and Guilt About Sex: Shame and guilt can be related to many factors, including personal shame about sex, cultural shame or interpersonal issues with a partner.

Anxiety-Related Problems With ED

• Relationship Conflict: Stress and anxiety related to relationship conflict can be a contributing factor to ED and an inability to experience sexual pleasure. Relationship conflict can include frequent arguments, a history of emotional and/or sexual infidelity, financial infidelity, child-rearing disagreements, problems with one's own family or with in-laws, and so on.

• Unresolved Sexual Trauma: When there is unresolved sexual trauma, partnered sex can trigger trauma-related guilt and shame which often has nothing to do with the current sexual partner.  Trauma-related triggers occur in an instant without a person's conscious awareness.  Since trauma-related triggers often occur outside a person's awareness, a man might not understand why he feels so emotionally overwhelmed in the moment because he doesn't realize he is triggered and that the trigger has nothing to do with his current partner.  Anything can act as a trigger including a scent, a word, a gesture, a movement, a particular sexual position and hundreds of other things that were related to the original trauma (see my article: How Unresolved Trauma Can Affect Your Relationship and Overcoming a History of Sexual Abuse).

• Sexual Libido Differences in a Relationship: This is the #1 problem that brings couples into sex therapy.  Even though they can accept that they have differences when it comes to food or entertainment, most people find it difficult to accept that they experience sexual libido differences with their partner. This can create sexual pressure for a man or feelings of sexual rejection which, in turn, can lead to ED or sexual avoidance (see my article: Relationships and Mismatched Sex Drives: What is Discrepant Sexual Desire?).

• Lack of Sexual Experience: When a man worries he won't be able to "perform" sexually or that he won't be able to satisfy his partner, this can lead to "spectatoring" where a man becomes so self conscious that he becomes a so-called "spectator." Rather that enjoying sex with his partner, he is  "spectatoring" which takes him out of the sexual experience and can create a problem ED (see my article: What is Performative Sex?).

• Stress and Worry Unrelated to Sex: A little stress in the form of sexual anticipation can enhance sexual pleasure, but too much stress can lead to ED.  

• Other Mental Health Problems: Generalized anxiety, depression and other mental health problems that are not directly related to sex can also contribute to ED.

How Does Sex Therapy Help Men to Overcome Erectile Dysfunction?

Sex therapy is a form of talk therapy for individual adults and couples (see my article: What is Sex Therapy?)

Sex therapy is an effective treatment for sexual anxiety and other sexual problems.

During a sex therapy session, there is no sex, nudity or physical exams (see my article: What Are Common Misconceptions About Sex Therapy?).

Individuals and couples seek help in sex therapy for many reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

Regardless of the sexual problem, sex therapy usually begins with an assessment, including taking a family history, relationship history and sexual history to determine how the current problem might be related to the client's history.  This usually takes several sessions.

Sex therapy is an effective form of treatment for ED and other sexual problems (see my article: How Sex Therapy Can Help With Sexual Anxiety).

The underlying issues of erectile dysfunction are different for each person, so there is no one-size-fits all approach to overcoming ED.  

If a man is able to maintain an erection when he masturbates and if he experiences normal erections during sleep and upon waking up (also known as "morning wood"), ED is usually related to an underlying issue that he might have no awareness about before beginning sex therapy.

A sex therapist is a trained mental health professional who has special training in sexual-related problems, including erectile dysfunction.

Sex therapists give sex therapy clients assignments to do at home either alone or with a partner.  This can include (but is not limited to):

• Practicing Sensate Focus or other forms of touch exercises (see my article: What is Sensate Focus?)

• Reading assignments 

• Keeping a journal related to the sexual problem (see my article: Keeping an Erotic Journal)

• Practicing sexual communication with a partner (see my article: How to Talk to Your Partner About Sex)

• Other assignments between sex therapy sessions

If the ED occurs within the context of a relationship, it's considered a relationship problem and sex therapy is more effective if both partners are attending sex therapy sessions together.

In future articles, I'll explore, among other topics, how the penis is often a barometer of physical, emotional and sexual health.

Also, see my article: Is It True That "Real Men" Are Always Ready to Get It Up?

Getting Help in Sex Therapy

In addition to whatever underlying issues there might be, men often feel too ashamed to seek help in sex therapy.  This is often due to distorted stereotypes of what it means to "be a man" or to "be strong."

Getting Help in Sex Therapy

Sexual shame is often reduced or eliminated when men learn how common erectile dysfunction is for men regardless of age, sexual orientation, race and other identifying factors.

If you're experiencing ED, rather than struggling on your own or ignoring the problem, seek help from a licensed mental health professional who is a trained sex therapist.

Getting Help in Sex Therapy

Overcoming anxiety-related ED can lead to more satisfying sex and a more meaningful life.

About Me

I am a licensed psychotherapist, sex therapist, couples therapist, hypnotherapist and trauma therapist (EMDR, AEDP, Somatic Experiencing and other forms of trauma therapy) with more than 20 years of experience.

I work with individual adults and couples and I have helped many clients to overcome sexual problems.

My office is conveniently located in Greenwich Village, Manhattan where I provide in-person and virtual sessions.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.