He’s popped a pill, but nothing has happened. Unbeknown to many lovers grappling with erectile dysfunction (ED), a man’s erectile difficulties aren’t always physiological. Instead, there may be a number of psychological and interpersonal issues that need to be addressed – ones that those little blue pills won’t cure.

According to a Harvard Medical School report, “Sexuality in Midlife and Beyond,” erectile dysfunction drugs do nothing to help the emotional and relationship issues that frequently accompany this sexual disorder. Yet physicians often neglect the complexity of this condition in managing it. Couples are left confused, oblivious to the other issues impacting their game.

In recent decades, feminism, the sexual revolution, and the contraceptive pill have all been pinpointed as reasons for his ED. Then, for a while, we actually did a good job looking at ED issues holistically.

Prior to Viagra, according to a 2008 review of impotence literature published in the Nordic Journal for Masculinity Studies, ED was largely seen as a result of both social and emotional factors.

Yet the medical focus these days is on the physiological causes, ignoring ED’s many other reasons, including ...

Sexual Ignorance

Men with ED are known to have rigid stereotypes about “normal” sexuality. Sex can only happen one way, with his sex life often boiled down to performance.

Males with ED have also often fallen prey to sexual mythology and misinformation, namely along the lines of him needing to be well-endowed, hard as steel, and able to go all night long. These myths increase his levels of sexual guilt and anxiety. All of these issues regarding sexual ignorance perpetuate performance anxiety, crippling his response altogether.

Emotional Issues

For some men, intimacy is seen as threatening. This may be due to a fear of exposure, losing control, or being rejected or abandoned.

Doing him in even more is his inability to recognize his own emotional signals. Ultimately, he experiences a great deal of shame from the ED experience, made even worse if he sees his ability to have intercourse as a sign of power.

Sensation Issues

He’s doing the wise thing in practicing safer sex, but his condom is decreasing sensation and impacting his satisfaction. Recent research out of West of Scotland University, Paisley, found heterosexual sex with a condom is associated with problems of dealing with stress. This helps to explain why ED can be a consequence of using protection.

Psychiatric Problems

Research in The Journal of Urology, conducted at Aristotle University of Thessaloniki, indicates that the majority of men who seek treatment for ED have at least one psychiatric condition. Among the psychiatric disorders patients have been known to present are:

— Depression

— Anxiety disorders: Chronic or acute stress, matters like money or work, can impair his response.

— Personality disorders: Conditions like being obsessive-compulsive can make it difficult for him to express himself and experience emotions. He thus has trouble letting go.

Psychiatric disorders like schizophrenia or bipolar disorder can cause a disorganization of his thoughts and feelings.

Relationship Problems

If he doesn’t feel good about his relationship, he’s not going to feel good about getting in the sack with his lover. Relationship difficulties can leave him feeling angry and alienated from sexual partner. Intimacy and trust can also be affected by his status in the relationship, especially if he’s feeling dominated. Other relationship issues resulting in ED include:

— Loss of attraction for his partner

— A lack of sexual chemistry

— Low or no desire issues

— Having an affair

— Divorce or separation

— Guilt over sexual intimacy given recent death of his partner

Sexual Issues

Sexual difficulties that are already present and affecting his confidence, like premature ejaculation, can invite ED. Erectile difficulties can also cause other sexual problems or relationship strains. In dealing with such issues, couples need to reduce the importance of genital contact.

Both also need to get into a mindset of sex being “successful” in spite of a lack of erection or intercourse. Dealing with ED can be the perfect opportunity for a couple of increase their sexual repertoire and expand their definition of pleasuring and sexual satisfaction.

Other sex-related issues that should not be overlooked include:

— Fetishes: He’s turned on only by a specific object of desire;

— He’s unsure about his sexual orientation;

— Being consumed with sexual secrecy;

— Having negative attitudes about sex;

— Sexual trauma.

Regardless of the issue, the stress, guilt, fear, and/or personal anxiety that result can lead to performance anxiety. This is where he becomes a spectator in his sexual performance, anxiously scrutinizing what’s adequate or sustainable to the point it inhibits his response.

Any male dealing with ED needs to be evaluated not only for biological or physiological factors at play, but for other his feelings, relationship to his partner, work demands/failures, disappointment in himself, his fear of aging and loss of health, and family life.

Make sure you’re working with a practitioner who is taking a psychosocial history. Psychological problems should be suspected more if you get erect during foreplay or during self-pleasuring, but fear penetration or performance failure.

Normal nocturnal and early morning erections, as well as sudden onset, also indicate that his ED is related to psychological or relationship issues, a specific occasion, or life event.

Couples should seek to work with a sex therapist in getting to a better place. By doing so, his partner needs to be supportive, understanding, and non-demanding. He must learn to be more receptive to what his partner shares. Most importantly, he needs to have the courage to speak about ED and its underlying issues.

Dr. Yvonne K. Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, "Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots."

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