Erectile Dysfunction

Erectile dysfunction refers to the consistent inability to maintain an erection when you want to have one. It is one of the most common complaints among men seeking counseling about sexuality. As with inhibited sexual excitement, several things can interfere with erections on a temporary basis—alcohol, fatigue, stress, or ambivalence about a partner.

A continual inability to achieve or maintain an erection can stem from a variety of causes:

Physical
  • Disease (chronic and acute)
  • Medication use and abuse
  • Alcohol/drug use and abuse

It is usually easy to establish whether an erectile problem is physical because most men experience erections during sleep (when psychological factors are minimal).

Psychological
  • Depression
  • Personality disorder
  • Anxiety
  • Prolonged stress
  • Identity and lifestyle issues
  • Shame or guilt
  • History of sexual or physical assault

In the majority of cases, difficulties with erections stem from psychological factors. Whatever the specific factors, if you have a consistent difficulty in maintaining an erection when you want to have one, it may be worthwhile exploring your feelings with a counselor or therapist.

Interpersonal
  • Communication problems
  • Shame and guilt
  • Differing interests/preferences
  • Relationship dissatisfaction
  • Inadequate knowledge/information