Physical vs Mental Erectile Dysfunction (ED)
Achieving an Erection vs Keeping It
“Is there a difference between guys who can’t even get it up versus guys who just can’t maintain it?”
A lot of the time for patients that have a physiologic problem like decreased blood inflow, diabetes, hardening of the arteries, hypertension, it’s an obtaining problem. They can’t obtain, physiologically achieve, the erection. There’s either not enough blood flow going in, or there’s too much outflow going out.
In my experience, the patients that have trouble maintaining erections typically are dealing with other medical factors. This can include medications, lifestyle issues, anxiety, self esteem, depression… Conditions like these are oftentimes interplaying in a complex and multifactorial way. A lot of times, this means ED.
So you fix what you can, you address what you can. But my ultimate goal away from just looking objectively at what the IIEF is saying, is to restore the sexual satisfaction or quality of life for the patient and their partner. And, I find that if you fix one then it’s a domino effect. Often just fixing one aspect of a patient’s difficulty can tip them over to where they reach a satisfied end point; a point where they can say “Yeah, this erection is working for me. Even better, it works for my partner.”
Physical vs Mental ED Causes: Which Is More Common?
I’m often asked if more men with ED are suffering from the psychological or physical aspects. I find the patients dealing with more psychological ED causes would skew younger, healthier patients. The more you’re talking about physiologic, or physical ED causes, it skews older patients with certain medical comorbidities or other illnesses, and- normal aging.
But even still, it’s usually a complex interplay of both psychological and physiologic factors.
Mental Health Conditions and ED
Depression. Anxiety. PTSD. Low self-esteem. These are examples of conditions that can affect erectile functioning.
Anxiety—so whether that’s performance anxiety or more generalized anxiety, or even panic disorder, or post traumatic stress disorder. Any of them can really affect sexual functioning, as well as ED can cause anxiety, cause that performance anxiety, and can cause depression
A history of sexual trauma is something that can manifest itself in erectile dysfunction and can also cause anxiety around sex.
Relationships Challenged by ED
In terms of relationship issues that manifest in erectile dysfunction, that could be resentment, it can be distrust, say someone’s worried about their partner having any kind of extramarital activity or sexual activity outside the marriage that’s not agreed to, that can be something that causes distrust. That can cause difficulties in the bedroom. And then also, as I said, this sort of pursuer/pursued dynamic where someone can just feel claustrophobic around their partner regarding sex. And that can cause problems.
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