Erectile Dysfunction: Medical Or Psychological?


Getting over erectile dysfunction: how hard can it be? That depends where your problem is rooted.

Oops, it happened again. A man in his early sixties came into my office with longstanding problems with erections. He had many factors working against him: He had a high-pressured career, he was overweight, and as the nest was emptying, he had less in common with his wife. He also drank, but I wasn't going to address that right away. He wasn't very communicative in my office, and I guessed that he wasn't very communicative at home either.

He said he used Viagra with varying success. Knowing that using medication was sometimes helpful to a man's confidence when he was learning how to be more pleasure-oriented, and less performance-focused during sex— especially a man in his early 60s who had trouble all the way along— I recommended he try using a different medication. I gave him a referral to an Urologist who specialized in sexual medicine, plus some reading material. I also asked that he bring his wife into the office with him for treatment. After all, he had acknowledged that his impotence was affecting his marriage, and his wife would need to be part of treatment.

He said he would speak to his wife and call me back. But as he skittered out of my office, business card of the urologist in hand, I knew I probably wouldn't hear from him. He had heard one thing: That maybe another medication would be the magic boner pill of his dreams.

Here's the thing about medications for erectile dysfunction. They are purely mechanical in their action. They help keep blood in the penis. That's it. The end. They do not help overcome performance anxiety. They do not communicate with a partner what a man needs or wants during sex. They do not increase sexual arousal. They do not overcome problems with depression, stress, or alcohol use.

Have you experienced varying results with the drugs used to treat erectile dysfunction? Are you frustrated? Is your partner frustrated? Have you been struggling for a year or two, or even a decade? You might truly benefit from sex therapy.

What will happen in sex therapy? Sex therapy is like other psychotherapy. It begins with developing a relationship with the therapist that engenders trust so that a man and his partner can open up and really talk about what hasn't been working. We then try to create a solution— a focused treatment plan that expands on a couple's strengths and improves communication, connection, empathy, and pleasure. They will understand their own sexuality better than most people, and they will use that knowledge to unlock the doors to create a satisfying sexual relationship.