Erectile Dysfunction: Tips from a Sex Therapist
Understanding Erectile Dysfunction
Erectile dysfunction (or ED) is the inability to keep an erection firm enough to have penetrative sex. That’s a pretty basic definition. The root causes can be physical or emotional. While you do not need to identify as male to experience ED, most of the folks who come to my practice with this particular concern are male-identifying.
These men often come to my office saying they feel emasculated, embarrassed, shameful, and describe a spiral of anxious thoughts like “please don’t happen again” or “what if I lose it this time?” Is that you or someone you love? I’m pleased to say that I’ve seen plenty of men in my practice move from stressing about erections to enjoying pleasurable sex lives.
Why Do We Lose Erections?
First, let’s clarify that it’s completely normal for an erect penis to soften. Most men experience this at some point or another for a variety of reasons that may not need treatment. When you lost your erection, were you stressed? Did you have a busy mind? Were you aroused? Did you want to have sex? Your relationship with your mind and body plays a big role in your ability to maintain erections when you want them. And losing an erection here and there may not indicate a larger problem. The real issue may be how your mind interprets the experience.
Your Mind and ED
Often, men I speak with are caught in a thought spiral about losing erections. Thoughts like “when will it happen again,” “oh no, it’s happening again,” or questions about your masculinity can throw you through a downward anxiety loop. Men also have negative thoughts about their bodies, worth, and sexual skillfulness that all impact their ability to be present with their personal and partnered sexual experiences. It’s hard to imagine feeling sexy or having fun with sex when your mind is focused on what could go wrong.
Other psychological concerns may also impact your erections. A history of trauma, depression, general anxiety, and other psychological experiences can throw a wedge in your capacity to stay present with your body and sexuality. In these cases, finding a good sex therapist to be with you and your unique experience is important.
Your Body & ED
Injuries, illnesses, surgeries, medical treatments (like chemotherapy), and any experience that impacts your neurology, blood flow, and muscles can impact your body’s ability to obtain and maintain erections. This is why if you’re concerned about your ability to have erections for any reason, I recommend seeing your primary care doc and a urologist. Even if you’re pretty sure your ED is psychological. Ultimately, sex therapy can help work through the emotional and psychological parts of ED, even if the root cause is a physical one. It will be helpful to have some clarity on what we’re working with.
Your lifestyle is another important factor to consider. Tobacco and alcohol use, obesity, and general stress and fatigue can all impact your experience with erections. Now is a great time to collaborate with your doc or health team to understand what wellbeing means for you and your body.
How Sex Therapy Helps Connects the Body and Pleasure
Much of the work I do with clients focuses on connecting to the body. When your mind is hyper-focused on all the things that could go wrong, it’s hard to get into the present sensation, and that sensation is imperative to get it up. In sex therapy sessions, I teach clients to practice a new relationship with their minds and bodies. Thoughts become less intrusive and powerful, and your capacity for moving to sensation and pleasure expands.
Partnered Communication
How do you feel about talking about sex and bodies explicitly? Expressing what you want or need? Asking about your partner's wants, needs, and boundaries around sex? As our bodies, preferences, and desires change, communication about sex and relationships has to be an ongoing journey of discovery.
In sex therapy, you can develop a greater understanding of yourself so you can communicate clearly and directly with your partner. When you invite a new habit of direct communication, you have incredible potential to lower pressure, assumptions, and miscommunications around sex.
Redefining Male Sexuality
What does it mean to you to be a man? How did you learn to be a man and what it is to be masculine? These are questions I always ask men who come in concerned about ED. The messages we absorb from caregivers, peers, and media impact us greatly (especially during childhood when all the curly parts of our brain were developing).
If you feel that your role as a man is to have things figured out, be a doer, show strength at all times, and need an erect penis for satisfying sex, imagine what that does to your head game when you lose an erection. In sex therapy, we look closely at your construction of masculinity so we can ditch the parts you find harmful and embrace a definition that feels preferable and authentic for you.
EMDR in Sex Therapy
One of the key parts of successful ED treatment at my online therapy practice has been through the use of Eye Movement Desensitization and Reprocessing therapy, also called EMDR. Those “is it going to happen again” thoughts are clinging to past experience.s EMDR can leave those memories in the past so you can stay more present with therapy, your body, and sex.
A Book Suggestion
Coping with Erectile Dysfunction by Michael E. Metz, Ph.D. and Barry W. McCarthy Ph.D. is THE guidebook for working with ED. I suggest this to every client who shows up concerned about erections. Those who read the book in conjunction with therapy generally find themselves feeling more satisfied with their sexuality more quickly. The book explains ED in detail, has step-by-step skill development, and is an excellent resource to begin redefining how you relate to sex.
Sex Therapy Can Help
If you choose to work with me as your sex therapist, I promise to hold an open, welcoming space. In this space, all questions, fears, and worries are welcomed. With many years of experience in the fields of trauma, couples work, and sex therapy, I have heard a whole spectrum of concerns. While I have the experience to address any and all of your concerns, I will hold space for you and your unique struggles. Considering sex therapy for Erectile Dysfunction, along with any other sexual concerns, is certainly a step in the right direction.
I provide all therapy services using an online format. So, I am able to serve folx in both Minnesota and Colorado. Sex therapy using an online medium allows us to meet when and where you are able. So, with added convenience and flexibility, we can get your sexual confidence and pleasure back on track. If you’re ready to get started with sex therapy, reach out to me.