Ask a Sex Therapist: What is Erectile Dysfunction and Causes & Cures For It?

by Cay Crow, M.A., LPC, AASECT-Certified Sex Therapist

Is Erectile Dysfunction Age Related?

“I have learned that the libido, like Elvis and jealousy, never dies. I know copulators of eighty-five. Who said you need an erection, a body or an orgasm for sex?” Hanif Kureishi, The Nothing

Yellow wilting flower

Even in the womb, males have an obvious, external indicator of excitement (not always sexual, mind you) in the form of an erection over which they have little conscious control. It presents itself at awkward moments like the first dance with a crush in junior high. Later, in a long-term relationship, the erection might become an invitation to play or, in some cases, a reason for the man’s partner to complain – “Again?” Too many women and perhaps some men see an erection as demand for sex but it is not. An erection simply means that a guy is healthy. As males age, erections might balk occasionally. The penis might say, “Not tonight, dear” more often than the partner. And the man may feel less than himself because his penis doesn’t work like it used to. Every organ in the body struggles to function as we age. Vision goes, then hearing. Hair grows where it never did before but not where it is supposed to.

Should I Use Medicine To Treat Erectile Dysfunction?

The penis is essentially a vascular organ. Blood flows in and out continuously. Drugs like Viagra work by interfering with this process, keeping more blood flowing in than flowing out. Anything that adversely affects the vascular system impacts erections. Also, the smooth muscle tissue around the erectile chambers that fill with blood need to relax enough for erections to happen. If you are anxious or tense, blood will not flow into the penis as freely. So take good care of yourself. Smoking is one of the worst habits for erectile health. Exercise and eat healthy. Manage stress. If you still have a problem, there are medications like Viagra, Cialis, Levitra, and Stendra although these drugs are not suitable for everyone. Too many ED sufferers believe these medications to be a quick fix. Even on ED medication, a man will not experience spontaneous tumescence. The reality is that desire, stimulation, and relaxation are essential components of the erection equation with or without boner drugs. Barry McCarthy, Ph.D., author of Male Sexual Awareness, says that, sometimes, drugs like Viagra cause more sexual problems than they solve by creating unrealistic expectations. The majority of men with ED believe drugs like Viagra will restore their sexual functioning to what it was like at a younger age; this simply is not true.

What is Erectile Dysfunction its causes and cures?

A doctor or therapist diagnoses erectile dysfunction (ED) when a gentleman is unable, for at least six months and 75-100% of the time, to achieve and maintain a level of turgidity capable of completing the sexual activity. The situation must cause significant distress to the individual or the relationship and the problem cannot have a medical cause. About 25 years ago, even doctors believed that ED was ‘all in your head.’ But thanks to the research of people like Irwin Goldstein, M.D., author of The Potent Male, the professional community understands that 80-90% of ED is due to physiological problems while only 10-20% is psychological. In fact, there is such a strong relationship between ED and cardiovascular problems that many doctors insist on a cardio workup when a man complains of ED. Any medical issue that impacts circulation can cause erectile issues. The most common culprits are heart disease, diabetes, and hypertension. Anxiety can be both a cause and an effect of ED.

What I see in my practice is men diagnosing themselves with ED after one episode of Mr. Happy not doing what is expected. So anytime a gentleman comes in with that diagnosis, I do not take his word for it. I also encourage men not to use the word “performance” when they talk about their sexual functioning. Language has tremendous power. Thinking about one’s sexual functioning in this competitive way creates an internal sense of shame and judgment around the natural waxing and waning of sexual interest and expression. When I work with ED clients, I try to help them realize that having an ED is a blessing in disguise. Whether their problem is physiological or psychological, they must reframe their approach to making love from one that is genitally-focused to pleasure-focused. This is often the most difficult shift for men to make, emphasizing pleasure not performance but in the long run, it is a godsend for both partners.

Cay L. Crow, LPC, AASECT-Certified Sex Therapist

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