Men who experience erectile dysfunction (ED) may compound the problem by over-speculation on what the root of the problem is. A man with ED may wonder,
- Is this all in my head?
- Is AccessRx legit?
- Does it mean I have an underlying medical condition?
- Is it an indicator of relationship problems?
Most medical experts believe that ED can have a physiological basis, a psychological basis, or both. Rare are medical experts who definitively state that ED is one or the other. The good news is that there are many excellent treatment options available for ED, so regardless of the cause, help is available. Here are 5 expert opinions on the physiological and psychological components of ED
1. Dr. Barbara Bartlik, MD, clinical assistant professor of psychiatry at Weill Medical College of Cornell University and Dr. Marion Zucker Goldstein, MD, associate professor of psychiatry at the School of Medicine and Biomedical Sciences at the State University of New York at Buffalo emphasize that because so many cases of ED occur along with conditions like hypertension, heart disease, and diabetes, men having trouble achieving or maintaining an erection should first contact their physician for a thorough physical exam. While nobody wants to have these medical conditions, in some cases treating them and adopting a healthy lifestyle takes care of the ED as well.
For men who do not have underlying physical problems, Bartlik and Goldstein recommend getting a referral to a trained sex therapist. Sometimes physicians prescribe medications like Viagra, even if they believe the problem with sexual functioning is psychological. Erectile dysfunction can lead to a downward spiral of anxiety that only makes the problem worse, but if a man is able to take an ED drug and enjoy sexual activity once again, the cycle of anxiety can be broken. The ED medication may not be needed long term as long as the man and his partner are able to move past the issues that contribute to his performance anxiety.
2. Maneet Bhatia and Chris MacKinnon, counseling psychologists at McGill University in Montreal are experts in male psychology, sexuality, and intimacy, and they point out that some men with ED do not experience relief with drug therapy. “For 25 percent of men with erectile dysfunction, medication can be ineffective, since their difficulties are largely psychological.” For these men, Bhatia and MacKinnon believe that sexual performance problems require that the men and their partners change their perspective on what “good sex” is.
They suggest a three-point plan for breaking the cycle of performance anxiety and restoring sexual satisfaction:
- Men with ED must avoid too-high standards for erections. Many men with ED underrate the quality of their erection during sexual activity.
- Men should understand that the occasional difficulty achieving an erection is not the same thing as ED. Erectile dysfunction refers to persistent difficulty with erections, not the occasional “off day.”
- Men should know that sexual performance is an evolving process, particularly in relationships that are new. Discovering how to achieve sexual satisfaction is a process, and placing too much emphasis on the quality of an erection can stall that discovery process.
3. Dr. Dan Rutherford, the original medical director for the website NetDoctor.co.uk and general medicine practitioner in St. Andrews, Scotland, says that psychological and physical causes often overlap in cases of ED. Rutherford believes that too many doctors first recommend medication for ED and only consider psychological factors if these medications fail.
Erectile dysfunction should not be viewed as an isolated problem that can be fixed once and for all, because there are often relationship issues that go along with ED. Figuring out whether psychological issues led to ED or whether ED led to psychological issues is a “chicken or egg” situation, according to Rutherford. The important thing is that communication between a man and his partner is essential to successful ED treatment. Working with a licensed sex therapy is indicated when a couple’s communication problems compound problems with sexual functioning.
4. Lisa Thomas, Licensed Marriage and Family Therapist and Certified Sex Therapist in Greenwood Village, Colorado, believes that too many men put too much faith in medication. She states, “For most men, erectile problems are caused by an anxiety issue, not a medical issue.” Thomas believes that while ED drugs do solve the mechanical problem of attaining an erection, if a man does not address the psychological questions of why he is having the problem in the first place, he cannot take control of his own sexual response.
Thomas acknowledges that men with vascular problems or other medical problems may benefit greatly from ED drugs. But she also believes that in many cases, persistent ED is a result of dodging sexual difficulties and “hiding behind a prescription.” For couples who cannot have sex at least twice a month, Thomas recommends taking the pressure off by regularly spending time intimately without either partner pushing for sexual activity. As sexual activity picks back up, a couple can learn to handle the occasional erection problem without blame, shame, or anxiety.
5. Dr. Mehmet Oz, co-creator of Sharecare.com and vice chair and professor of surgery at Columbia University, also directs the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital. In addition, Oz is an Emmy-winning host of “The Dr. Oz Show,” a nationally syndicated talk show. Dr. Oz says that physicians and counselors today are moving away from the older conventional wisdom that all ED is psychological.
The view that men have complete control over their ability to maintain an erection psychologically is becoming less popular as more research shows that physical processes unrelated to psychological health are often correlated with ED. He says on Sharecare.com, “We now know that a man can’t will his penis to an erection like a magician levitates an assistant.”
But he doesn’t dismiss psychological causes for ED altogether, pointing out that different chemical reactions in the brain can result in stress, anxiety, and depression, and that these problems are also associated with ED.
Making Sense of It All
So what is a man who is experiencing ED to make of these differing recommendations from medical and psychological experts? Is therapy the answer or is medication the answer? Until someone comes up with a definitive test that can say whether a particular man’s ED is caused primarily by physiology or psychology, men experiencing ED should allow for both possibilities.
If a man, with the help of his doctor, concludes that his ED is based on psychology or relationship issues, he does not necessarily have to forego medications. On the contrary, many physicians believe that ED drugs can “jump start” a man’s sexual functioning and help him regain confidence while he works with a professional counselor to address psychological issues.
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