How to Help Your Male Partner with Psychological Effects Of Erectile Dysfunction

A Sexologist explains why ED is so common and gives her top tips for overcoming it

If you - or your partner - has ever experienced difficulty getting or maintaining an erection, let me first reassure you that this is completely normal. In fact, most men or penis owners will experience erectile difficulty at some point in their lifetimes. 

This is because as men get older, erections naturally come less and less frequently. As a teenager, they are so frequent they can be inconvenient and very unpredictable! This usually steadies into your twenties and early thirties, and then as each decade passes the frequency and ease in which erections come gradually decreases. This means by the time you reach your forties, fifties and sixties, you will likely start to notice the change. 

Having erection trouble from time to time isn't usually cause for concern. However, experiencing ED can be extremely stressful and upsetting, and for many people it becomes an ongoing issue that impacts their confidence, sex life and relationships. 

The good news is there are lots of things you can do. If you - or your partner - is struggling with ED the first step is getting expert-led sex-positive education. Hint - keep reading! Often the problem is less about what’s going on in your body, and more about what’s going on in your head. 

What Is Psychological Erectile Dysfunction?

Erectile Dysfunction - or erectile difficulty - can be caused by many factors. Most people assume if they are experiencing ED that there must be something physically wrong with them. 

And while there are lots of physical causes for ED (heart disease, high blood pressure, high cholesterol, diabetes, obesity, smoking, low testosterone, alcohol, prostate cancer etc.) many causes are psychological. 

Psychological ED is when a penis owner struggles to get or maintain an erection for psychological or emotional reasons - not physical.

How Can You Tell If Your Erectile Dysfunction/Difficulty Is Psychological?

If you are still getting an erection at night or in the mornings, and/or you are still able to get an erection in specific circumstances (eg during masturbation or self pleasure but not during partnered sex), then your erectile difficulties are probably psychological. 

The fact that your body is still able to give you erections in sleep shows that everything is in fine physical shape, but that something might be blocking you emotionally.

If you notice that your morning erections are less frequent or less rigid it is worth visiting your GP, as it may be a sign of an underlying health condition.

What Are The Causes Of Psychological ED?

• Stress is a huge mood killer. When we are stressed (inside or outside the bedroom) our body releases cortisol. This is a hormone that inhibits testosterone - the primary male sex hormone responsible for sex drive and blood flow changes that cause an erection. If we are continually stressed at work it can start impact our sex life. 
  
  
• Performance anxiety - Similarly, if you are nervous about pleasuring your partner or performing in bed, this performance anxiety can lead to erectile difficulties. The problem is the more you worry about staying hard, the more performance anxiety you get, and it becomes a vicious cycle. 
  
  
• Busy mind - When our mind is busy and we are stuck in our head it is much harder to drop into our body and feel pleasure. We might find our mind wandering, or struggle to stay in the moment. This is why mindfulness and meditation can be so important for sexual happiness. 
  
  
• Guilt/shame - Most of us were raised in a conservative and sex negative environment, meaning sexual shame and anxiety is very common. When we experience sexual shame it stops us enjoying the moment and accessing pleasure. Many people who experience ED often get even more embarrassed or shameful when they ‘struggle to perform’, which again becomes a vicious cycle. 
  
  
• Low body confidence - Low self-esteem can trigger performance anxiety. The more you worry about your looks in bed, the more stressed you become. All this tension may lead to erectile difficulties.

• Porn reliance - If you become over reliant on audiovisual stimulation such as porn, erotica or fantasies to build arousal and erections, you might struggle to achieve the same sexual response in other situations - eg during partnered sex. This is why mixing it up and trying new things during self pleasure is so important. Try removing the porn gradually, and focus on the physical sensations.

• Relationship issues -  If we don’t feel happy or safe in a relationship, our body and nervous system is in a heightened state of alert and up-regulation. All of this tension and stress could result in physical symptoms such as ED

• Mental illness - Depression and other mental health disorders, like anxiety, can trigger imbalanced brain chemicals. And not being able to perform the way you want in the bedroom can lead to feelings of frustration, anxiety, or depression, making ED even worse. In fact, men with clinical depression are about twice as likely to develop ED according to a recent study.
  
  
• Sleep issues- Sleep deprivation and tiredness may cause a man's testosterone levels to dip.  Researchers have also suggested that stress and fatigue related to lack of sleep may make sexual problems worse.

What Are The Questions You Can Ask To Find Out?

If you suspect you or your partner is struggling with ED for emotional or psychological reasons, the first thing to do is try and remove any shame, blame or guilt. Approach the conversation with love, respect, and empathy, and create safety to share openly. 

Remind yourselves that ED is extremely normal, and silence and shame will make overcoming it harder not easier!

Here are some questions you could gently explore to find out if your ED is psychological: 

• Do you experience morning erections?

• Are you under a lot of stress or anxiety at the moment?

• Do you find our mind wandering during sex and that it’s hard to stay in the moment?

• How are you sleeping?

• Are you feeling any conflict or stress in the relationship at the moment?

• Are you drinking or smoking a lot at the moment?

• Are you able to achieve an erection while masturbating?

• If so, what are your masturbation/porn watching habits? 

• Do you get nervous or anxious during partnered sex?

• How is your mental health at the moment?

What is Psychological Impotence?

Impotence is defined as the inability to achieve or maintain an erection and/or orgasm. Psychological impotence - similarly to Psychological ED - means the root cause for the issue is mental or emotional rather than physical. 

In penis owners, there are three types of erections; psychogenic, reflexogenic and nocturnal.

• Psychogenic - When you are turned on by your brain - eg through audiovisual stimulation (eg porn, erotica) or through fantasy. Impulses from your brain activate the erectile process
• Reflexogenic - when you are turned on by your body - eg through touch or stimulus to the body/genitals. Impulses spread from the nerve endings throughout the body and then activate the erection centres
• Nocturnal - Occur during deep sleep (during the REM cycle)

Psychological impotence usually only impacts Psychogenic and Reflexogenic erections. You are still able to get hard in your sleep.

What Is Sexual Performance Anxiety?

Performance anxiety is the pressure to perform or please a partner during sex. People of all genders can experience performance anxiety, and it reduces our ability to stay present and in the moment during sex and intimacy.

For men and penis owners, performance anxiety could express itself by having the following thoughts during sex and intimacy: 

• Is my partner enjoying this?

• Am I hard enough?

• Am I big enough?

• Am I doing the right thing?

• Does my body look good?

• Am I going to last long enough?

• Am I going to be able to stay hard?

• Am I making strange noises?

• Am I sweating too much?

Performance anxiety is one of the major causes of ED.

How To Help Your Partner With Psychological Erectile Dysfunction

• Communicate! Remove the cone of silence that often surrounds sex, and create a safe, happy, shame-free environment to talk openly. Reassure them that ED is not a big deal. Practice being really clear about your desires before and during sex, and having chats afterwards about what you enjoyed, what was hot for you, and what you are curious to try next time. 
  
  
• Compliment them! Everyone needs a bit of reassurance now and again, and it can really help with performance anxiety. Practice complimenting to your partner during sex, saying things like “I love it when you touch me like that”, “you look so hot right now” and “that feels amazing”.
  
  
• Explore other types of sex and intimacy - There are lots of amazing ways to have sex without penetration! If your partner is worried that they will experience ED, try other forms of intimacy that don’t require an erection to feel great. Oral sex, sensual full body massages, genital massages, dirty talk, steamy showers, watching porn together, watching you masturbate, strip teases, reading erotica together, breath work and tantra - the list is as long as your imagination.
  
  
• Slow it down -  There is no rush! Slow down your sex and intimacy to be more sensual. Allow the desire and pleasure to build at its own pace. Enjoy the journey - not the destination. 
  
  
• De-stress the nervous system first - If your partner is stressed, try and encourage them to do some form of physical activity or mindfulness exercise that is designed to help them relax and drop into their body. For example a bath, shower, massage, meditation, walk or a work out. 
  
  
• Breathe - A great way to relax and down-regulate the nervous system is to deepen your breath and lengthen your exhale. Practice breathing together with long, slow, deep breaths. This can also be highly arousing and erotic and breath work is the foundation of erotic practices such as tantra. 
  
  
• Talk to an sexology expert - such as a certified Sex Coach or Sexologist. We help people learn the tools for how to build pleasure and desire in the body, such as breath, movement, sound, touch and mindfulness.
  
  
• Get medical support - if you are worried your partner might be suffering from clinical depression, anxiety or another form of mental health concern, encourage them to seek professional help.