Archive for the ‘Erectile Dysfunction’ Category

Erectile Dysfunction: Immediate Factors


Lack of arousal. One of the most overlooked causes of ED is the lack of mental sexual arousal on the part of the patient. Often the patient himself may not be aware of this. Men often expect that they will experience an automatic erection when in a sexual situation and may be alarmed when it does not happen. Simply asking the patient about his level of sexual excitement may serve to pinpoint the cause of the problem. Once a lack of arousal is identified, further questions can focus on the reasons for the lack of sexual excitement.

Performance anxiety. The experience of performance anxiety takes a variety of forms. Most often, it is worry about having an erection problem. It may also be fear of displeasing the partner or of negative reactions by the partner. It may include fear that the erection problem will never go away or that it will lead to embarrassment or the loss of a relationship. Sometimes, it expands into a sense of failure as a man. Research has demonstrated that, for men with erectile dysfunction, anxiety results in decreased sexual arousal and erections. Similarly, Bancroft and Janssen’s “dual control model” of sexual arousal has shown that anxiety serves as the primary source of inhibitory control. It is important to note that performance anxiety can be either a cause or an effect of ED. Most men with ED will experience some amount of performance anxiety, even if there is a clear organic cause. Likewise, performance anxiety may not be the original cause of the ED, but may be a secondary cause once the ED has started.

Inappropriate conditions for sex. Patients with ED may not recognize that they are trying to be sexual when the conditions are not right. Therefore, asking about the patient’s physical and mental state before and during sex may identify obstacles to erectile response, such as feeling stressed, ill, tired, or preoccupied. Timing, the partner’s physical or mental state or other elements of the situation may not be conducive to a good sexual response.

Other sexual dysfunction. Other sexual dysfunctions are often present in men with ED. Results from a study of sexual dysfunction found that two-thirds of men with hypoactive sexual desire had ED as well. Likewise, men with ED frequently also have premature ejaculation.

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These two conditions should always be assessed in men with ED. If there are cooccurring sexual dysfunctions, the question becomes which condition may be primary. A temporal ordering of the onset of the problems may make this clear. For example, many men with ED subsequently develop inhibited desire as a result of the frustration and distress of the ED. Conversely, the ED may be the result of a loss of sexual desire. At other times, the sexual problems appear develop simultaneously. These cases highlight the possibility of a more pervasive sexual inhibition.


Inadequate sexual skills. Sometimes, people just do not know how to have good sex. Whether the result of ignorance or unrealistic expectations, a patient may not be aware of the kind of stimulation that he requires for sustained sexual excitement. Problems of this type may be identified through the examination of the couple’s sexual script.

Partner’s response. In assessing the sexual inter-action for clues to the obstacles to an erection, one should not forget the other person who may be present. A frequent problem noted by men with ED is that their partner is not aroused, which decreases their own arousal and increases their anxiety. This may be the result of a sexual dysfunction on the part of the partner (e.g., inhibited arousal, pain, or anorgasmia). The partner may also be experiencing her or his own sexual anxiety or anger about the problems in the sexual relationship.

Lack of feedback. A satisfying sexual encounter usually requires a process of feedback between partners about their experiences of pleasure or displeasure. Individuals learn what works for the other person sexually and what to avoid. The absence of feedback can lead to continuing unproductive ways of seeking arousal or to missing the sexual activities that would produce arousal.