How are erection problems addressed in sex therapy?

Erectile dysfunction is one of the sexual dysfunctions that affect more men. However, luckily, it can be treated effectively both from medicine and from sexual therapy based on the findings of Psychology and the methods of emotional regulation.

In this article you will find an overview of how erectile dysfunction is addressed through psychosexual therapy, as well as the factors that can cause this problem.

• Related article: "The 9 main sexual and psychosexual disorders"

What is erectile dysfunction?

Also popularly known as "impotence," erectile dysfunction is the inability to maintain a full erection during sexual activity. It is, along with premature ejaculation, the most common sexual dysfunction in men.

Erectile dysfunction can be produced or facilitated by a large number of organic alterations; basically, all those that directly or indirectly affect the physiological process linked to sexual arousal and the triggering of the changes it produces in the male genitalia. This includes injuries from bumps, burns, or cuts, as well as diseases that damage cells. nerve cells involved in erection, as well as those that alter the production of certain hormones.

In practice, however, and if we look at the statistics, pathologies with organic causes easily identifiable with those most associated with erectile dysfunction are cardiovascular disease and benign hyperplasia prostate. That is, two phenomena that directly influence the functioning of the genitalia (it is not necessary to forgetting that an erection occurs when the corpora cavernosa fill with blood) and their areas surrounding.

On the other hand, as we move forward, erectile dysfunction it is a problem that is statistically closely linked to age; It affects around 7% of men under 40, 22% of those in their 40s, and one in two of those in their 70s.

However, it would be simplistic to assume that erectile dysfunction is basically a medical problem. Many times the main causes are psychological, and even in cases where there is an organic disease, emotional alterations tend to overlap with the symptoms of the latter. That is why when therapy is offered to men with problems to achieve erections, in the early stages much importance is given to determining the cause or causes of what It happens, from there, to offer personalized solutions in which the cognitive, emotional and behavioral processes that play a possible role in the appearance of this are not ignored. phenomenon.

Between the psychological aspects that can cause or favor the appearance and maintenance of erectile dysfunction the following should be highlighted:

• Depression
• Anxiety during sex
• Intrusive thoughts related to failure to get an erection
• Insecurity with one's own nudity and sexuality
• Conflicting relational dynamics with the last sexual partners one has had

How is erectile dysfunction treated in sex therapy?

These are the main areas of intervention in patients with erectile dysfunction, although they are always used or not depending on the specific needs of each person.

1. Psychoeducation and sex education

Something as simple as inform about aspects related to sexuality, emotional management and healthy habits that must be followed to prevent sexual dysfunction is very useful to combat erectile dysfunction, on all in cases in which this occurs mainly because of fears and the belief in myths that circulate about the sex.

2. Imagery exercises in therapy

The imagery is based on the realization of imagination exercises, having previously practiced so that these mental images and their associated sensations are very vivid, very much like the world real. They allow you to control emotions during the course of key actions, in this case, focused on sexuality and sexual arousal. In this way, it is possible to practice managing anxiety and other emotions in a "controlled environment." in which it is easier to start making progress by starting with a few relatively simple challenges first.

In this way, you lose your fear of the type of experiences associated with erection. In addition, the patient is trained in the ability to let go of worry about being getting or not getting an erection (these fears often get in the way) and focusing instead on the satisfaction.

3. Neurofeedback

Neurofeedback it is used in a wide variety of problems caused totally or partially by poor regulation of anxiety. It consists of inducing the patient to a certain mental state while he receives information about his nervous activity in real time, thanks to a series of sensors applied to his skin. In this way he learns to encourage those psychological operations that bring him closer to a certain goal, and to discard the rest.

4. Improved self-esteem through cognitive restructuring

Low self-esteem is closely linked to sexual dysfunctions, both as a cause and as a consequence. For this reason, it is common for therapy to work to help the person have a more adequate level of self-esteem.

This involves a wide variety of techniques and strategies, but one of the most important is cognitive restructuring, which consists of leading the patient to question dysfunctional beliefs that she has been clinging to and that were causing her problems, replacing them with others that allow to have a more constructive mentality and not to fall again and again in the avoidance of experiences.

5. Making a calendar of challenges

Between therapy sessions, patients are required to carry out a number of tasks in their private lives. These goals to be achieved throughout the week are temporally distributed and designed following an ascending difficulty curve and adjusting to the level of progress of the person; The fact of having short-term objectives to be met (within days or hours) makes the patient feel motivated for continuing to improve.

Bibliographic references:

• Althof, S.E. & Wieder, M. (2004). Psychotherapy for erectile dysfunction: now more relevant than ever. Endocrine, 23 (2-3): pp. 131 - 134.
• Anna Kessler Sam Sollie Ben Challacombe Karen Briggs Mieke Van Hemelrijck (2019). The global prevalence of erectile dysfunction: a review. BJU International, 124 (4): pp. 587 - 599.
• Avasthi, A.; Grover, S.; Rao, T.S.S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian Journal of Psychiatry, 59 (1): pp. 91 - 115.
• Kendirci, M.; Nowfar, S.; Hellstrom, W.J. (2005). The impact of vascular risk factors on erectile function ". Drugs Today (Barc), 41 (1): pp. 65 - 74.
• Shamloul, R.; Bella, A.J. (2014). Erectile Dysfunction. Biota Publishing.