30 Ways to Help Psychogenic Erectile Dysfunction
Psychogenic erectile dysfunction refers to challenges initiating or maintaing an erection due to psychological and interpersonal factors. This form of ED is not caused by a physical issue and can be diagnosed by your medical provider. Psychogenic erectile dysfunction is typically addressed through a combination of medication (such as sildenafil), Cognitive Behavioral Therapy (CBT), Sensate Focus, and individual or couples therapy.
Some of the most common causes of psychogenic ED include relationship issues, unrealistic expectations of sex, self esteem issues, mental health (depression and anxiety), being unprepared (such as inadequate lubrication or not stimulated enough), and lifestyle factors (drinking, drugs, sedentary lifestyle, and chronic health issues). Homophobia, heteronormativity, and minority stress can all play a role in ED as well.
Having negative expectations of sexual performance becomes a self-perpetuating cycle, where men can overly focus on cues that signal failure and have a strong evaluative focus on their own bodily signals which in turns distracts from eroticism. It is vital to address performance anxiety.
With psychogenic ED, people often engage in spectatoring (self observation during sex), self-monitoring, performance demands, and failure anxiety, which leads to an activation of the sympathetic nervous system leading to genital arousal inhibition. Some might avoid all sex, worsening the negative associations with sex. Severe anxiety symptoms worsen ED. Negative automatic thoughts (I am a failure, I need to perform, my erection is not firm enough) and unrealistic, unattainable expectations (an erection is essential for sexual satisfaction, without a firm erection my partner will leave me) perpetuates a vicious cycle of ED.
Talking about ED improves sexual function, sexual satisfaction, and sexual intimacy. Working through psychogenic ED is an opportunity to reframe sex, (re)learn how to be present, enhance sensuality and eroticism, and ultimately deepen enjoyment and connection.
30 Ways to Help Psychogenic Erectile Dysfunction
Practice being in the present moment and be curious and creative during sex.
Shift focus away from erections and instead focus on the quality of pleasure and connection
Incorporate relaxation exercises before and after sex.
Try relaxed breathing during sex.
Allow yourself to take breaks as needed.
Practice self compassion: "Other people experience this too, no one is alone in their struggle, I am human and not a machine, may I be kind to myself"
Expand your sexual script.
Have a fluid style to sex.
No rushing.
Make time every day for sensual touch (doesn't have to be sex).
Good sex is about being in the moment.
Always try to end sex on a good note.
Practice receiving sexual pleasure.
Bring in new components such as visual/touch/fantasy. Play around with experiencing pleasure in different areas in the body.
Identify some key values for sex. What matters most? For example, warmth, playfulness, creativity, freedom, pleasure. Instead of focusing on the erection, focus on your values for sex.
Challenge unrealistic sex expectations from society, such as macho-beliefs, sexual myths, and societal expectations.
Unlearn unhelpful arousal templates from pornography, having a more realistic and holistic view of sex and orgasms.
If watching pornography, try experimenting with taking a break from it.
Reframe sex. Sex is not only about penetration. Many people cannot orgasm from penetrative sex alone.
Practice mindful masturbation on your own, learning what kind of touch you enjoy.
Actively debunk myths about sex - that sex equals intercourse, that men are always ready for sex, erections stay rigid the entire time. If it starts with "I should" it is probably not helpful for good sex.
Enjoy the sex that you do have. Practice having “good enough” sex.
Be playful rather than perfect.
Ask for your needs to be met. Open communication is vital.
Each person is responsible for their own orgasm and sexual pleasure.
Emphasize pleasure/intimacy/satisfaction instead of performance, penetration, and intercourse.
Approach sex with curiosity. Remember, stress, pressure, performance anxiety, and relationship conflict is a libido killer.
Take things less seriously.
Paradoxical intention. You can try either not having an erection or having sex without any kind of penetration. The key to working through erectile dysfunction is to lose the erection, relax, and get the erection back.
Recognize when distracted by negative thoughts, for example if you are overly focusing on your past or future sexual performance or are being judgmental towards yourself. Worrying during sex will make sex less enjoyable.
Dual Control Model of Sexual Response
Our sexual response is made up of two parts: a gas pedal (accelerator) and brakes. The accelerator responds to all the sexually relevant information in the environment — everything you see, hear, touch, smell, taste, or imagine that your brain codes as sexually relevant and it sends the "turn on" signal. The brake, at the same time that that's happening, is noticing all the very good reasons not to be turned on right now — everything you see, hear, smell, touch, taste or imagine — that's a potential threat, and it sends a signal that says "turn off." So, arousal is not just the process of turning on the ons, it's also turning off the offs.
Sensate Focus
Sensate Focus was originally developed as part of an intensive two week program by pioneering sexologists Virginia Johnson and William Masters. Although mainstream Sensate Focus exercises have been watered down and are broadly misunderstood, many people have found these exercises to be an effective way to address psychogenic erectile dysfunction.
In essence, Sensate Focus is about learning how to be mindfully being present to sensations in the moment and refraining from forcing pleasure and arousal. Sensate Focus in Sex Therapy by Linda Weiner provides clear illustrations and descriptions of how to engage in sensate focus exercises and how engage in Sensate Focus Phase 1 and Phase 2.
For more information, here’s a two page description of a hierarchy of Sensate Focus exercises as well as a queered Sensate Focus description.
