Erectile dysfunction is one of the most common sexual disorders , and its causes are not always purely biological. Therefore, it is important to know the psychological factors that lead to its appearance and maintain it.

Interview with Mónica Dosil: causes and psychological consequences of erectile dysfunction

On this occasion we talked to Monica Dosil, a psychologist based in Castelldefels with more than two decades of experience working in psychotherapy and sex therapy, to talk about the link between erectile dysfunction and psychology.

To what extent does sexuality shape our identity?

Sexuality defines our life and also our identity. When you describe yourself, you do so based on tastes, hobbies, qualities, and interests, but it is your sexuality that gives meaning to everything. Sexuality is a state that encompasses all the traits of our personality, an energetic quantum that describes implicitly and explicitly how we behave.

If you are a committed person in your personal or work relationships, you are also committed to your sexuality. If you are an introverted person, and you reserve information or emotions, you are also committed to your sexuality.

We can affirm that sexuality shapes our identity, and this is fundamentally because it originates before the constitution of our way of being, and is one of the bases on which personality is built.

The eroticism that our body experiences in its first moments of life when it is caressed and attended to generates the first experiences of pleasure, which will later be the germ of our more or less magnificent sexuality.

How does what we believe about ourselves, our self-esteem, affect us in the sexual sphere?

It’s crucial. If you feel good and safe you act accordingly, feeling free to develop naturally and boldly in the field of sexuality, if you feel insecure in your way of being. That is to say, if your self-concept is low, you will see it reflected in your sexuality.

Insecure people have difficulty in showing their body, make love with the light off, are uncomfortable in positions related to the sexual act, do not want to be caressed in some parts of your body … in short, they can not flow freely and their thinking, in some way limiting, is directly influenced by the pleasure they experience, as they try to make a management control of all situations and can not focus on enjoying your body or indulge in the art of giving pleasure.

Many people believe that erectile dysfunction is a purely medical problem. Is it common for its causes to be basically psychological?

It is true that there is a percentage of cases that have organic etiology, which is why the urologist must play a priority role in ruling out organic pathology. The second step is to go to the specialist in sexology, who can be a doctor or a psychologist in his constitutive training, and it will be this professional who will assess the origin of the difficulty and program a treatment.

Erectile dysfunction, commonly and inadequately called impotence, is the inability to achieve an erection or to maintain an erection firmly enough for full sexual intercourse. It is common for it to occur occasionally in the male, and this is nothing to worry about.

It is when it begins to occur continuously that we must take action, since it is then that it is considered a symptom, that is, the body manifests itself and indicates that something is happening.
Furthermore, it is important to intervene in their resolution, as it produces undesirable consequences such as stress, lack of self-confidence and ultimately a persistent decrease in sexual desire.

The psychological causes of erectile dysfunction are varied and sometimes it is a combination of physical and psychological issues. Regarding the psychological causes, it must be taken into account that the brain plays a key role in activating the physical events that cause an erection, and that the first necessary factor is sexual arousal.

If you suffer from depression, for example, the first thing that disappears in that circumstance is sexual desire, and then it will probably affect the ability to have erections.

The most common causes of erectile dysfunction are depression, anxiety and general mental health disorders. Stress is considered a combined case of physical and psychological origin. On countless occasions, relationship problems due to communication difficulties or any other type of discomfort in the relationship, also cause erection problems as a consequence.

In my private practice, I have observed many times that infidelity, in the case of men, results in somewhat high erectile dysfunction.

Is erectile dysfunction a problem that, when experienced in the first person, is reflected even in social relationships of any kind, even subtly? For example, in the tendency to be insecure.

Of course. It’s a situation that produces personality withdrawal.

It is common in social groups to find references to men’s sexual potency in all kinds of more or less casual conversations. Being a man is related in the biology of the species as well as in our society to sexual potency. In the case of being affected by this dysfunction, the effect on self-esteem is total.

Life expectancy is increasing in human beings, and other relevant circumstances such as physical decline as a result of the years lived give as a consequence, in man, a decrease in his capacity to maintain his erection.

It is important not to reinforce this situation with excessive concern about such an experience, as the good news is that it always has a solution.

In our society, sexual conversations usually take place, the man who suffers from these difficulties is ashamed and tries to hide the situation, hiding it and pretending to be normal.

Personality flaws begin to appear that were not happening in the first place, such as disabling stress caused by the problem situation.

Does this problem also affect the way this sexual dysfunction is perceived? For example, if it affects self-esteem, the person may believe that it is something that has no solution and is part of their body.

That’s right. It is true that in many cases the man presents erection difficulties since his adolescence and, as this person has always experienced this reality, he ends up thinking that he is like that and that what happens to him is normal, so he does not expect any improvement and does not ask for help. It is then that resignation to the problem appears.

It is in the man who begins to suffer this situation later that the fear of irreversibility appears and he begins a process of resignation.

This type of sexual difficulties are consulted to us, the professionals of sexuality, after a long time of evolution, this is what makes the recovery difficult, since the nervous system gets used to the previous and usual situation.

In the end, shame is what makes the person unconsciously choose to resign himself rather than tell his trusted doctor or anyone else who might encourage him to find a solution.

How can psychologists intervene to treat erectile dysfunction?

Psychological treatment has proven to be highly effective for this type of case. Firstly, the personality profiles that are usually affected by impotence are particularly perfectionist. These people are so busy doing things so well that they become disconnected from their own desire, and even find themselves too concerned with their sexual partner’s pleasure.

Obviously, this does not happen to all perfectionists, it only happens to those who have great difficulty in managing their anxiety. Depression and anxiety are the major causes of impotence, when you suffer these symptoms is when it’s time to intervene from psychotherapy.

Sometimes people present depressive symptoms and are not even aware of it. Note that not all depressions are caused by not being able to get out of bed, there are many people who suffer from subclinical depressive symptoms, which go unnoticed, because they do not show their face.

The psychologist offers specific exercises and tools such as relaxation exercises, cognitive restructuring and others, always with the objective of eliminating the irrational thoughts that limit the man who suffers from the disorder. The treatment is definitely effective, and we must keep in mind that it requires powerful personal work and daily effort. It is like going to the gym, it requires dedication and exercise routines.

All too often people expect changes to be made by the sexology professional, but it is the person who comes to the clinic who has to start training his or her mind on a daily basis to achieve notable and profitable changes.

If the man with erection difficulties sets himself the goal of achieving it and puts all his efforts into it and provides himself with good guidance, be assured that he will achieve it.

As a result of the work, the person will get longer lasting erections, prevention of incontinence, more pleasant ejaculation, and the ability to delay ejaculation. All are obvious improvements as a result of the effort in recovering from erectile dysfunction.

How does recovery occur? Does it take time to get better?

Recovery occurs progressively, and one must always focus on improving cardiovascular flow. A diet free of unwanted fats and an exercise routine of approximately 30 minutes a day will be essential.

The exercises must be oriented towards cardiovascular activity, to improve the circulatory flow, in addition to incorporating Kegel exercises, which are an exercise routine for the pelvic floor, into your daily life. They are exercises for the Pubococcygeus (PB) muscle located between the anus and the testicles. When you exercise the PB, you get better blood circulation throughout the pelvic area.

As stress and complex emotional processes affect the erection, psychology works on managing the levels of emotional pressure at which the erection is affected.
person submits to himself.

Managing anxiety and stress with competence is possible, and produces excellent effects in improving this difficulty – the more you train, the sooner you improve!