Erectile Dysfunction: A Guide

What is Erectile Dysfunction?
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​It's something most men don't want to discuss. It's the elephant in the room and yet it is so common. While the experience varies, erectile dysfunction is the leading sexual concern for men worldwide.

People experience erectile dysfunction in many different ways. Your erection may not be as hard as you'd like. Maybe you can't stay hard. It could be that you don't get an erection at all. Erectile dysfunction can come with feelings of lower sexual desire. It may be something you experience all the time or only sometimes.

Who Experiences Erectile Dysfunction?
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​Erectile dysfunction can affect anyone, although some men are more likely to be impacted than others. One certainty is that you are not alone. The numbers of men experiencing ED is estimated to reach 322 million globally by 2025. This can be an uncomfortable topic to share, so it's easy to think you're the only one. Currently, about 1 in 4 men experience ED, making it likely to affect someone you know or have met.

​What Contributes to Erectile Dysfunction?

There are a few factors that contribute to erectile dysfunction, and it's often a combination of things, rather than just one. When trying to understand what contributes to ED, it's a good idea to consider the psychological, relationship, lifestyle and physiological influences.

Psychological Factors
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​It can seem unrelated, but what's going on in your mind significantly influences what happens in your body. For about 30% of men, there's a psychological factor contributing to their erectile dysfunction. Stress, depression, and anxiety all make it more challenging to get an erection by disrupting the feelings of sexual excitement in your brain. They send everything a little out of balance, including your erections. The tricky thing is that it can become a cycle, with stress, depression and anxiety leading to ED and the subsequent experience making you feel even more stressed, depressed and anxious.

Performance anxiety can come with, and sometimes before, erectile dysfunction. Men today are under enormous social pressure to be sexually gifted. The rise of porn culture sets an expectation of men to be rock stars in bed and sex to be the same as in movies. It's not just men that get performance anxiety; women do too. 

In today's culture, men aren't always encouraged to talk about sex authentically. There are no 'how-to' classes. You just figure it out, looking to porn and peers for coaching. The expectations set aren't always realistic and can create performance anxiety.

Sex is physical and makes you highly aware of your body. If you have any body image concerns, sex might bring them to the surface. Feeling uncomfortable in your skin or worrying about how you look can fill your mind with negative thoughts, distracting you from pleasurable sensations and stopping you from being in the moment.

What we think impacts everything we do, and sex is no different. Your thoughts and beliefs around sex can increase your pleasure and engagement or lead you to withdraw from, and avoid, sex. A feeling that sex is bad, painful, wrong or a myriad of other negative things tells your body that you shouldn't be having sex. ED can be a way of your body following these instructions.

Relationship Factors
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​Arguments, tension and communication problems can be felt physically as stress impacts your body. Trying something new with your partner or being with a new partner might also contribute to erectile dysfunction. If you're stepping into a new space where you might be worried about lack of experience, being judged or making a good impression, nervousness can affect how your body responds.

As your relationship progresses, things shift. Life changes along the way with you and your partner changing in response. New stresses come up, and the way you connect and communicate with your partner might alter. The excitement and thrill of a new partner fade as your relationship continues and, while many good things grow from long term commitment, the sexual connection you feel can become different.

Sexuality and gender concerns may be something that you're going through. Questioning who you are and what you want. The best sex is authentic sex, and if your situation feels like you're not being true to who you are, it's natural for your body to respond to this.

Lifestyle Factors
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​Heavy alcohol consumption and smoking are two lifestyle factors that significantly increase the chances of erectile dysfunction. Another contributor could be whether you're getting enough sleep. Sex isn't at the top of the priority list for a tired body, and without sleep, your body experiences imbalances.

What you eat and how you exercise are fundamental to how your body feels and functions. The saying that you are what you eat is, literally, true. Our bodies continually replace cells. When your diet is less healthy, the unhealthy food you consume is what becomes your body.

Physiological Factors

​Health issues can be related to erectile dysfunction, and it's a good idea to have these checked out by your doctor. Certain medications, including anti-depressants and blood pressure medication, could also be playing a role.

Aging happens to everyone and brings changes to your body. For men over 40, one of these changes is often ED.

What Are the Options for Erectile Dysfunction?
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​Depending on the contributing factors, there are several different options for erectile dysfunction.

Counselling and Sex Therapy
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​Counselling and sex therapy (like we do at Sex Therapy - Perth) give you understanding and insight into factors contributing to your ED, and how to work through them. It's a safe, confidential and non-judgmental space to share your experience with someone who knows how to help and support you. Merely talking about it can be a huge stress reliever. Added to this, your counsellor can give you practical ideas to try at home.

Sometimes, couples counselling may be a good option. Together with your counsellor, you can talk openly about what you're both thinking and feeling. Your counsellor can give suggestions about things to try together, like low-stress positions and slowing down sex to let things build. Studies have shown that, for men with stress-related ED, having the partner involved in counselling resolves the problem 50-70% of the time.

Lifestyle Changes
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​Changes to your lifestyle can be effective on their own or together with counselling and sex therapy. This might include starting a regular exercise routine, sustaining a low blood pressure, shifting to a balanced and nutritious diet, maintaining a healthy weight, avoiding alcohol and cigarettes and learning stress reduction techniques.

Prescription Medication
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​Prescription medication is sometimes used for erectile dysfunction. The most commonly known options are Viagra (those little blue pills) and Cialis. When considering medication, it's essential to keep in mind that there might be side effects including flushing, visual abnormalities, hearing loss, indigestion, headache, body aches, dizziness, digestive issues, congestion and runny nose.

When You Need Someone Else to Talk to
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​For everyone, the causes of ED will be different, and so will the best and most effective paths forward. It's about understanding your situation and what's right for you. If you want to talk about what you're experiencing, whether it's concern about erectile dysfunction, communication, performance anxiety, sexual function, relationships or anything else to do with sex, we're here for you. Appointments with our experienced sex therapists are safe, supportive and confidential. You can book an appointment by going to our booking page or contacting us at any of the options on our "Contact Us" page.