Erectile Dysfunction

No one welcomes erectile dysfunction, also known as ED.

Up to 30 million men in the United States experience ED in their lifetime.

ED is the inability to achieve or maintain an erection throughout the completion of sexual activity for a period of 6 months.

The emergence of this dysfunction often causes significant psychological and relational distress for both the symptom bearer and their partner.

Like many sexual disorders, the onset of ED usually involves a complex history that requires a thorough assessment and an interdisciplinary approach. This means that if you decide to seek therapeutic support for ED or any other sexual disorder, it’s crucial to meet with a qualified therapist who possesses a thorough understanding of your particular sexual dysfunction.

Below I’ve listed five critical components to help you understand ED and what you can do about it.


The following information is probably the most important thing that you need to know about ED (and is often the most overlooked). ED is often linked to underlying medical problems.

ED can be an early symptom of a larger disease. The most commonly seen are vascular conditions that inhibit the circulation of blood to the penis. Neurological diseases, hormonal imbalances (not enough testosterone), diabetes and prostate cancer are known contributors to ED.

If you are working with a therapist on ED, be sure to create a team of support that not only includes your therapist but a good urologist and general practitioner.


ED can show up in a variety of ways. Although rare, some men experience lifelong ED. Others acquire ED after having had satisfactory erections in the past. If you acquired ED, you may have experienced it slowly over time or suddenly.

ED can also be general or situational. General means ED happens in all sexual situations, whether alone or partnered.  Situational ED is more common and only occurs with certain partners or at certain times. In any case, a full medical and psychological work up is important to help you resolve your symptoms.


Sadly, the medical community seems to view ED as primarily a biological issue.

Docs dispense medications like Viagra or Cialis like candy without offering psychological support. ED can be a reaction to psychological and relational distress.

Many cases of ED involve issues of anxiety, depression, poor self-image, lack of relational satisfaction, lack of physical attraction, negative sexual messages from the family of origin, feelings of inadequacy, sexual incompatibility, religious contradictions to sex, to name a few.

Effectively resolving ED requires a holistic approach to treatment.

If you have already consulted with a urologist, be sure to include a qualified sex therapist as part of your treatment team.


ED functions similarly to panic disorder. Once you’ve had your first panic attack, you grow fearful and anxious of experiencing it again. Your anxiety about having another panic attack breeds an attack.

ED works the same way. One single episode of ED can manifest a significant amount of anxiety about recurrence. That anxiety leaves no room for arousing sexual thoughts. Before sex commences or during sex, your anxiety recreates ED.

For some, this vicious cycle becomes harder and harder to escape.

With the right guidance, you can learn how to restructure your thought patterns and reduce performance anxiety.


ED does not just affect you. Unfortunately, as a result of ED, your partner may suffer significant relational distress. Your partner may place blame on themselves for the development of your ED.

They may feel unattractive, confused, and abandoned. As a result, they may develop low sexual desire. Since ED greatly impacts confidence levels, you too might develop low sexual desire. If not treated, these symptoms can lead to greater relational problems.

ED may be the cause of your relational problems or the result of your relational problems.  This dysfunction affects you and your partner individually as well as how you exist together.


You may feel ashamed and embarrassed about this diagnosis. You are not alone.

Do not allow these difficult reactions to prevent you from seeking treatment. Your body is communicating an important message. Your physical health and/or your relationship may be at risk.

The good news is that help is available to you. With the right team in place, you and your partner can learn how to create a strong, healthy relationship and a satisfying sex life.