ERECTILE DYSFUNCTION AND PERFORMANCE ANXIETY

Erectile Dysfunction (ED) is the inability to achieve or maintain an erection. It may or may not affect ejaculation. ED, also called Impotence, can be classified as Primary or Secondary Impotence. Primary Impotence is when a man has never had 'successful' intercourse with a partner, but can achieve normal erections in other situations, eg through masturbation. Secondary Impotence is when a man is currently experiencing impotence, but has been able to 'successfully' complete intercourse previously.

Erectile Dysfunction can affect most men at some point in their lives, and it is estimated that half of all men aged between 40 and 70 will have it to some degree. However, it is common among all age groups, with a study in the July 2013 Journal of Sexual Medicine suggesting that ED is more common among young men than previously thought. Statistics of ED by age group are:

26% of adult men below 40

13.1% of 40-49 year olds

33.5% of 50-59 year olds

51.5% of 60-69 year olds

69.2% of 70-79 year olds

(source: Impotence Australia 2016 )
* Research also showed that younger ED patients were more likely than older men with ED to smoke or use drugs. See next section on causes.

CAUSES OF ED

There are many causes of ED, and many of them are treatable. Some causes are physical, some psychological, and can be due to:

Diabetes
High cholesterol
Heart disease
Post prostate cancer
High blood pressure
Alcohol or drug use
Liver or kidney disease
Post surgery on bladder, prostate gland, lower bowel and spine
Poor blood flow to the penis resulting from blocked arteries
Side effect of using certain medication

If a GP has been consulted and all physical causes have been ruled out, erectile dysfunction may be caused by one of the following:

Stress
Anxiety
Grief
Depression
Performance anxiety
Stress or confusion around sexual identity
Fear of sexual contact resulting in an STI or pregnancy
Previous psychological trauma or sexual abuse
Sexual problems with partner
Sexual boredom
Lack of communication with partner or other relationship issues

PERFORMANCE ANXIETY

Often when men experience ED once, they can go on to worry about it further, building a fear termed as 'performance anxiety'. This is the anxiety a man experiences when he perceives he's not getting an erection fast enough, that the erection is not firm enough, or that it does not seem to last long enough. Once a man experiences just one case of ED, a cycle may become established whereby anxiety about a repeated episode of unsatisfactory erections is experienced whenever the man commences or even thinks about sexual activity.

This can be worked through successfully with a therapist who specialises in this area. Treatment can involve practical advice such as exercises to delay penetration, lifestyle changes such as losing weight, exercising regularly, reducing stress, reducing alcohol consumption. Treatment can also involve psychosexual counselling, which involves exploratory work to uncover the roots of any underlying anxiety, or shifting any unhelpful thoughts that may be contributing to erectile dysfunction eg. Self esteem, sexuality or personal relationships.

This is done in a confidential setting, at a pace that feels comfortable for the client. Men can find it difficult to consult a health professional, particularly on anything sexually related, so it is important the client feels as safe as possible when talking to a therapist.

Erectile dysfunction and performance anxiety can greatly impact on men emotionally, and cause them a significant amount of stress and worry. Common feelings men with erectile dysfunction and performance anxiety experience are:

Feeling 'less like a man' or a 'loss of manhood'
Feeling insecure
Low self esteem
Sadness
A sense of loss
Fear of approaching a new sexual partner
Fear of intimacy
Anger and aggression
A sense of shame or guilt
Worry they won't be able to pleasure their partner

IMPACT ON PARTNERS

Erectile Dysfunction and Performance Anxiety can also impact on partners, as a man may avoid contact and withdraw emotionally. His partner may feel rejected and unsure of his love. The man and his partner may feel sad, angry and guilty, and may not know how to talk about it or where to seek support. The inability to communicate can aggravate relationship distress. It is common for a couple not to be able to communicate effectively about sexual issues, especially when they've never had to.

Common feelings partners of men with Erectile Dysfunction and performance anxiety experience are:

Guilt for not being able to make their partner's penis erect
Helpless or unsure where to go for support
Rejected or unloved, unsure if their partner is still attracted to them
Feeling unattractive
Confused or frustrated
Anxious
Scared or worried their partner is having an affair
Insecure about their partner's love for them
Worried about the health and wellbeing of their loved ones
Sad for their partner and for themselves

It is important to recognise that ED can affect both partners, and partners can play a crucial role in treatment and provide valuable support. Couples can work together to bring about a positive result for their relationship.

SOME COMMON MYTHS DISPELLED

Many men with ED and their partners can have unrealistic expectations about what is the perceived norm for sexual activity in the bedroom. This can exacerbate the problem, particularly if men compare their performance with their perceived norm, and feel inadequate and disappointed.

Some common sexual myths are:

Sexual encounters and intercourse should flow seamlessly
It's up to the male to initiate sex
Erotic or arousing sexual thoughts should be sufficient for an erection, without any direct sexual stimulation
Both partners should always reach climax
Sex isn't possible without a hard erection
Men should be ready and able to last for hours
If my partner was attracted to me, he'd be able to achieve an erection

None of the above is true, and being able to express these fears and have them normalised, can be immensely relieving and empowering for those suffering from ED or Performance Anxiety.

ED and Performance Anxiety are very common, and frequently affect men and their partners at some point in their lives. Recognising that there is a problem and seeking support is the first and often hardest step. Talking about it to a professional who specialises in working with ED in a safe, confidential environment can be a positive experience, for both individuals and on the relationship.

If you think you're suffering from ED or Performance Anxiety and would like to talk to someone in confidence, contact Emily Hirshman-Smith on:

Emily Hirshman-Smith
Counsellor and Psychotherapist

Email: enquiries@applecrosscounselling.com.au

Applecross Counselling & Psychotherapy
Attadale Business Centre
14b, 550 Canning Hwy
Attadale WA 6153
www.applecrosscounselling.com.au

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