Erectile Difficulties: Why They Happen and How We Can Work Through Them
Erectile difficulties are far more common than most people realise, and they're rarely something you simply have to put up with. Whatever the cause, they tend to sit at the meeting point of the physical and the emotional. The first thing I want you to know is that there's usually a reason behind it, and once we understand that reason, there's almost always something we can do.
Why Erections Can Be Difficult
Physical causes of erectile difficulties
Erectile difficulties can come from a number of physical places, including:
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Cardiovascular disease
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Prostate issues, including after surgery or treatment
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Diabetes and hormonal changes
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Certain medications
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Smoking, alcohol and other lifestyle factors
Psychological causes of erectile difficulties
Just as often, the cause is psychological rather than physical, including:
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Performance anxiety
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Stress carried over from work, relationships or elsewhere in life
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Not feeling fully present in, or connected to, the experience
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Not feeling desire or attraction in that moment
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A difficult past experience that's created anticipatory anxiety about it happening again
The one I see most often, by far, is anxiety - either anxiety specifically about performance, or anxiety from elsewhere that ends up showing up in the bedroom. That's because an erection depends on your body being calm and settled; anxiety activates the opposite state, and the two can't easily coexist.
How I Work With You on Erectile Difficulties
If we work together on erectile difficulties - something I work with regularly as part of Sex Therapy - my first job is to help you understand what's actually driving it. Because they can sometimes point to an underlying physical health issue, particularly cardiovascular disease, I'll often suggest a GP check first, so we can rule things in or out and know exactly what we're working with.
Where anxiety is playing a part - which is the pattern I see most often - we work on regulating your nervous system, so you can stay calm and present rather than slipping into the performance anxiety cycle. That's the cycle where you become anxious about losing an erection, which activates your body's stress response, which then makes it harder to get or maintain one - teaching your body to brace even harder next time. EMDR is a wonderful tool here, both for regulating the nervous system and for working through any past experiences that are keeping it on high alert. Where it's helpful, we can also bring your partner into the room and work on the pattern within the relationship, alongside pelvic floor exercises to support things physically.
Ready to explore what's underneath your erectile difficulties
If you'd like to understand your body and work towards feeling differently, I'd love to hear from you.
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Are you also experiencing ejaculation issues? Read more about ejaculation difficulties below
Frequently Asked Questions
Are erectile difficulties normal?
Erectile difficulties are common, and almost every man experiences them at some point. They're not something you have to accept as simply normal, though - persistent difficulties usually have an identifiable cause, and in most cases they can be eased or resolved with the right support.
What is erectile dysfunction?
Erectile dysfunction is the medical term for regularly finding it difficult to get or maintain an erection firm enough for sex. It can stem from physical causes, psychological ones like stress and performance anxiety, or a combination of both.
Can erectile difficulties be treated?
Yes. Once we understand the underlying cause, the aim is to work through it directly, whether that's regulating the nervous system, breaking a performance anxiety cycle, or working alongside your GP on a physical cause.
Should I see a doctor about erectile difficulties?
It's often a helpful first step, especially if it's a new, sudden or persistent issue. Certain checks can rule out or identify physical causes, including cardiovascular disease, which gives us clearer ground to work from.
What is the performance anxiety cycle?
It's the loop where a difficult experience creates anxiety about it happening again, that anxiety triggers your body's stress response, and the stress response makes it harder to get or maintain an erection - reinforcing the fear next time. Working on nervous system regulation, including through EMDR, helps interrupt this cycle.