Erection Problems

erection problems

Erection Problems.

Sometimes it is OK. It is normal, a one off  problem sorted with a bit more care about your lifestyle. But, when it is not, when there are constant erection problems, take it seriously.

First, see a doctor. Erectile dysfunction can by a symptom of a serious medical condition, get it checked. When you know your erection problems all about stuff going on in your head, read on.

I have been in practice for over a decade, I specialise in this stuff. In my experience there are four broad reasons for persistent erection failure.

  1. There is an underlying physical cause – see a doctor
  2. A constant anxiety and dread about keeping it hard
  3. Arousal is missing.
  4. All-consuming guilt.

Any good therapist will be able to tell the difference, it is important to get it right. Otherwise you can be spending a lot of time and effort trying to fix the wrong erection problems.

Sex Anxiety

Let’s take Matt as an example. Matt meets a girl (Sue) and they get on well. Conversation is easy, they have a connection, it’s all looking good. After a couple of dates, they decide to spend the night together.

Matt and his girlfriend start to explore each other’s bodies some more, and the clothes come off. They spend some time pleasing each other and then Sue brings out a condom. Matt has nothing for her to put it on.

That can only mean one thing. Now, as much as he tries Matt cannot get hard enough and is beginning to panic.  Sue tries to help, but nothing helps. Sue blames herself, Matt pleads that it is not her fault and starts to panic. The night does not end well, and Matt goes home to his own flat.

They make it up to each other, even laugh, and recognise that was the first fight! Matt worries about it, he knows the next week end she expects him to get it right. He spends all week worrying and fails even worse.

What Sue doesn’t know is, Matt has been here before. When the condom came out the voice in his head started to shout. “I am going soft, I will fail”.

Learning a terrible lesson

Matt had a problem a few years ago. He did not expect to have an erection failure.  He never experienced any erection problems before, and he has no idea why it all failed him then. The memory and the impact of that night is still with him. He tried again the following morning and failed again. His pattern was set. That time with those erection problems still bug him today. From that one scary, terrifying moment he has changed his whole opinion of himself. Now he is ‘the man who  can’t keep it hard’. He is anxious to try again desperate to succeed, though somehow, knowing he will fail. Matt sinks in to a pattern of avoidance.

Treat The Anxiety Or The Arousal Problem?

Not all erection problems start with a shock, or a trauma. The situation for Raj is very different to Matt.

Raj is in his mid thirties, and doing well as a  professional. His family is very keen for him to marry. Doing so now is very much part of his culture, and he succumbs to the pressure. Some weeks later, after they are hitched he comes to see me. He is desperate to solve his erection problems. The, family are starting to wonder what is happening. Raj is now in a state of high anxiety about having sex with his new wife. They like each other a lot, they met many times before the ceremony. It was an arranged marriage, but in a modern way. He is terrified of letting her down again.

Therapy Choice

Now, as a therapist should I be treating him for the fear and the worry he has now developed? No. The current fear and worry is a result of the problem; it is not the cause of the problem. Now, Raj is only scared about sex because he experienced an erection problem. The cause of the problem was something else.

This is the reason a good case history is essential. Raj could be on medication, where ED is a known side effect. Is he exhausted from a 14hr shift?

Raj did not have much of an erection the first time with his wife, for one simple reason. She was not arousing him, despite his use of sex drugs. For years Raj had been watching gay porn and playing with his male cousins. He was not that into girls. He likes the companionship of his wife, they became great friends, but he is homosexual. No amount of therapy will change that fact.  No amount of therapy will change his erection problems when expected to perform with a girl.


John likes porn. Most men do. There is that old saying ‘All men are wankers or liars.’ But, too much is too much. The artificial or porn trains your brain in a way you don’t always want.

John met Jane at work. Jane liked the look of John and invited him to lunch. The inevitable happened and they date, and they spend the night together. Foreplay is fine; John has erection problems. He was not much aroused when exploring each other, and totally soft when Jane wanted him hard.

Jane was not arousing him. Fundamentally, Jane was different to his usual set of sexual stimuli. All the porn he finds on line. In the lead up to his erection failure he was not worried, he was not anxious, he was not expecting a failure. He just was not turned on much. This is the difference between an anxiety issue and an arousal issue. Yes, it is true Matt now worries and feels scared about a repeat failure. He focused on the emotional upset and embarrassment a failure will cause. John never expected to have erection problems, after all he really was into sex. Every time in front of the screen he was good and hard. Until it happened, until he did failed he was cool and OK about sex.

Porn and brain damage?

This is where porn really damages. Porn trains your brain. In principal the Paleomammalian complex parts of your brain. Repeated practice and repeated exposure to a fantasy type of stimulation creates a strong learned response. Meeting a girl, and bringing her home, thinking about her in exciting sexual terms, are functions of your Neomammalian complex part of your brain. Once the clothes come off, more basic instincts take over. The Paleomammalian complex. If these have trained to respond to something different compared to the girl you are with, you will get disappointed.

Consuming Guilt

Does feeling guilty about sex cause erection problems? Rarely is guilt is the primary problem for one of my clients. But, it does happen and it is real. Occasionally, a guy will tell me about how sex, and all things sexual were repressed in the family home. Growing up, going through puberty he learned sex was bad, naughty or forbidden. It was not spoken about, and that is dangerous. Now that the guy is an adult he carries with him a sense of shame about his basic instinct. He is desperate to be sexually active, but a part of his brain says NO. Wrong, it’s dirty, don’t do it, you can’t do it.

Problems with cheating

More common is the guy having an affair. Roger is a middle-aged chap, with grown up kids and a loveless, sexless marriage. He sought the physical companionship of a female friend in a similar position. On their first try he experienced erection problems, which surprised him greatly. For all the years he was with his wife, he never had a problem at all. In the years the marriage was sexless, he was able to masturbate. Now, having failed the first time with his new female friend he is very scared to try again.

It is not the fear that is the fault. He is feeling very guilty about cheating on his wife. Guilt, in this context is a tricky thing for me to deal with. Couples counseling would have been a better choice, which is why I declined to continue treating Roger. For his circumstances, I was not the right person for him.