Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection. The disturbance causes marked distress or interpersonal difficulty. The erectile dysfunction is not better accounted for by another Axis I disorder, a\nod is not due to the direct physiological\l effects of a substance (drugs, alcohol, medications) or a general medical condition.

Causes

Physiological causes of erection difficulty are: hormonal, vascular, or neurological disorders, smoking, alcohol use, street drugs, medications, high fat diet, and lack of exercise. It is helpful to get an exam by a urologist to rule out these physical causes early in the sex therapy.  It is now thought that erection difficulty might have a physiological basis in as high as 50% of the cases.

Psychological causes of erection difficulty – life stress, relationship difficulty, stored anger, performance anxiety and depression.

Treatment

Psychological treatment

Sex history taking to develop a sense of the individual’s unique strengths and difficulties.  Areas to be covered: sex education from family, church and peers. A history of sexual experiences and relationships and the impact of them.  Exploring how assertive the person is in asking for what he wants and saying no.

Ø Learning about the cultural myths that affect male sexuality and developing conditions for good sex.

Ø Graduated steps of touching and couple exercises that can help the man overcome erectile dysfunction.

Ø Ban on intercourse to take the performance pressure away.

Ø Graduated massage sessions can help in addition with other relaxation training.  The touching exercises start with the ma\n learning to focus on his soft penis and notice sensations.  Then he practices masturbation to gain and lose erections. Once he is confident that he can gain and lose erections alone, he can include his partner to do the same thing, manually and orally.

Ø Penetration – graduated steps to achieving penetration and thrusting.

Ø Using mental imagery and self-talk to enhance performance is another technique that can assist the man in developing the confidence in his erections again.

Ø Sex education videos, books, massage therapy, are all adjunctive strategies that will probably b included in the course of treatment.

Medical options

  • Vasodilators like Viagra, Vasomax, or apomorphine
  • Vacuum pump like ErecAid
  • Injectible like Caverjet
  • Suppository like Muse
  • Penile implants
  • Altering your medications to reduce the negative effect on your sexual functioning .