Erectile Dysfunction: Causes, Myths, and How Sex Therapy Can Help
Erectile dysfunction (ED) is the most common male sexual dysfunction. By the age of 40 approximately 40% of all men experience ED, and this only increases with age. Occasional or transient erection difficulties happen to nearly all men, with more than 90% of men reporting at least one instance of erection loss by 40. This is a normal part of bodily function, and not necessarily a sign of erectile disorder.
Despite how common ED is, it is also one of the most feared symptoms among men. ED can impact a man’s self-esteem, confidence, and overall quality of life.
This blog will explore the causes of ED, dismantle common myths, examine the profound impacts on individuals and relationships, and review effective psychological and medical treatment options.
What is Erectile Dysfunction?
ED is when there is the consistent inability to achieve or maintain an erection firm enough for sexual intercourse. From a clinical diagnosis perspective, this must occur in 75-100% of sexual encounters for at least 3-6 months or more, and cause distress for the individual or couple. In formal diagnosis at least one of the following three symptoms must be present:
- Difficulty achieving an erection
- Difficulty maintaining an erection
- Significant decrease in erection firmness
ED may be generalized and occur in every situation, or situational and only occurring under specific conditions. Due to the fear, anxiety, and embarrassment experienced, ED can often lead to sexual avoidance.
Common Causes of Erectile Dysfunction
Biological causes: this includes age related changes such as a decrease in sex hormones; vascular and cardiovascular disease such as high cholesterol, high blood pressure and diabetes; endocrine and metabolic conditions; neurological damage such as Parkinson’s or spinal cord injuries; medical treatments such as antihypertensives and SSRI antidepressants; and pelvic surgeries.
Psychological causes: The most immediate cause of ED especially in younger men is performance anxiety where there is fear about getting and maintaining an erection, which makes it harder in and of itself to experience an erection. Other factors include negative sexual thoughts; constantly self-monitoring during sexual activity; mental health conditions such as depression or anxiety; low self-esteem; poor body image; and a history of sexual trauma.
Relational causes: ED can be created and maintained by relational issues such as anger, resentment, power struggles; lack of desire or interest from a partner; a partner’s sexual dysfunction such as pain during intercourse; and performance pressure.
Lifestyle and societal factors: Tobacco use, excessive alcohol, and recreational drug use can lead to erection difficulties Societal norms about producing and sustaining an erection on demand can contribute to performance anxiety. Work and life stress such as financial concerns can be exhausting and reduce sexual motivation and function.
Myths About Erectile Dysfunction
ED means I am less of a man: ED is not a sign of personal deficiency or failure. Self-worth and masculinity being tied to erectile capacity is societal mythology. ED is extremely common and is often a symptom of treatable physical conditions or underlying psychological challenges.
ED is entirely in my head or entirely physical: ED is often an intricate interplay of biological, psychological, and relational factors. Even when biology contributes to initial onset, it is psychological and relational factors that can maintain ED in the long term.
I must remain erect from the beginning to end of sexual activity: Even in men without ED, erections naturally come and go. This is a natural fluctuation. Often the fear of this natural fluctuation and increasing performance anxiety is what contributes to chronic ED.
If I don’t have an erection, there is no point to sex: While sexual intercourse may not be an option in that moment, thankfully, there is so much more to sexual intimacy than just sexual intercourse. Having a robust sexual menu that focuses on pleasure and intimacy, rather than a pass or fail mark of erection/intercourse/orgasm leads to greater sexual satisfaction overall.
Viagra will cure me: Viagra (or Cialis) are safe and effective medications, but they are not a magic pill or cure all. While targeting the biological component, it is still important to understand and address the psychological and relational factors at play.
How Erectile Dysfunction Affects Individuals and Relationships
Emotional Impacts: Anxiety, shame, and depression can be severely worsened by the presence of ED. It can profoundly decrease self-esteem and sexual confidence.
Relational Impacts: Out of fear of losing an erection, men may try to rush intercourse with increasing anxiety. This in turn can contribute to co-occuring problems such as premature ejaculation. Tragically, ED can promote cycles of avoidance where the man abandons sexual touch to protect themselves from failure. This then often leaves the partner feeling rejected, unattractive, or unloved. More and more sexual activity is measured on erection and penetration, shrinking sexual intimacy. This cycle can then lead to decreased sexual desire.
The majority of couples experience sexual problems at some point in their relationship. It is often a natural part of life that can be met with more acceptance rather than shame. At the same time it is important to recognise that communicating and learning to work together as a sexual team is essential for nurturing pleasure, arousal, and erotic flow.
Practical Steps You Can Try Now
Speak to your GP: if you have not yet spoken to your primary GP about your concerns, it is essential to book a session and let them know about your struggles. This is especially important with ED as it can often be a symptom of other underlying health issues that need to be addressed. Speaking with your GP can also provide you with medical treatment such as PDE-5 inhibitors (Viagra or Cialis).
Focus on sensual connection, not performance: enjoy pleasure and connection. Touch and be sexual without the expectation or demand for erection or intercourse. Enjoy different forms of touch for their own sake, without it needing it to lead to a particular goal. Ask yourself, “What feels good right now? What do I want to continue feeling pleasurable?”
Expand your sexual repertoire: broaden your definition of sex beyond penetration. Vary affectionate, sensual, and erotic activities that also contribute to emotional and physical satisfaction. A penis does not need to be erect to enjoy pleasure, and pleasure can be experienced beyond penetration!
When to Seek Support
If erectile difficulties are persistent and occurring in the majority of sexual encounters or resulting in personal and relationship distress, it is important to seek support.
Consult a GP to first conduct essential medical screenings and rule out or identify any underlying biological factors. At the same time, seeking sex therapy can address the contributing psychological or relational factors that maintain ED, and support you in experiencing overall sexual intimacy and satisfaction.
How Sex Therapy Can Help with Erectile Dysfunction
In Sex Therapy I provide a safe, confidential space to discuss sexual concerns. I support individuals and couples to understand and communicate the emotional and relational impacts and contributors to ED. We also explore education and skill building that reduces performance anxiety and breaks vicious cycles of avoidance.
Taking the First Step
ED is a common experience for men, especially with age. Treatment for ED combining medical and psychological interventions is associated with higher improvements in erectile function. In addition to this, experiencing sexual satisfaction with ED is possible, especially with support.
If you feel embarrassed or ashamed, you are not alone in this experience. I encourage you to not allow those feelings to get in the way of starting a conversation with your GP. Seeking support early prevents anxiety and avoidance from spiralling out of control and further complicating your sexual health and relationship.
If you and your partner are struggling with ED, specialised online counselling in Australia (with me!) can provide the compassionate support needed to improve your relationship, move beyond performance pressure, and rediscover mutual sexual pleasure and intimacy.
Written by Justine
References
1. Crooks R, Baur K, Widman L. Our Sexuality. Enhanced 14th ed. Mason (OH): Cengage Learning, Inc.; 2025.
2. Gambescia N, Weeks GR, Hertlein KM. A clinician's guide to systemic sex therapy. 3rd ed. New York (NY): Routledge; 2021.
3. Gunasekaran K, Khan SD, editors. Sexual Medicine: Principles and Practice. Singapore: Springer Nature Singapore Pte Ltd.; 2019.
4. McCarthy B. Sex Made Simple. Eau Claire (WI): PESI Publishing & Media; 2015.
5. McCarthy B, McCarthy E. Rekindling Desire. 2nd ed. New York (NY): Routledge; 2013.
