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Erectile Dysfunction Radio Podcast

Today, we are discussing psychogenic erectile dysfunction. Psychogenic means the origins are psychological.

The Erectile Dysfunction Radio Podcast empowers and educates men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST.

Transcript of Episode 2 – The Psychology of Erectile Dysfunction

Today, we are discussing psychogenic erectile dysfunction. The first thing we’re going to do is define what psychogenic even means. The word psychogenic means the origins of are psychological. Now, there are a number of ways to categorize erectile dysfunction. And for our purposes, I want to introduce three distinct categories that can help you better think about and ultimately address erectile dysfunction.

The first category, which we mentioned already, is psychogenic ED, or erectile dysfunction whose origins are completely psychological in nature. This type of erectile dysfunction accounts for about 10% to 20% of all cases of ED, which means, depending on other factors in your life, if you are generally young and healthy, there’s a significant chance that you’re experiencing psychogenic erectile dysfunction.

The second category is organic erectile dysfunction. That means that there is a strong biological, neurogenic, or other medical basis to what is causing your erectile dysfunction. Currently, the working assumption is that all cases that are not psychogenic, meaning 80% to about 90% of all erectile dysfunction cases, are assumed to be organic in nature.

There’s also a third category and that is the category which is a mix between psychogenic and organic factors. This mixed category probably accounts for the vast majority of cases, meaning that most cases are not purely psychogenic, and they are not purely organic. There are factors from both that are contributing to your erectile dysfunction.

So let’s ask the question, why are these categories so binary? Why is it that we attribute 10% to 20% of erectile dysfunction to psychogenic causes, and 80% to 90% of erectile dysfunction to organic causes, and there really is not any statistical numbers left for that mixed case? So, part of this is understanding that the treatment and understanding of erectile dysfunction has shifted dramatically over the past 40 to 50 years, in particular, in the past couple of decades.

So let me share with you just a little bit of the brief history of erectile dysfunction treatment, so you can better understand what I am referring to. Erectile dysfunction, for many, many years, certainly through the ’50s, ’60s, ’70s, probably through most of the ’80s, was considered to be a psychological condition.

It was assumed that about 90% or more of cases of erectile dysfunction were of psychological origin.

With the advent of medications that have proven to be very effective for treating erectile dysfunction, the thinking around erectile dysfunction shifted rather dramatically, to assume that most cases, accounting to about 80% or 90%, are actually organically driven, with only 10% to 20% now being considered psychological.

The working assumption was that there must be a singular or binary cause, which continues to impact the way we think about erectile dysfunction to this day.

However, a lot of medicine and mental health treatment are beginning to recognize and incorporate the need to understand things as not binary, but rather, complex, understanding that the 90% swing that went from psychogenic to organic with the advent of Viagra® is probably not a fair and true way of assessing and ultimately addressing erectile dysfunction.

My working assumption is that almost every situation of erectile dysfunction involves components of your psychology. And if it is not directly impacting your erections, it may still be impacting you. Let’s talk about what treatment looks like for each of these categories, so that you can better understand the role of your brain, regardless of the type of erectile dysfunction that you’re experiencing.

As we mentioned before, psychogenic erectile dysfunction implies that the causes of your ED are purely psychological. This most commonly occurs in younger men who are generally healthy. And in my experience in working with men who do have psychogenic erectile dysfunction, treatment can be rather quick, and can yield positive results without having to use any medical interventions.

The mixed presentation, which I think I most commonly see in my practice, generally involves a combination of medication and psychological intervention. And that combination of treatment, in my experience, seems to yield the best results.

There is a subset of erectile dysfunction cases that have a very strong organic basis. And it is with no doubt that medical intervention has to be a part of that treatment. And to assume that psychological interventions alone would be effective would probably not be correct. That being said, the experience of erectile dysfunction itself can be very, very distressing to many men.

Even when men find the appropriate medical solution, the anxiety, the fear, the negative impact that it had on their relationship, can persist well beyond the medical intervention alone. A lot of those men too, can benefit from understanding more about the role of their brain in their erection process.

What is important to understand is that no matter what is causing your ED, your brain will continue to play a crucial role in the solution to that process.

I want to share with you a story about a man that I worked with. I think this story can highlight how psychological factors can impact erections, irrespective of what is causing them.

This gentleman was 43 years old when he came to see me. He had a medical diagnosis that was clearly impacting his ability to gain and maintain an erection.

Thankfully for him, the medical issue, at least in terms of how it impacted his erections, was able to be resolved with one of the popular medications for erectile dysfunction.

However, he still came to see me because this man had developed significant anxiety and concerns about whether or not he would be able to get an erection.

He also began to worry about how his partner was reacting to his attempts to engage. Through his work, he was able to better address that anxiety, and ultimately have a much more enjoyable and engaging sexual relationship with his partner.

This aspect of the erection process is not going to be addressed by medication. Those medications are not going to fix your anxiety, and they’re not going to fix your relationship, which is one of the primary locations where that erection is looking to express itself.

So yes, your erectile dysfunction can have organic components to it. There’s probably a good chance that it does, but addressing the organic components alone could leave a lot of potential benefits and  solutions on the table. With an issue as important as an erection, it is my belief that you should leave nothing on the table, and pour everything into finding a comprehensive solution that works for you.

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