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Urologist and pelvic surgeon Dr. Rena Malik creates educational content on her YouTube channel that she hopes will help people enjoy a safe and healthy sex life. In a new video, she addresses an especially sensitive topic: erectile dysfunction. While there can be a number of physiological issues which can cause erectile dysfunction, Malik adds that psychological factors can also contribute to this problem.
She begins by categorizing the three different types of erection: reflexive, caused by physical stimulation; nocturnal, occurring during sleep; and psychogenic, provoked by a mental image or desire. As Malik explains, mindset is just as important as the hormonal and neurological components when it comes to achieving and sustaining an erection.
"Pyschogenic erectile dysfunction is the inability to get or maintain an erection during sex due to psychological factors," she says. "These can include things like self-esteem, depression, anxiety, relationship issues... In fact, mental health disorders and erectile dysfunction are very commonly linked."
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Malik cites studies which have found that people who experience erectile dysfunction are disproportionately more likely to also be dealing with depressive symptoms and emotional stress. As for whether the depression causes the erectile dysfunction or vice-versa, she says it can go both ways: a depressed person might have a reduced sex drive and struggle to connect with their partner, or somebody with erectile dysfunction may end up feeling depressed as a result of its impact on their sex life.
If erectile dysfunction has become a sudden, recent issue, that is also a clue that the cause may be psychological, Malik adds. "Whereas people who have medical causes of erectile dysfunction, typically it occurs more gradually."
One common course of treatment for psychogenic erectile dysfunction is cognitive behavioral therapy (CBT), which focuses on understanding, managing and reframing the individual's expectations of sexual intercourse. Another option is sex therapy with sensate focus exercises, which focus on the pleasure of touch outside of the expectation of sex. And finally, if the E.D. is caused by a mental or mood disorder, Malik explains that psychiatric treatment for these conditions may become necessary.
