Erectile Dysfunction: Silence Hidden Under the Sheets

Erectile dysfunction is often still a taboo subject. It affects men of any age and causes great mental exhaustion. We talked about it with the psychologist, José Martín del Pliego.
Erectile Dysfunction: Silence Hidden Under the Sheets
Gema Sánchez Cuevas

Written and verified by the psychologist Gema Sánchez Cuevas.

Last update: 07 June, 2023

Sexual encounters should always be rewarding, fun, and stimulating. They shouldn’t ever be situations marked by fear or anxiety. However, sadly, this is often the case in instances of erectile dysfunction. 

The difficulty in achieving an erection and sufficient rigidity of the penis, which allows a satisfactory sexual relationship, can appear at any age. But it only becomes a problem if it’s a recurrent experience and the man opts for silence and self-criticism.

The clinical psychologist, José Martín del Pliego, explains that there are several causes of erectile dysfunction. They range from organic to psychogenic factors, or both. It’s extremely important to  always consult a specialist so as not to increase any mental exhaustion, as well as problems in the relationship.

We’re going to explore some more of this expert’s views.

As a rule, if a man has an erection when he wakes up, it indicates that there are usually no biological causes causing the lack of arousal.

Erectile dysfunction

Erectile dysfunction continues to be a silenced and almost taboo topic . However, the impact on a man and his partner is immense. Hence the relevance of consulting with experts such as José Martín del Pliego. He’s a clinical psychologist who trained as a sexologist at the Sexological Society of Madrid (Spain).

Currently, he works giving clinical assistance to patients with problems in their sexual responses. Moreover, for years, he’s organized sexual orientation education workshops for high school and university students. These workshops are supported by telephone and online assistance facilities for resolving urgent questions.

Today, we’re looking to learn a little more from this expert about a disorder that’s actually more common than you might think. We asked him the following questions:

What are the main causes of erectile dysfunction?

There are different causes.

Organic causes

    • Lung failure, angina pectoris.
    • Certain medications, substances, and excessive alcohol consumption.
    • Diabetes.
    • Phimosis, prostatitis, urethritis.
    • Infections.
    • Sclerosis.
    • Cirrhosis.

Behavioral and emotional causes

  • Mental health problems such as depression, anxiety, or stress.
  • Anxiety in anticipating the act. As such, being afraid of sexual intercourse. This is the basis of all arousal problems. It’s a fear of failure in a sexual relationship.
  • Extremely puritanical and strict education in which the individual sees sex as ‘something bad’.
  • Lack of adequate stimulation.
  • Monotony in erotic games. Poverty in the erotic world of the couple. In effect, the individual loses the vision of sex as a game.
  • Negative or pressing first experiences.
  • Ambivalent emotions toward the partner. Part of the individual loves their partner and another part rejects them.
  • Latent homosexuality.
  • Poor sexual education or childhood abuse.

If the man has an erection on waking, it indicates that there are usually no biological causes behind the lack of arousal. When the lack of an erection is of a physiological origin, the installation and evolution of the problem are usually gradual. However, if it’s of psychological origin, it can appear more suddenly and unexpectedly.

At what age does erectile dysfunction usually appear?

As you can see from the multitude of problems that can cause erection difficulties, age isn’t the main cause. On the other hand, there are some age-related diseases that interfere in this area. They can be due to vascular, hormonal, or neural causes. This makes it logical that, as in the rest of their anatomical and physiological functioning, over time, men will tend to experience more difficulties. If they maintain healthy sexual habits, it’ll be easier for them to prolong their sexual behavior.

Patients of any age can experience erection problems. There are many different causes for the beginnings of such an issue. However, their evolution and maintenance are usually of a psychological nature. It’s usually caused by a man’s anticipatory anxiety about the lack of an erection 

How does it affect men?

If a man experiences an erection problem and doesn’t give it much thought, his subsequent sexual responses will probably be normal. But, some men tend to anticipate failure in the next sexual encounter. Therefore, fear is activated in their brain. This is located in a different place from that of pleasure. And, in the context of a threatening situation, sexual relations cease to make any sense.

Indeed, when the survival system is activated, everything else stops. The man gradually loses his confidence and starts to feel vulnerable. In addition, he may carry out self-checks to see if his erection is powerful enough. Gradually, he starts to avoid sexual encounters because his lack of sexual response makes him feel so bad. This ends up affecting his self-esteem, confidence, and mood.

And what about the relationship?

Erection problems can cause a great deal to happen in a relationship. For instance, loss of intimacy can produce estrangement. Moreover, the partner may feel rejected and sometimes unattractive. This affects their self-esteem since their partner has increasingly less initiative to maintain their sexual relationship. In fact, he might try to invent excuses for not having sex. And, if he does, it’s often a compulsive act because he’s trying to take advantage of an erection if it appears. Unsurprisingly, this results in an unsatisfactory relationship for both partners.

Good communication is necessary. Both partners need to understand the problem and solve it together without blame or reproach. After all, the problem is a reflection of a sexual stimulus. It’s not something that the sufferer can solve with willpower alone. It’s a blocking response that he’s unable to handle. He may also reexperience the trauma in subsequent sexual encounters.

Is it reversible?

When the problem has a biological basis –although anticipatory anxiety always appears sooner or later, the first thing to do is solve the health issue and see how the other evolves.

There are different specific medical treatments for the treatment of erectile dysfunction that can help facilitate a more correct response. For instance, there are oral medications, known by the trade names of Viagra, Levitra, Cialis, and Stendra. They tend to work quite well. That said, they do have side effects and not everyone responds well to them. And, if the psychological cause is strong, the effect of the medication will be extremely limited.

As a last resort, there are also surgical treatments, such as prostheses that cause an erection. In most of these cases, psychological therapy will be necessary. It usually provides good results.

How is it worked on in psychological therapy?

Sex therapy is the most important kind of help. Whether or not there are physical problems associated with the erection problem, psychological monitoring will be necessary. However, there are certain things to bear in mind:

  • The man shouldn’t blame his partner or himself for the appearance of a sexual problem. He has to solve it by putting it on the table. If he hides it, as in anything related to emotions, it’ll become more difficult to deal with.
  • When sexual difficulty appears, their partner must be careful not to generate more tension. For instance, criticizing or questioning will hurt him enormously.
  • Sexual difficulties are extremely common problems and not necessarily pathological.
  • Sexual activity goes beyond intercourse. If an erection doesn’t appear, other things can be done. Indeed, a lack of an erection doesn’t have to mean the end of the encounter.
  • Sexual activity is a form of communication. If sexual communication isn’t satisfactory, it must be improved.
  • Internal sensations should be considered. The man needs to develop the ability to communicate his feelings and needs to his sexual partner.

Functional analysis

Functional analysis of the problem, where it comes from, why it’s maintained, and where it fits in with the individual’s biography helps us, as professionals, to work on the focus of the problem. Consequently, the patient can acquire tools that help them unblock and reduce their state of internal alert.

The way the therapy works depends on its focus. Behavioral techniques often serve to generate more tranquility in relationships, via different training sessions. Or, in a more profound way, by seeking and healing the origin and maintenance of the problem.

Sexual therapy in erectile dysfunction is successful in approximately 75 percent of cases.

What’s the best treatment?

Since we’re talking about an automatic and involuntary unconscious response that generates an alert to a lack of an erection, I prefer to work on the source of the problem, the limbic system. This is the emotional area in which the block appears. This means it’s possible to reprogram a more neutral sexual response or to look for the emotional origin of the problem.

To do this, I use emotional release techniques such as hypnosis or brain spotting. They act directly on the origin of what’s happening and solve the problem in a deeper way. In fact, they work on the problem’s origins.

Could you give some advice to men experiencing erectile dysfunction?

I’d tell them that anyone can suffer from this type of problem. As such, it shouldn’t be given too much importance. It’s a common problem and, as men, we have to accept that it’ll probably happen to us at some point in our lives.

I’d also advise them against being too self-critical. This is because, in sexual encounters, we use excess energy. And, with the kinds of lives we lead today, we don’t have too much of it.  Above all, I’d tell them they mustn’t lose sight of the fact that sexual encounters should be fun, not something that causes tension.

I’d also explain that if they really feel that erectile dysfunction is a problem for them because it’s happening a great deal and making them worry, to visit a specialist who works on this type of issue. They’ll help them assess what’s causing it.

The sooner it’s treated the less alert is recorded in the brain and the easier the treatment is. Furthermore, it won’t cause too much wear and tear on the sufferer’s relationship.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Pomerol Monseny, J. M. (2010). Disfunción eréctil de origen psicógeno. Archivos Españoles de Urología (Ed. impresa)63(8), 599-602.
  • Vela, L. R., Ibarra, A. G., Regueiro, D. P., & Sanz, L. R. (2002). Disfunción eréctil. Actas Urológicas Españolas26(9), 667-690.
  • Wespes, E., Amar, E., Eardley, I., Giuliano, F., Hatzichristou, D., Hatzimouratidis, K., … & Vardi, Y. (2010). Guía clínica sobre la disfunción sexual masculina: disfunción eréctil y eyaculación precoz. European Association of Urology, 842-99.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.