Erectile Dysfunction and Impotence Problems


Erectile Dysfunction (sometimes called impotence) can feel embarrassing and stressful for some men. Erection problems can have a direct impact on sexual confidence and enjoyment, and cause a huge amount of distress both for men and their partners.

This is such a common problem in our therapy room that we have written a guide as this problem often doesn’t need a session with a therapist to overcome.  Our guide Confidence Staying Hard teaches you about how erections work, what can get in the way of them happening even when you want them to and exercises to practice alone to have a positive impact on what happens when you're with someone else. The more this goes well, the less likely you are to lose your erection and this cycle will gain momentum over time. 

How common is erectile dysfunction (ED)?

Very common.

In fact the majority of men have had occasional problems getting an erection or maintaining an erection at some point in their lives. This is usually caused by stress, tiredness or excessive alcohol and is very normal.  A temporary loss of erections (although often a source of anxiety) is nothing to worry about.

For some men, erection dysfunction can occur more frequently. Recent studies suggest that around 13% of men aged 16-54 have experienced ED for more than three months over the last year.  Problems with erections can affect men of any age, but the rates of erection difficulties do rise with age (up to 50% of 55-70 year olds report persistent ED).


What is erectile dysfunction (ED)?

ED can mean different things to different men at different times.  For some men it will mean getting a weak erection or soft erection which might be sufficient for some types of sex but is often problematic when attempting penetration with a partner. For others ED may mean getting no erection at all, or losing erections part way through sexual experiences.

Some men find that they are able to get harder erections or stronger erections at certain times, for instance on their own or in the morning. Some men are able to get an erection in particular situations, for instance on holiday or with a trusted partner, but not at other times. Other men might notice that they struggle in all situations, regardless of the context.


What causes Erectile Dysfunction (ED)?

The causes of ED can be wide ranging and will vary between individuals. There are lots of possible factors that can contribute to erection problems. These can be physical, psychological or a combination of both.

Physical causes of impotence

Physical causes of ED are more common as men get older.

The most common physical cause of ED is reduced blood flow into the penis. This is due to a build-up of fatty deposits (atheroma) in these arteries, which cause the arteries to narrow and harden. This is the same process that affects the arteries of the heart in heart disease, and can happen more quickly in men with diabetes and high blood pressure.

Lifestyle factors can play a big part in the narrowing and hardening of the arteries, and associated ED. These include:

  • Smoking
  • Being overweight
  • Fatty and high calorie foods which cause high cholesterol
  • Lack of regular exercise

Alcohol and recreational drugs can also prevent men getting erections, especially when consumed excessively.

Talking with your doctor about ways of changing your lifestyle can have a significant effect on your ability to gain and maintain erections.

Other erectile dysfunction causes can include having experienced:

  • Surgery (e.g. for prostate cancer)
  • Radiation therapy
  • Certain medications (prescribed to treat depression, heart disease and cancer)
  • Neurological conditions (such as multiple sclerosis or stroke) which can affect the way the brain sends messages around the body during arousal

If there is a physical cause, then the erectile dysfunction symptoms tend to develop slowly. So, you may have ED from time to time for a while, which may gradually become worse over time. If the ED is due to a physical cause, you are likely to have a normal sex drive, but will notice it is becoming harder and harder to get and maintain erections over time.


Psychological Factors

If you notice that erection dysfunction symptoms have started suddenly it might be a sign that there are psychological factors influencing this.  Men who experience ED with psychological causes are typically able to get stronger erections when they sleep or when they wake up in the morning, and some are able to get an erection when masturbating alone, but will often struggle with losing erections in the context of sex with partners.

Common psychological causes for ED can include:

  • Not being aroused by the sexual situation
  • Feeling stressed, tired or bored
  • Worries about sexual performance or about getting an erection
  • Concerns about using condoms, sexually transmitted infections or pregnancy
  • Relationship difficulties
  • Feelings of guilt or shame around sex
  • Anxiety or worry about any aspect of your life (even if it has nothing to do with sex!)


Treatment for Erectile Dysfunction (ED)

There are things you can do to improve or address your concerns about ED. For erectile problems, having a physical examination including blood tests is essential and is recognised as best practice.

You can see your GP to raise any concerns you have about sex, but we realise that this can be a daunting prospect for some people. The knowledge and experience it requires to assess sexual problems can be complex, so it can be beneficial to see a doctor who has specialist training in sexual medicine. See our recommended independent doctors here.  A doctor can also prescribe medications or other medical treatments specifically designed to cure erectile dysfunction and help you achieve harder erections or stronger erections.

Erectile Dysfunction treatment can involve both medical and psychological approaches, and many men find that a combination of both can be very effective.

Once a physical cause has been ruled out, you can then be sure that other changes to your life or relationships will make a difference. Consider learning more about how erections work with our PDF resource 'Confidence Staying Hard' so that you can start to implement changes in your life and relationships that make a difference. 

"I didn’t really understand what some of the factors were that were making it more difficult for me to stay hard with sexual partners before. It seems obvious to me now, but I’d got into a habit of stressing about staying hard, and this was getting in the way – physically getting in the way- of my erections being as I wanted them to be. This taught me how to overcome that."       - Anonymous, 31                                                                                                                                                                                                                      


It is also worth considering some of the psychological factors that might be contributing to your difficulties. Speaking with a specialist Psychologist or Psychosexual Therapist can help you to understand the causes of ED in more detail, and provide information about highly effective strategies or exercises to overcome erection difficulties.

If you prefer to see someone one on one from the outset, sex therapy is really effective to overcome difficulties with erections. In an initial consultation with one of our psychologists we will discuss with you all of the ways in which we can help. An initial consultation is a way for you to learn more about the process and receive tailored advice before committing to therapy.

If you are interested in talking more with one of our team about the difficulties you are facing with erections and how we can help use this button to book an appointment or contact us by phone or e mail.