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Biology and Psychology of Erectile Dysfunction

If you work with male patients, especially older ones, you might find some of them dealing with erectile dysfunction (ED). When a man has ED, he’s unable to achieve an erection that’s firm enough for intercourse. ED is a frustrating condition that often causes problems in relationships and diminished self-esteem. Many ED patients feel like they’re “less of a man” because they can’t perform sexually the way they used to.

What causes ED? There are a number of potential causes, some biological, some psychological. In this post, we’ll discuss some of the more common causes.

Biological Causes

To understand the biological causes of erectile dysfunction, it helps to understand the physiological process of erection.

A man can be sexually aroused by a variety of stimuli, such as the touch of his partner, the sight of someone attractive on television, or a fantasy he thinks over in his mind. Once this happens, signals in the brain trigger activity in the penis. Soft tissue in the penis relaxes and arteries expand to allow increased blood flow. This additional blood makes the penis erect. Veins constrict so that the blood stays in the penis until the sexual stimulation ends or until the man ejaculates. At that point, the veins open again, allowing blood to flow back into the body.

Medical conditions that interfere with this communication and blood flow process are often linked to ED. Here are some common culprits:

·         Diabetes

·         Cardiovascular disease

·         Obesity

·         High blood pressure

·         High cholesterol

·         Low testosterone

·         Kidney disease

·         Stroke

·         Multiple sclerosis

Men with diabetes may develop ED because of neuropathy – nerve damage that, in this case, prevents the transmission of signals from the brain to the penis. Men who have had a stroke may have similar problems with nerves, as can men with multiple sclerosis.

Men recovering from prostate surgery are prone to erection dysfunction as well. The prostate is surrounded by nerves essential for erectile function. Surgeons try to spare as many nerves as they can, but in many cases, patients still have erectile problems. Penile rehabilitation can help in this situation.

Atherosclerosis – hardening of the arteries – can happen to men with heart disease, diabetes, and high cholesterol. When atherosclerosis occurs, the arterial pathways into the penis are narrowed or blocked. With less blood flowing into the penis, a man may not be able to get an erection rigid enough for sex. Or, he might not be able to get an erection at all.

Often, ED can be treated by targeting the underlying medical condition that causes it. Medications and devices are other helpful options.

Psychological Causes

Psychology may also play a role in the development of erectile dysfunction. Depression, anxiety, and stress are all possible triggers. A man may be having financial problems or a conflict with his employer. He may have performance anxiety and be so concerned about satisfying his partner that he cannot get an erection.

Problems in a relationship can affect erectile function as well. Unhappiness, anger, and communication breakdowns may fuel the frustration and depression associated with ED.

Another angle to consider is past sexual experiences. A man who has been sexually abused in the past may need to work through feelings of fear, humiliation, or guilt before he can have satisfactory erection.

A man whose ED stems from psychological causes may find counseling or sex therapy helpful. He may choose to take these routes on his own or with his partner.

It’s possible that a man’s ED may have both biological and psychological causes.

Assurance and Understanding

Many men are reluctant to admit they’re having sexual problems. They may feel nervous about bringing it up and awkward about describing their feelings.

If you suspect that your patient has ED, assure him that it’s a common and treatable condition and that getting help will benefit not only his sex life but his overall health and well-being.


Sexual Medicine Society of North America

“Common Causes – Erectile Dysfunction”

“ED as an Indicator”

“Questions to Ask Your Health Care Provider about Erectile Dysfunction (ED)”