Why erectile dysfunction? Why now? One index of recent preoccupation with erectile dysfunction is the increased number of television and other ads by the pharmaceutical industry.

Changes in public attitudes allow for near-blanket advertising of remedies for this condition that in previous years would not be acceptable to media gatekeepers or good manners. Either there are indeed millions of men with this problem, or the drug companies are mistaken about how many men suffer from the problem.

It would be wrong to assume that the recent sweep of erectile dysfunction ads means there is some corresponding rapid increase in the disorder itself. However, our greater willingness to talk about it can have the benefit of bringing to light some of the less obvious causes for the condition.

An important idea to keep in mind about impotence is that there are primarily physiological causes for some men, but psychological explanations in other cases.

A given patient may have a condition with both aspects, yet actually benefit more from a treatment plan by a psychiatrist than a urologist.

It’s time we spoke

The Mayo Clinic lists “depression, anxiety or other mental health conditions, stress, relationship problems due to stress, poor communication” as causes for erectile dysfunction. Patients may or may or may not be aware of the role such emotional issues may be playing.

Even if they sense psychological problems are a factor, talking about it to a doctor can be awkward.

Figuring out whether the problem is more psychological and emotional rather than vascular or “mechanical” may require the consulting physician to ask very personal, intimate questions.

Some men may be more comfortable thinking about their condition as a medical problem mostly involving blood pressure and stamina.

After reviewing the patient’s medical history and basic physiological variables such as weight, heart rate and blood pressure, the consulting physician may suspect the fundamental problem is psychosexual or emotional.

Getting some men to open up about this can be a tricky business, and the more diverse nature of 21st Century populations can require doctors to be sensitive to a whole range of issues.

Some men will have a background in cultures that do not encourage them to divulge intimate sexual information. However, a dispassionate, clinical chat that begins with physiological rather than emotional themes could be a gentle way to eventually broach sensitive topics.

The impotence issue can be explored gradually, perhaps after general physical and emotional health issues have been explored.

There could be a role for group therapy as well. Tamara Melnick, Ph.D, and colleagues reviewed a series of studies about treating erectile dysfunction and concluded “there was evidence that group psychotherapy may improve erectile function.”

Men with this problem will want to explore whether talking about their problems in a group setting, possibly in conjunction with medication, will help.

When the real reasons for impotence are not easy to divulge or even know

Men with impotence issues will need to balance considering how their physical health might affect erectile dysfunction, but should consider the possibility that the real problems lay elsewhere.

The reason for lack of getting or maintaining an erection, or for a lack of desire at all, could have everything to do with economic, family, relationship, parenting or self-esteem issues.

Some men may find themselves preferring to explain erection difficulties as stemming from primarily physiological causes; for instance, recent weight gain, recovering from illness, lower back pain or other common health concerns.

Clinicians will over time develop intuition about the respective role that physiological causes have compared to “life issues” in their patient’s situations. Oftentimes there is no easy separation. Complicating matters is the lack of knowledge men may possess about their own bodies, emotions and sexuality.

The complexity of these issues may not lend themselves to a fast-food type approach where the patient walks out with a prescription for the latest ED drug.

Doctors have to be shrewd in assessing whether financial pressures, conflicts with one’s partner, or coping with the death of a loved one and other intimate “existential” issues are causing the problem.  The possible contribution of such factors can be drawn out, given time and trust.

Time pressures can work against exploring the emotional side of impotence

Real tact and skill are called for here. The all-too-brief availability of the modern physician may create time pressure to not explore deeper emotional problems and just prescribe drugs after a fifteen minute consult.

Patients need to be their own advocates though, and this kind of short interaction might not allow for deeper issues to be raised.

Men may need a series of talks to trust a doctor enough to divulge a feeling that stress about money woes, drinking, body image, coping with the aftermath of losing a parent or other issues is part of the problem.

This time is not easy to come by in the modern medical world, but not all health issues can be resolved through an efficient exchange of information and a prescription for drugs.

For that matter, they may not be fully aware that such emotions and psychosexual issues are interfering with their sexual enjoyment and performance. Doctors routinely confront limits on patient’s self-knowledge.

It might turn out that a man is biased towards non-emotional explanations of why maintaining an erection is difficult, and instead cite recent health incidents, sleep issues, getting older, weight gain or lower back pain. Getting to the root of the problem is non-trivial indeed.

It can take a number of counseling sessions to create a safe enough zone for a man to explore the full range of factors involved. Men need to make getting enough access to physicians and other medical professionals a priority.

Empowered patients will at first recognize if there is a need for extended interactions and then make serious efforts to get doctors and others to cooperate.

Conclusion

Some men may find the erectile dysfunction medications that are available nowadays adequate to manage their impotence. Others may need to address emotional and psychosexual barriers to satisfying sex.

A sensitive and experienced physician can gently help a man explore what is going on in their life that might be leading to erectile problems. Men may find this type of conversation difficult and may instead come up with other explanations for the problem.

The relationship between physiological and psychological aspects of impotence can be quite complex and not quickly resolvable through a brief consultation and prescription for drugs.

Overall, the nature of the problem can be brought to light, but this may require a series of conversations with doctors. Doing so can be a challenge but empowered patients will make it a priority.

Men have more resources than ever to address both the physiological and psychosexual dimensions of this problem.