Erectile dysfunction, the masculine silence under the covers

The sexual encounter should always be something rewarding, fun and stimulating; never a situation marked by fear or anxiety. However, many times, behind that tension there can be something quite common among men. We are talking about erectile dysfunction.

The difficulty to achieve an erection and a sufficient rigidity of the penis, which allows a satisfactory relationship, is something that can appear at any age. However, the problem arises when it becomes a recurring experience and one opts for silence and self-criticism.

The clinical psychologist Jose Martin del Pliego explains that there are several causes that give rise to this alteration, which range from organic factors to psychogenic factors -or both-. However, the most decisive thing is to always consult specialists so as not to increase mental exhaustion, as well as problems in the affective relationship.

We go deeper with the expert in the following interview.

Let’s talk about erectile dysfunction

Erectile dysfunction continues to be a silenced and almost taboo topic. However, the impact for the man and his partner is immense. Hence the relevance of consulting with experts such as Jose Martin del Pliego, a clinical psychologist trained as a sexologist at the Sexological Society of Madrid.

Currently, she works giving clinical assistance to patients with problems in their sexual response and, for years, she has organized sexual orientation education workshops for high school and university students when required. All this supported by telephone and online assistance to resolve urgent questions.

Today, we’re looking to learn a little more from him about a disorder that’s actually more common than we might think.

Erectile dysfunction can encourage rumination about the problem.

Q. What are the main causes of erectile dysfunction?

There are different causes. 

Organic causes

• • Lung failure, angina pectoris.
  • Certain medications, substances, excessive alcohol consumption are frequent causes of erection problems.
  • Diabetes.
  • Phimosis, prostatitis, urethritis.
  • infections.
  • Sclerosis.
  • Cirrhosis.

Behavioral and emotional causes

• With mental health problems, depression, anxiety or stress it is easy for problems in the sexual response to appear.
• Anxiety anticipating the act. Being afraid of possible sexual intercourse. It is the basis of all arousal problems. Fear of failure in the relationship.
• Very puritanical and strict education in which sex is “something bad”.
• Lack of adequate stimulation.
• Monotony in erotic games. Poverty in the erotic world of the couple. Common topic when the vision of sex as a game is lost.
• Negative or pressing first experiences.
• Ambivalent emotions towards the partner. There is a part of the person that can love the partner and another that rejects it
• latent homosexuality.
• Bad sexual learning or stories of childhood abuse.

If the person has erections when waking up, it indicates that there are usually no biological causes that cause the lack of arousal. When the lack of erection is of physiological origin, the installation and evolution of the problem is usually gradual; however, if it is of psychological origin, it can appear more suddenly and unexpectedly.

Q. At what age does it usually present?

As we can see from the multitude of problems that can cause erection difficulties, age is not the main cause, but it is true that there are age-related diseases that interfere in this area, whether due to vascular, hormonal, and neural. This makes it logical that, as in the rest of our anatomical and physiological functioning, over time we will have more difficulties. If a healthy sexual habit is maintained, it is easier to prolong sexual behavior.

In consultation you find patients of any age with erection problems and, although the beginnings of the problem usually have many different causes, the evolution and maintenance is usually of a psychological nature, with that anticipatory anxiety to the lack of erection that colors their alertness. future relationships.

Q. How does it affect men?

It is the key to the matter. If a man has an erection problem and he doesn’t give it much importance, his following responses will be normal. However, it is common for there to be men who generate a lot of alert and anticipate a failure in their next relationships. Therefore, the area of ​​the brain of fear is activated, which is located in a different place from that of pleasure; and, faced with an alert situation, sexual relations make no sense.

When the survival system is activated, everything else stops. Confidence is gradually lost and a perception of vulnerability begins to appear in that area. “Self-checks” may appear, to check if the erection is powerful enough. Little by little, they avoid relationships because of how bad it makes them feel not being able to respond, which ends up affecting their self-esteem, confidence and mood.

Q. And what about the relationship?

Erection problems can cause a lot to happen in a relationship. Loss of intimacy can produce estrangement. The partner may feel rejected and sometimes unattractive, thus affecting their self-esteem since the person with erection problems will have less and less initiative to maintain relationships. In fact, sometimes he tries to invent excuses for not having them and when he does, they are sometimes compulsive because he tries to take advantage of the erection if it has arrived, having unsatisfactory relationships for both of them.

Good communication is necessary, to understand the problem well and solve it together without blame or reproach; because, when the problem arrives, the erection is a reflection of a sexual stimulus and it is not something that can be solved with willpower alone. It is therefore a blocking response that man cannot handle and that can be re-traumatized in each relationship that does not work.

P. Is reversible?

When the problem has a biological basis –although I indicate that the part of anticipatory anxiety always appears sooner or later–, the first thing to do is solve the health issue as much as possible , to see how the other evolves.

There are different specific medical treatments for the treatment of erection that can help facilitate a more correct response. Within the oral medications, with its trade name, are Viagra, Levitra, Cialis, and Stendra. They work quite well, considering that they do have side effects and not everyone responds well to them. If the psychological cause is strong, the effect of the medication will be very limited.

There are also surgical treatments, such as prostheses to cause an erection, as a last alternative. In most of these cases, psychological therapy will be necessary, which usually gives good results.

Q. How do you usually work in psychological therapy?

Sex therapy is the most important thing to work on . Whether or not there are physical problems associated with the erection problem, psychological monitoring will be necessary. Now, there are some things to keep in mind:

• It does not help to blame the partner or oneself for the appearance of a sexual problem. You have to solve it by putting it on the table. If it hides, as in everything emotional, it becomes more difficult to work.
• When sexual difficulty appears, the couple is essential so as not to generate more tension. Criticizing or questioning the other hurts enormously.
• Sexual difficulties are very common problems without being pathology.
• Sexual activity goes beyond intercourse. If the erection does not appear, other things can be done and not turn the lack of erection into the end of the match.
• Sexual activity is a form of communication. When sexual communication is not satisfactory, the communicative aspect may have to be improved.
• Look at the internal sensations, feel what I feel and develop the ability to communicate feelings and needs to the sexual partner.
• Take responsibility for yourself, instead of delegating that responsibility to your partner. For many people it is easier to blame the other than to assume the problem.

The functional analysis of the problem, where it comes from, why it is maintained and where it fits in with the person’s biography helps us to work on the focus of the problem so that the patient can acquire tools that help them unblock and reduce this internal alert. 

Depending on the focus of the therapy that is done, it will work in one way or another, sometimes with behavioral techniques that serve to generate more tranquility in relationships, with different training sessions, or in a more profound way, seeking and healing the origin of the problem. and its maintenance.

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

Q. What is the best treatment?

Since we are talking about an automatic and involuntary unconscious response that generates an alert to a lack of erection, I personally prefer to work on the focus of the problem, on the limbic system , the emotional part where the blockage appears 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 brainspotting , which act directly on the origin of what is happening, and solve the problem in a deeper way and thus work with the problem from its origin.

Q. Could you give some advice to men who have erectile dysfunction?

I would tell them that at some point we can all have this type of problem and that it should not be given more importance; It is something common and we have to accept that it will happen to us at some point.

It is necessary to avoid being too self-critical and tremendous because in sex excess energy from the system is used and, in the type of life we ​​lead, what we do not have excess is that energy. We must not lose sight of the fact that the sexual encounter should be something fun, not another element of tension.

If you really feel that it is a problem for you, because it happens to you very frequently and you already worry, go to the specialists who work naturally on this type of issue so that you can assess where what is happening to you comes from.

The sooner you treat it, the less the alert will be recorded in your brain and the easier the treatment will be for you without too much wear and tear on your relationship.