Introduction
Psychological factors play an important role in erectile dysfunction. They influence the genesis of erectile dysfunction, quality of life and partnerships, diagnostic assessment and effectiveness of therapy. The causes of erectile dysfunction (ED) can be divided into components directly affecting sexual intercourse (such as fear of failure, distraction), factors of the recent past, and vulnerabilities associated with the development of sexuality. For a classification of causes of erectile dysfunction, see Table 1.
Erectile dysfunction, more than most other psychological and physical ailments, can undermine a man’s self-esteem and affect his well-being, as well as the harmony in his family life. For the patient himself, the consequences of ED usually include decreased self-esteem and a sense of masculine identity, a tendency to withdraw and avoid friendships. Social and occupational difficulties, as well as psychological or psychosomatic disorders, may occur. The most significant psychological consequence closely associated with erectile dysfunction is depression.
In addition, numerous studies of the quality of life of men suffering from erectile dysfunction have revealed significant and far-reaching psychological impairments that can be significantly improved with adequate treatment or avoided entirely.
| Category of Erectile Dysfunction | Common Disorders | Pathophysiology |
|---|---|---|
| Neurogenic |
Stroke Alzheimer’s disease Spinal cord injury Radical pelvic surgeries Diabetic neuropathy Pelvic injury |
Interrupted neuronal innervation Failure to initiate NO release |
| Psychogenic |
Depression Psychological stress Performance anxiety Relationship problems |
Impaired nitric oxide (NO) release Loss of libido Sympathetic nervous system activation |
| Hormonal |
Androgen deficiency Hyperprolactinemia Diabetes Chronic opioid use |
Loss of libido Inadequate NO release Morphological changes in penis (atrophy) |
| Vasculogenic (arterial and cavernosal) |
Hypertension Atherosclerosis Hyperlipidemia Diabetes mellitus Obesity Trauma/pelvic fracture Tobacco use Peyronie’s disease |
Impaired penile veno-occlusion Inadequate arterial inflow |
| Drug-induced |
Antihypertensives Antiandrogens Antidepressants Alcohol abuse |
Central nervous system suppression Decreased libido Alcoholic neuropathy Vascular insufficiency |
| Systemic diseases |
Aging Diabetes mellitus Chronic renal failure Generalized atherosclerotic disease |
Multifactorial Neuronal and vascular dysfunction |
ED and Relationship Psychology
Erectile dysfunction is not only difficult for the man affected, it can also be a great burden for the partner. Many people feel helpless or even guilty when their partner’s potency goes on strike.
Sexuality has important functions for a person’s mental balance, but on the other hand, it is inextricably intertwined with relationships, couple dynamics and couple bonds. It follows that a sexual disorder such as erectile dysfunction cannot be considered in isolation from partner relationships, which in some patients contribute significantly to the development of the disorder or support it through destructive interaction processes. The causes of partner-related potency disorders may lie within the man himself in the form of a deep-rooted fear of women or female sexuality, but they can also come directly from unsuccessful partnerships.
The latter can be divided into conflicts over the status and dominance of partners in the family or relationship, problems with intimacy and trust, and difficulties related to sexual attractiveness and sexual desire. Many men with erection problems demonstrate deep insecurity about their sexual behavior towards women and experience a stressful, anxious sense of responsibility for their partner’s sexual satisfaction, even if they don’t understand what it really means for each individual woman. Along with widespread inflated ideas about sexual performance and women’s increased sexual self-confidence, many men experience difficulties with their sexuality, are under pressure from stereotypes and adopt a defensive attitude in which the main goal is not to do anything wrong or fail, as if sexual intercourse is an exam.
During the treatment of erectile dysfunction, one should not lose sight of the fact that stable partnerships and an attentive partner have a fairly important protective function against sexual disorders, since problems can be leveled or compensated. Many couples are in satisfactory relationships even if their sexuality is disrupted by certain factors. Various studies show that men in long-term relationships are more satisfied with their sexuality and complain less about erectile dysfunction. In any case, it is important to consider aspects of partnership when diagnosing and treating potency disorders. Particular attention should be paid to the following diagnostic criteria: whether erectile dysfunction arose in a long-term relationship or with a new partner, whether potency was previously stable or it has always been unstable, whether the sexual problem is a manifestation of a broken relationship in a couple or it contrasts with a good relationship. It is also important to pay attention to what the man’s partner’s sexual interest and sexual experience is.
The close interaction of somatic and psychosocial factors necessitates an interdisciplinary approach to the diagnosis of most male sexual problems. The most important tool for assessing psychological determinants is the sexual history, which should focus primarily on the specific context in which the potency disorder developed and on sexual status, as well as factors related to the male partner, before focusing on sexual development and its aspects. Involving a partner in the process of diagnosing ED is in most cases useful and can significantly supplement or correct the doctor’s verdict.
Issues of public understanding and openness regarding erectile dysfunction
In the last decade of the 20th century, the term “erectile dysfunction” replaced the outdated definition of “impotence” and is defined as the inability of a man to achieve or maintain an adequate erection sufficient for satisfactory sexual intercourse.
The inability to have a full sex life is one of the most powerful emotional pains for any man. At all times, close attention has been paid to this issue. The image of a man strong in spirit and body is glorified in classical works of all peoples, cultures and times. With the development and intensification of the impact of civilizational traumatic factors, the problem of erectile dysfunction is becoming one of the most pressing social problems, and not just personal ones.
ED is almost never an independent disease. It is only a symptom, sometimes the first manifestation of diseases of internal organs and their systems in a man’s body or his psychological disorders. In this sense, erectile dysfunction is often only the most visible, above-water part of an iceberg, the massive base of which is hidden under the water column. As a rule, with the exception of injuries to the genital organs and pelvic bones, erectile dysfunction is preceded by a fairly long period of formation of various pathological processes. Predisposing factors here are stress conditions, neurotic disorders, chronic intoxication caused by smoking, alcohol, taking various medications or drugs, which causes progressive polyneuropathy, impaired vascular patency of the genital organs and a decrease in testosterone levels due to impaired liver function. In addition to family conflicts, modern mass culture plays a certain role in the formation of neurotic disorders of erectile function. Propaganda and the cult of sex lead not only to an increase in urogenital and venereal diseases that affect the reproductive system, but also create a feeling of insecurity among physically healthy men in front of sexual models of show business. An important factor in the weakening of erection, as a consequence of promiscuity and previous urogenital infections, are diseases of the prostate gland, primarily chronic prostatitis.
Until recently, it was customary to distinguish two main types of erectile dysfunction – psychogenic, due to psychological reasons, and organic, associated with diseases of the internal organs. The latter, in turn, was divided into three main types – vascular (lack of blood supply), neurogenic (impaired conduction of nerve fibers) and endocrine (hormonal disorders). According to studies from the 1990s, it was believed that psychogenic causes of sexual dysfunction in men account for 35%, organic causes for 25%, and in 40% of cases there is a combination of organic and psychogenic causes. Scientific research in recent years has significantly changed this ratio in favor of organic diseases.
Today, lifestyle and nutrition are considered as central factors influencing the production of NO by the vascular endothelium and erectile function. In addition, there is evidence that lifestyle changes aimed at reducing low-level inflammation may also help reduce the severity of ED. Experimental and clinical studies have demonstrated that correcting major factors associated with erectile dysfunction, such as smoking, alcohol abuse, obesity and physical inactivity, can significantly increase testosterone levels and improve erectile function. Therefore, lifestyle modifications can prevent the progression of ED and even reverse its early manifestations.
Today, the attitude of both doctors and a wide range of people towards problems with potency, including erectile dysfunction, has changed significantly compared to previous years. The idea that erectile dysfunction is an ordinary disease, a health problem that can and should be treated, and not be ashamed of it and not hide it from your partner and even from yourself, is becoming more and more firmly established in society. It is important for men to realize that, despite the fact that erectile dysfunction does not threaten their life and direct health, this difficulty must be combated using both lifestyle changes and medications, turning to urologists, psychologists and other specialists, and not hope that the disease will go away on its own, and not pretend that everything is fine.
In the end, if a person has a stomach or leg pain, he goes to a specialized specialist, and does not claim that he is healthy. The positive shift in the attitude of the general population towards ED is due, in part, to scientific and medical information that has become more accessible with the development of the Internet. However, unfortunately, this phenomenon is still quite highly stigmatized, and primarily by men themselves, who often don’t consider it possible to share their problem even with medical workers. Such an attitude towards erectile dysfunction can result in serious psychological and social consequences, while an open and conscious attitude towards problems with potency contributes to their speedy resolution.
Conclusion
If erectile dysfunction develops, it is extremely important not only to consult a doctor immediately, but also to explain the situation to your partner. Silence is the worst strategy you can take in this case. Sincerity will prevent misinterpretation of a man’s behavior and will help the couple maintain a full-fledged harmonious relationship.
Despite advances in health awareness and public openness about potency problems, people suffering from sexual performance problems may be hesitant to discuss them with their doctors due to feelings of embarrassment. It is critical to understand that erectile dysfunction is well understood and that there are a variety of treatment options available to men.
While occasional problems with potency may not be cause for alarm, persistent erectile dysfunction can lead to stress, lower self-confidence, and contribute to problems with your personal and even professional life. It will also indicate that there is an underlying health problem that requires treatment.
If you have concerns about erectile dysfunction, you should definitely overcome any embarrassment and consult your doctor. In some cases, addressing the underlying condition may be enough to reverse erectile dysfunction, while in other cases, medications or alternative remedies may be recommended.
