The question "When is erectile dysfunction psychological?" floats around and I find this is a really interesting question. To me, as a therapist, the question highlights the possibility that erectile dysfunction is not psychological.
Now, that thought speaks to something else going on about how we see erectile dysfunction. The medicalisation of erectile dysfunction! Medical professionals diagnose erectile dysfunction as a problem in and of itself and it will be offered as treatment with drugs like sildenafil and tadalafil. And once a person who is struggling to get an erection, who's been diagnosed by a doctor with having erectile dysfunction, will often feel that they are sick and poorly, that they're broken in some way because they have got a diagnosis and they're told that their genitals are not functioning properly, that it is broken and that it needs to be fixed.

The impacts on this on a person is already huge, emotional and psychological, because
being told that you are broken, of course, how is a person going to feel? People do feel broken. They feel incredibly vulnerable when they have erectile dysfunction.
What happens, however, when we consider erectile dysfunction more broadly?
It's really, really important to know that oftentimes, even in the medical profession, that erectile dysfunction is not well understood. A lot of doctors will struggle to understand
how erectile dysfunction comes up, mainly because erectile dysfunction can be incredibly uncharacteristic of a person. By this I mean that an individual may enjoy an active sexual life for many, many years and out of nowhere (seemingly) they will struggle with erectile dysfunction.
There can be loads of inconsistencies too. To name just a few, perhaps somebody will have a morning erection, but they won't get an erection when they choose to be intimate with another person. They may be able to get an erection with some people, but they're not with others.
How do we diagnose something as broken physically and medically, when sometimes
it will be operating as wanted?
Erectile dysfunction for me is best understood NOT as the problem in and of itself.
I don't believe that the penis not being able to get an erection is the problem. Instead, to me I see that the erected penis and erectile dysfunction is the expression of something else going on within somebody's body and somebody holistically in their mind, psychologically and emotionally.
By this I mean that erectile dysfunction is the impact of something else. It is the impact rather than the cause or the effect rather than the cause.

In order to understand the psychological causes and impacts of erectile dysfunction we can consider the whole person and explore how it happens, including the inconsistencies and
it being uncharacteristic of a person. The entire person, their psychological life and
their history and their relationships and their emotions are all considered a part of it.
I don't believe that erectile dysfunction is always the causes of a medical and physical "problem".
In fact, I'd be as bold to say as 90% of the time erectile dysfunction is not medical.
It is not the problem in and of itself, but instead is the expression of something happening within the psychology, relational and emotional life of a person.

Written by Lily Llewellyn
28th November 2024
Lily is a psychotherapist trained and educated in person-centred counselling to master's level and achieved an MA in anthropology. Her areas of interest include our relationships with ourselves and others.
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