Erectile dysfunction: Sexual and Couple therapy
Erectile dysfunction (ED) is the appearance of a change in the quality of erection both in terms of rigidity and in the ability in attain or maintain an erection sufficient to permit satisfactory sexual activity.
As in many cases, the trigger is the psychogenic component, so assessment, orientation and psychological treatment are essential.
Frequently the psychogenic ED coexists with other sexual dysfunctions such as Hypoactive sexual desire disorder or Premature ejaculation; they can be both its cause and its consequence.
The adequate approach to ED often requires a shared multidisciplinary approach and collaboration with different professionals.
What causes psychogenic erectile dysfunction?
Men with ED require achieving an erection and/or penetration in each sexual encounter. Psychogenic ED usually appears abruptly and random erections still occur.
The “performance demand” does not allow them to enjoy the sexual act, which generates in the patient alertness and self-monitoring of their erection. This causes men to be more focused on obtaining and maintaining an erection rather than relaxing and giving or receiving pleasure.
As a result of worrying about a good sexual performance, they have anxiety and the fear of not being able to respond to the slightest difficulty. This fear is called “anticipatory anxiety”, which is when a person experiences increased levels of anxiety by thinking about an event or situation in the future while trying to have control over the uncertainty.
It generates insecurity, anxiety, dissatisfaction, guilt and frustration, both individually and in the interaction with the partner.
In most cases, the level of communication with the partner is unsatisfactory both at a sexual level and at an affective level (lack of assertiveness or empathy).
Finally, stress triggers should also be considered in certain situations (new sexual partner, one-night stand, stress, workplace issues, grieving for couple break-up, family issues and all kinds of external factors) as they can be a determining factor in the appearance and maintenance of the dysfunction.
What does a psychosexual therapist do?
The aim of sex therapy is to help with externalizing a sexual problem and then beginning to overcome it to enjoy anew a satisfactory sex life. This is done by means of various stages/tasks that the patients are usually expected to complete in the privacy and intimacy of their own home (individually or with the partner).
The initial goal is to express, detect and modify the causes in order to reduce the level of anticipatory anxiety (fear of failure) about sexual performance and decrease the “always working” requirements.
Cognitive-behavioral techniques are suggested to overcome the sexual performance anxiety.
- Sexual psychoeducation (sexual information, sexual myths and taboos).
- Promoting a healthy lifestyle (Self-care) and self-esteem.
- Relaxation Training, “Mindfulness” and attention techniques: here and now.
- Diaphragmatic breathing: Part of the physiological process of erection includes the correct operation of the parasympathetic nervous system (PNS) and deep breathing activates the PNS.
- Improving introspection of the automatic and anticipatory thoughts (Dysfunctional Beliefs) and cognitive restructuring (change)of those thoughts.
- Personalized systematic desensitization by gradual exposure.
- Personalized self-stimulation program and Sex Therapy stages adapted to each patient.
- EMDR Therapy.
When the patient who visits the clinic has a partner, Couple sessions are oriented towards the cooperation and involvement of the two parties, taking responsibility and sharing the therapy simultaneously.
Both at an individual and at a partner level, it is advisable to acquire communication strategies (assertiveness) for the improvement of communication quality.
Often, it is combined with psychiatric or pharmacological treatment (PDE5), which is called Combination therapy.
The sessions will be 1 hour long bi-weekly, in which individual and couple visits will be staged. Tasks will be delivered in between both individual sessions and in collaboration with the partner.