When a Man’s Impotence Is Purely Psychological

Erectile dysfunction may start in your head, but it manifests in your genitals.

Posted Jan 22, 2020

nee dpix free image
Source: nee dpix free image

As many writers have observed, the causes for male impotence and erectile dysfunction (ED) fall into three categories: physical/medical, lifestyle, and psychological. But ultimately the dynamics of this common disturbance aren’t that separable. For many, such difficulties start out as physical but eventually become mainly mental and emotional.

Because other subjective factors accounting for a male’s inability to perform need to be considered, and ruled out, before concluding that the problem exists essentially in their head, I’ll first list the non-psychological causes for this so-frustrating male malady:

Physical/Medical It's estimated that as many as 30 million men in the U.S. alone are afflicted with this condition; high blood pressure, high cholesterol, and heart disease generally; diabetes; obesity, atherosclerosis; multiple sclerosis; metabolic syndrome; certain prescription medications; tobacco; Peyronie’s disease (i.e., scar tissue inside the penis); Parkinson’s disease; alcoholism, as well as other forms of substance abuse; sleep disorders; fatigue; treatment modalities for prostate cancer or an enlarged prostate; and injuries or surgeries affecting the pelvic area or spinal cord.

Lifestyle (and because how a man chooses to live his life can’t but affect his body and physical health, these elements frequently dovetail with entries in the first category): Smoking, heavy drinking, using certain drugs (which can damage a man’s blood vessels and reduce penile blood flow), being overweight, and failing to get enough exercise.

Many articles that specifically take up the psychological causes for impotence and ED focus on the concept of stress. And in various ways, all of the more explicit mental/emotional causes include some form of stress—such as relationship challenges, low self-esteem, depression, guilt, and addiction to pornography (in which the images and videos can so super-charge a male’s arousal that real women in their life, whose physical form rarely match these “hopped up” visuals, leave them insufficiently turned-on to get or stay hard).

But if there’s a single word that encapsulates the different psychological reasons that a man might find himself unable to perform sexually, it’s anxiety. And that’s hardly limited to performance anxiety either. It can explain generally why a male can’t safeguard his potency during an initial sexual experience, and also why—if he’s deemed such an encounter a mortifying, self-revealing failure—such a mindset will jinx later encounters as well. Although the past doesn’t necessarily determine the future, if one thinks it will, then it may well be a self-fulfilling prophecy. Or, as one article summarizes it, “The fear of failure itself makes failure more likely.”

To illustrate how a man’s mind can block his natural potency, I’ll offer an example from my own clinical caseload. It centers on one of my client’s single, bewildering sexual encounter that, regrettably, led to a whole series of failed encounters—basically because of how he, Larry, continued to negatively perceive this alarming ED experience. It was only many years later when, in desperation, he decided to try therapy that I was able to help him attach a different meaning to his so-distressing ordeal. And that’s what empowered him to regain full sexual functioning and at last end his interpersonal erectile dysfunction (i.e., it never manifested itself in “non-relational” masturbation).

At the time of his demoralizing sexual mishap, Larry was 20, and his partner, Linda, was 19, and not yet sexually “initiated.” Prior to Linda’s readiness to offer up her virginity to Larry, he’d never had any problems with sexual performance. But these earlier experiences were casual “hook-ups,” or one-night stands, and shallow at best. They involved no real emotional connection.

Larry’s relationship with Linda, however, was unprecedented. He’d been dating her for over two months and their bond was more personal, their level of sharing considerably deeper than what he’d had with young women in the past. The problem, though, was that he’d recently begun questioning the relationship’s viability. During his last few dates with Linda, he’d experienced her company as, frankly, somewhat boring. And although he was flattered and reassured by how much she seemed to like him, he worried that he really wasn’t able to reciprocate in kind—that not only were his feelings for her less than hers for him, but also that they were in the process of deteriorating. As much as he liked and respected her as a person, he was far from sure that she'd be the right partner for him.

So when Linda told him one evening that she was ready to have full-fledged intercourse with him, his initial excitement was tempered by his growing—though not yet fully conscious—ambivalence about their future as a couple. Consequently, after they’d begun “fooling around” and were lying naked in bed together, he discovered that his erection had entirely disappeared. And no matter what either of them did to bring it back, his member remained defiantly limp. Linda couldn’t have been more sympathetic and supportive, but he nonetheless felt guilty, embarrassed, and ashamed—as though his sudden impotence was now broadcasting his deepest doubts about himself, never really resolved from his childhood, growing up with a volatile, highly critical, denigrating father.

Shortly thereafter, he called Linda to tell her that he thought they should break up. His sexual failure had taken such an emotional toll on him that he couldn’t see himself ever attempting sex with her again. She endeavored to get him to change his mind, but having now become so anxious about the whole relationship, he couldn’t be persuaded. Later, tormented by guilt over how callously he’d ended their connection, he hid this whole worrisome fiasco from his friends, much too ashamed to admit to anyone that what he’d concluded about himself was that he was hopelessly defective.

But inasmuch as issues unresolved tend to get recycled onto even roughly similar situations, Larry discovered that physically intimate relationships had become impossible for him. And after four dismaying episodes of continued impotence, he essentially stopped dating, devoting all his time to his studies and professional pursuits. Still, by the time he was 26, he realized how empty he felt not being in a relationship and that he absolutely had to confront his seemingly inexorable problem.

When he referred himself to me, I had him share in as much detail as he could remember what happened that “fatal” night when he couldn’t maintain an erection. My objective was to help him develop a new understanding of why he hadn’t been able to perform, which could restore his hope that it was the particular situation and not his virility that originally caused his impotence. And also that it was his unwittingly “defining” himself on the basis of this one experience that best explained its replication in subsequent relationships.

What we both learned was that, ironically, his erectile dysfunction was purposeful. That is, because he’d become ambivalent about the relationship and knew that Linda’s giving him her virginity was a big thing to her, he was—subconsciously—afraid that their having intercourse would give her the message that he was just as committed to the relationship as she was. Now appreciating that it was his preceding, non-performance anxiety that made it impossible for him to function sexually with her, he was able to recognize that the root of his fears was something other than what he’d earlier assumed.

In short, it wasn’t that he couldn’t perform but that, deep down, he didn’t want to perform because of how he believed Linda would react to their “consummating” their relationship. It was his subconscious mind telling him not to lead her on that forbade his penetrating her. And his supposed impotence was actually an expression, or “acting out,” of this reluctance to become more deeply involved with her—a case of “mind over (organic) matter.”

Getting Larry to alter his original comprehension of his sexual dysfunction ended up making all the difference for him. He could grasp that in the future, so long as he could hold onto, or "internalize," this now amended viewpoint,  his past sexual failures no longer had to dictate future performance. In addition, I was able to help him revise the self-demeaning beliefs that arose, or were reinforced by, his “haunting” experience—such as “I’m a bad person,” “I’m a loser,” “I’m inadequate,” “I’m hopeless,” and (last but certainly not least) “I can’t trust my body.”

Coincidentally (though maybe not), during the course of Larry’s therapy he met someone whom he was deeply attracted to—and she with him. So I had him, when he masturbated, visualize making passionate love to her, and he reported that such “rehearsal” led to unusually powerful orgasms as he began to create a new reality in his head. And he was all the more delighted when the two of them did make love that, newly confident in his sexual prowess, he had no trouble lasting as long as he wanted.

Obviously, had Larry not resonated with my unprecedented characterization of his “calculated” impotence with Linda, my approach would not have succeeded. So to the degree that you, or someone you know, has had problems with impotence or sexual dysfunction, it’s key that its origins be correctly identified. For when this is done, the difficulty, all along more in one's head than in their genitals, can be effectively addressed—and finally resolved.

© 2020 Leon F. Seltzer, Ph.D.  All Rights Reserved.

References

Erectile dysfunction health center (2019, Aug. 27). https://www.webmd.com/erectile-dysfunction/default.htm

Erectile dysfunction and your lifestyle (2019, Oct. 1). https://www.webmd.com/erectile-dysfunction/guide/lifestyle-factors-linked-to-ed

 Erectile dysfunction—Symptoms & causes (2018, Mar. 09). https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

Holland, K. (2016, Sept. 15) Is erectile dysfunction psychological? https://www.healthline.com/health/erectile-dysfunction/psychological

Neuman, F. (2018, Oct. 08). If I lose my erection. https://www.psychologytoday.com/ca/blog/fighting-fear/201810/if-i-lose-my-erection

Psychological causes of ED—Is it all in your head? (2018, Mar. 15). https://www.forhims.com/blog/psychological-causes-of-ed