Portrait Dr. Birte Nachtwey

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence.


Common Causes of Erectile Dysfunction

Erectile Dysfunction (ED) is more common than you may think. Estimates vary between one third of all men and 3 – 76,5 % global prevalence. It is more common in older men, but for young men, it is also not uncommon. Some studies found that from 20 – 29 it is 8% and from 30 – 39 11%. 

There can be a number of medical reasons, especially in people that have health conditions like diabetes, neurological disorders, cardiac diseases or endocrine disorders affecting hormone levels. It can also be a side effect of certain medications, a lifestyle issue (e.g. drug and alcohol abuse) or be related to mental health problems. For this reason, it is always good to talk to a GP or Urologist about it at least once.

If these causes are ruled out, it is very commonly caused by emotional issues within a relationship or a person himself. Anxiety, depression or performance pressure are very wide spread. Fears to fail or disappoint the partner, lack of self – confidence, insecurity, high stress level or anger can affect your ability to arouse.

 Some people have long established arousal habits or modes that may work efficiently if they are by themselves, but not if they interact with another person. Some people may have specific arousal sources (e.g. a fetish) that work, while their absence can cause ED.


Erectile Dysfunction Symptoms

ED symptoms may include trouble getting and/or keeping an erection, or getting an erection that is not firm enough to have intercourse. If this happens occasionally, this is completely normal. 

If it happens more frequently, even though this may feel very embarrassing, it is good to speak to a GP or Urologist and, after ruling out medical conditions, seeking help with a sex therapist. 

This is not a condition that you have to be totally stuck with for the rest of your life for most men.

ED can lead to loss and lack of desire, avoidance behaviour, depression, anxiety and relationship problems, just to name some. There earlier you seek help, the better.


Erectile Dysfunction & Sexual Therapy

There are a number of drugs like Viagra (Sildenafil) or Cialis (Tadalafil) that can support an erection by helping to keep the blood in the penis, even in small doses. They need to be prescribed by a GP and purchased from trustworthy vendors. They can help break a vicious cycle of frustration and make you feel more confident, but most men feel that they would rather be independent of taking long term medications.

Therapy for ED includes talking about the possible emotional, cognitive and physical causes, as well as relationship dynamics. They are evaluated, often over several sessions. The personal arousal mode and habits are assessed and an individual treatment plan is made. This can include working on beliefs and taught patterns, your, inner system or team, behaviour and habits. It can also include physical exercises related to muscle tension and breathing habits and working on your nervous system through alterations of arousal habits. 

In any case, there will be no explicit arousal or sexual actions in the therapy sessions. There may be homework exploring things by yourself and/or with a partner outside the sessions. Everything will be decent.


Portrait Dr. Birte Nachtwey