For most men, an erect penis is a key source of self-esteem, and repeated difficulties with erections can be highly distressing. Problems with getting or maintaining an erection sufficient for intercourse are very common. While most men experience occasional erectile difficulties, persistent issues can lead to personal and relationship stress, anxiety, and self-blame.
Common Causes of Erectile Dysfunction
- Psychological Factors: For men under 40, erection problems are often caused by stress, anxiety, performance pressure, or relationship issues. Anticipatory anxiety and self-consciousness can make erectile difficulties worse.
- Physical Factors: Age and health can contribute to ED. Alcohol overuse, smoking, medications, chronic illness, diabetes, vascular problems, and prostate surgery are common physical causes.
How Erections Work and Why Focus Matters
Erections naturally vary over time. Younger men often experience spontaneous erections, while men over 40 may notice changes. By age 50, over half of men report mild to moderate erectile difficulty.
Focusing too much on the penis or performance disrupts natural arousal. An erection is the result of engagement, sensual receptivity, and shared pleasure with a partner. Linking sex with performance can trigger ED, creating a self-perpetuating cycle of anxiety.
Breaking the Cycle of ED
If erectile difficulties persist longer than six months, couples can become trapped in a cycle of anticipatory anxiety, avoidance, and performance pressure. This cycle continues regardless of whether the initial cause was physical or psychological.
Key Tip: Focus on giving and receiving pleasure rather than performance. Addressing both physical and psychological factors with professional help can restore a healthy, enjoyable sex life and improve relationship satisfaction.
What happens in an erection?
Prior to an erection, first there is the feeling of sexual desire (he is ‘turned on’). This is quickly followed by arousal. With arousal, his penis becomes erect when the smooth muscle of the penis relaxes and allows blood to flow into three spongy bodies inside the penis (the two corpora cavernosa and the corpus spongiosum).
The penis is a hydraulic system. It rises and stiffens as it fills with blood.
How common are Erectile difficulties?
In Australia, about 30% of men report erectile dysfunction. It has been estimated that erectile dysfunction (of all degrees) affects 52% of men aged 40 to 70 years, with higher rates in those older than 70 years. Research suggests that the prevalence of ED among Australian men falls in these ranges:
- 13.1% of 40-49 year olds
- 33.5% of 50-59 year olds
- 51.5% in 60-69 year olds
- 69.2% of 70-79 year olds
Worldwide, only about 1 in 6 men with moderate to severe erectile dysfunction seeks help from health professionals. The majority suffers in silence.
A New Growing Problem: Porn induced Erectile Dysfunction
Very recently there have been increasing reports of young internet porn users complaining of delayed ejaculation, inability to be turned on their real partners and erectile difficulties.
Many numbers of men in their 20′s with a serious porn habit (and increasing need for more extreme material) have begun complaining that they can’t get it up anymore with a real girl.
Recent behavioural addiction research suggests that the loss of libido and performance occur because heavy users are numbing their brain’s normal response to pleasure. Years of overriding the natural limits of libido with intense stimulation desensitizes the user’s response to the neurochemical dopamine which is behind sexual desire and erections.
This is a very worrying trend for young men.
Is the “Magic blue pill” the answer to erection difficulties?
Since 1998 with the introduction of enhancement medication, it has been popularly believed that erectile problems are caused mainly by physiological problems, especially vascular problems, rather than psychological issues or relationship distress.
However, this medical approach oversimplifies the problem and promises more than it can deliver. ED is more complex. Although the achievement of an erection is very important, a healthy, fulfilling sexual relationship is much more intricate than a mechanistic view allows.
For every man who has been helped, an equal number, or perhaps more have “failed” with medication. When this happens, these men feel even more stigmatized and demoralized after trying and not succeeding than before.
An Important Assessment question
If you find you can get an erection through self-stimulation, or with your partner stimulating you, or while you are sleeping, or when as you wake, then it is likely that the physical factors are functional for you.
This usually means that anxiety, distraction, fatigue, and negative emotions are playing a major part in interfering with your sexual function and will need to be addressed by a Relationship Psychologist or Sex Therapist.
What are all the Causes of Erectile difficulties?
Erection difficulties are an unfortunate by-product of our modern Western lifestyle. Many men are in a constant state of stress, leading a sedentary lifestyle and eating and drinking all the wrong things.
They often also believe that they need to prove their sexual potency to their partner when in the bedroom and then feel stressed and disappointed when their equipment fails them.
Erectile difficulties are caused by a combination of Bio-Psycho-Social factors, and as a result, problems can arise from a variety of reasons. Here are some of the common ones
1. Psycho-sexual
Psycho-sexual factors are particularly important because they affect not only erections but also your sexual desire.
- unrealistic expectations of your performance
- feeling you have to perform for or prove yourself to your partner
- inability to relax when having sex
- lack of confidence as a lover
- no desire, not ‘turned on’
2. Diet & Lifestyle Factors
- sedentary behaviour (lack of exercise)
- high calorie, high cholesterol diet
- obesity
- smoking
- excessive alcohol (more than 2 glasses per day)
- recreational drugs
- prescribed medications (some anti-depressants, anti-hypertensive and anti-psychotic drugs)
3. Physical Health
Some sources estimate that 75% of cases of erectile dysfunction are due to poor physical health. Because the penis has the smallest blood vessels in the body health problems often show up here first. If nocturnal and morning erections are no longer happening for you, see your doctor. Erectile dysfunction is often an early warning sign of one or more of these health conditions:
- Cardiovascular disease
- Stroke
- Diabetes
- Prostate disease
- Alzheimer’s
- Spinal cord or pelvic injury or surgery
- Parkinson’s
- Hormonal change
- Kidney or liver problems
4. Emotional & Mental Health
- depression
- stress / anxiety
- fear and apprehension
5. Partner & Relationship Related
- insufficient physical stimulation by partner (especially with age)
- communication problems and emotional conflict
- power struggles
- performance anxiety
- lack of sexual attraction
- lack of trust, comfort and co-operation
- not feeling close
How does Erectile difficulties affect partners?
Women respond to their partners erection difficulties in a number of different ways.
It is often difficult for a woman not to feel hurt or confused particularly if her partner tries to cope by avoiding having sex or being affectionate, which is a very common response. In these instances, It is not unusual for a woman to begin to question her sexual attractiveness, or her partner’s interest in her.
Other women will minimize the sexual side of the relationship, saying that intimacy is all that counts. Others will become demanding, believing her partner owes her intercourse.
The healthiest role for the partner to play is to be a caring involved sexual friend, and if possible, maintain her sexual desire and arousal, as this often invites her partner’s arousal.
Treatments and Solutions
For many men, their GP is the first port of call as they don’t know where else to go for help.
Unfortunately, while there are some GPs who are well schooled in erection difficulties, many are not, and often can only offer very minimal advice and treatment or feel uncomfortable even discussing the problem in any depth.
Pro-erection drugs can be a vital resource in treatment. However, the challenge is to make a fuller comprehensive assessment of your particular problem, and also very importantly, to show you how to integrate the drug into your couple sexual style and your relationship.
Our Sex therapists and Relationship Psychologists at the Hart Centre can help you in working with your GP in comprehensively assessing your problem, and in working out the multi-faceted solutions.
We can take the guesswork out of your problem and can provide the link with your GP, so that we are all working together to create the best solution for you.
Sexual Education
Many people believe that because sex is natural, it should come naturally. However, like any skill, a few tips to point us in the right direction can be very helpful. For example, some men experience erectile dysfunction due to a lack of sexual education; in other words, they do not know what to do in particular situations.
Healthy erections depend on a man being able to relax, knowing how to manage challenging situations, having good physical health and healthy blood flow. Knowing how to achieve these will lead to many years of healthy erections and sexual enjoyment.
The essence of erectile difficulties is that you have lost your comfort and confidence with erections and intercourse. ED is a changeable problem.
The goal of ED treatment is not just to restore erections and resume intercourse, but to establish a new way of understanding desire, pleasure, arousal, intercourse and sexuality that will allow you to not only maintain your gains, but also to help any further problems as you age.
Increasing sexual awareness and adopting positive, realistic sexual expectations is part of a new, healthy model of male sexuality.
What to Do Next?
Consult a Sex Therapist or Relationship Psychologist to address erectile difficulties and rebuild a healthy, satisfying sex life.
We work with clients across Australia, with dedicated services in major cities including Sydney, Melbourne, Perth, Canberra, Brisbane, and Adelaide offering support both in-person and online.
Reach out today and start building a stronger foundation for connection and trust.
To Check which of our psychologists are closest to you, please use our Find a therapist page.
Alison Rahn, (Sex Therapist) & Julie Hart (Psychologist) © Copyright 2012
References:
Chew KK, et al (2000) Erectile dysfunction in general medicine practice: prevalence and clinical correlates. International Journal of Impotence Research (12), 41-45.
Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P (2004) Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction British Journal of General Practice 54 (508), 819-825.
Esposito K, Giugliano F, Di Palo C, et al (2004) Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial. The Journal of the American Medical Association (JAMA) 291(24), 2978-2984.
Melman A & Gingell JC (1999) The Epidemiology and Pathophysiology Of Erectile Dysfunction, The Journal of Urology, 161 (1), 5-11.
Moreira ED, Lisboa CF, Villa M, Nicolosi A, and Glasser DB (2002) Prevalence and correlates of erectile dysfunction in Salvador, northeastern Brazil: a population-based study, International Journal of Impotence Research, 14, Suppl 2, S3–S9.
Metz & Mcarthy. (2004) Coping with Erectile Dysfunction.
Julie Hart 
