Individual
Negative attitudes about sex. There may be multiple reasons for a man’s negative attitudes or beliefs about sex, and these should be indentified for a complete understanding of his ED. Possible reasons include: sexual abuse history, ambivalence about sex, negative attitudes about sex from cultural or social sources, negative feelings about one’s partner, and expectation of problems.
Excessive need to please one’s partner. A man’s excessive preoccupation with his partner’s satisfaction or response may create performance anxiety as well. The effect of this excessive focus is that he does not attend to his own sexual arousal, and he is not able to experience enough sexual arousal to produce and maintain an erection.
Unrealistic expectations. Performance anxiety is also often created by a man’s unrealistic expectations of himself. Given that inaccurate information and unrealistic images of sexual behavior are common, many men have irrational beliefs about their sexual response. Often these assumptions about sex are unconscious. The partner may bring her or his own unrealistic expectations to the sexual encounter as well.
Feelings of sexual inadequacy. A frequent under-pinning to impaired erectile response is a man’s internal sense of sexual inadequacy, which leads to expectations of sexual failure. This sense of inadequacy may be recent or have lasted for many years. It may stem from or predate experiences of ED.
Stress. Stress may have both an immediate and an underlying role in ED. At the time of sexual activity, acute stress may make it difficult for the man to relax and attend to appropriate sexual stimuli, due to the interference of intrusive worries. Over longer periods of time, stress may serve to inhibit sexual desire and arousal, leading to performance anxiety and avoidance.
Paraphilia. Another cause of insufficient sexual arousal during a sexual encounter is the presence of competing or interfering sexual fantasies. On occasion, the evaluation of ED identifies the presence of predominantly homosexual fantasies in men who present as heterosexual and vice versa. An underlying paraphilia, i.e., sexual arousal to nonconventional fantasies, may be also identified. Examples include fetishism, transvestism, and pedophilia. If such fantasies are a man’s predominant sexual interest, he may simply not be aroused by his partner or their sexual activity.
Comorbid mental health problem. Other mental health problems in either the man with ED or his partner may lead to ED.
Interpersonal
Anger. A common interpersonal cause of ED is anger, especially unresolved anger toward one’s partner. Such anger may lead to a phenomenon of “sexual sabotage,” in which the man consciously or unconsciously attempts to deprive his partner of sexual pleasure. The man’s partner may also manifest such sabotage, such that she or he is frustrating the man’s desire for sexual pleasure. There is a wide variety of possible sources to such anger, which often require a careful examination of the current relationship.
Avoidance of intimacy. Another common pattern seen in men with ED is the situation in which the man experiences problem-free sex during the courtship phase of relationship but suddenly develops ED when the relationship requires a more serious commitment. Men who experience mistrust or fear of rejection in the context of a relationship may also manifest this conflict about sexual intimacy through ED. Viagra Australia over the counter – sildenafil citrate Au fast delivery.
Communication problems. Obstacles in healthy communication may lead to ED in several ways. First, conflicted communication frequently leads to resentment and withdrawal. Second, poor communication may lead to a lack of under-standing about the sexual needs or wants of the man’s partner.
Other relationship dysfunction. A wide variety of other relationship difficulties may negatively impact erectile response, including mistrust, struggles for control, and conflict about the sex-ual relationship. For this reason, most sex thera-pists also have expertise in couple therapy.