Psychological erectile dysfunction affects young and middle-aged men – purely physical problems generally manifest in older patients, an unpleasant side-effect of aging. The basic psychological causes of erectile dysfunction are anxiety and fear, depression, bad previous experiences and occasionally the attitude of the man’s partner, or his to her including not ‘fancying’ the partner any more.

Other contributing psychological factors include overwork, stress or even a blend of guilt and bereavement, particularly when trying to begin a new relationship after bereavement. Almost all men who suffer from severe depression experience erectile dysfunction. Men are not good at seeking treatment for conditions which might be classed as ‘mental disorders’ such as depression so the first indication of the man’s depression might be when the erectile dysfunction manifests. In this case it would be vital to seek treatment for the depression before the sexual dysfunction could be tackled.

Nerves about performing called ‘performance anxiety’, can result in premature ejaculation particularly in inexperienced men. An understanding partner can help in this situation with patience and gentle humour. Another possible cause in inexperienced men is doubt about his sexuality. Some men do not realise they are homosexual until they try to have a physical relationship with a woman; this latent ‘gayness’ can make sex a trial until understanding is reached.

A new cause of erectile dysfunction or ED, particularly in very young men, seems to be overuse of porn. The proliferation of internet porn is so widespread that men and boys can access it from a very young age. More and more young men are asking – on internet blogs and chat-rooms, rather than doctor’s surgery for reasons of embarrassment – about sexual performance being affected by extreme exposure to porn. It seems that the constant bombardment of sexual images ‘desensitises’ the pleasure centre in the brain, making him not want intercourse with a real-life partner. Erections do not reach full potential and can be quickly lost, or result in delayed ejaculation. The good news is that this type of erectile dysfunction has a relatively easy cure: completely stop accessing porn for at least 6 – 12 weeks, and refrain as much as possible from any self-stimulation, such as masturbation. This is frequently enough to ‘reset’ the brain’s pleasure centres and make a real partner an attractive and desirable proposition again.

Conditions such as ADHD and bipolar disorder can make a normal sex life very challenging. Sufferers can range from wanting sex frequently, several times a day, or hardly at all. ADHD sufferers frequently will enjoy sex when initiated by the partner, but tend not to initiate it themselves. They can have an abnormal libido, some need sex as reassurance or ‘self-medication’ to quote the exhausted wife of an ADHD sufferer while others love to talk and think about sex but find the reality of it to be boring and will often be distracted by something completely irrelevant while their partner is ‘getting down to business’. Bipolar sufferers can swing from a hypersexual state to not wanting it at all. This will tie in with the ‘manic’ and ‘depressive’ phases of the disorder.

Other causes of erectile dysfunction can include previous spinal cord injuries which can have an on-going effect on the nervous system and affect intercourse and the ability to maintain an erection. Vascular disease can announce itself initially by having an effect on the blood flow to the penis; this may be a first symptom of the heart problem and medical attention should be sought. Narrowing of the tiny veins can make it difficult for sufficient blood to be pumped into the penis to initiate an erection and venous leak or cavernosal failure can mean that an erection quickly dissipates – not enough blood is being held to maintain the firmness. Smoking can cause vascular disease and high blood pressure and also introduces high levels of carbon monoxide to the system which means the heart has to work harder to pump blood around the body. The three main prostate ailments, benign prostate hyperplasia, prostatitis and prostate cancer can all cause problems with sexual performance.

In purely psychological cases medication combined with treatment can help the patient to start enjoying his sex-life again, which can in itself allay anxiety, thereby breaking a potential vicious cycle. The three medications most popularly used to treat erectile dysfunction are:

Viagra: the famous ‘little blue pill’ and most popular of all erectile dysfunction treatments. The effects last up to four hours, although they can be negated by food. This does not mean an erection will last four hours, it means that for four hours a good erection will be able to be produced.

Cialis: a newcomer to the erectile dysfunction world. Their main two claims are that the effects last up to 12 hours from ingestion and that having something to eat will not negate the effects.

Levitra: similar to both, but not quite as long-lasting as Cialis.

All three medications are contraindicated in patients who are taking certain heart drugs. They all work by widening blood vessels, and increasing blood flow to the penis.

Psychological erectile dysfunction is an awful situation for a man to find himself in. Advice and treatment is available, but it all depends on the patient asking for help, rather than suffering in silence and maybe even blaming his impotence on his partner.